Investigating factors enabling the acceptability of perennial malaria chemoprevention implementation in Osun State, Nigeria: evidence from a qualitative process evaluation

Abstract

Background: Malaria remains a life-threatening disease predominantly in resource-constrained settings including Nigeria. Despite the availability of interventions to prevent, diagnose and treat malaria, children under five years remain vulnerable. Perennial malaria chemoprevention (PMC) is an effective intervention to prevent malaria in children under 24 months. However, the uptake of PMC may be affected by community acceptability of the intervention. The study explored the acceptability of PMC in Osun State, Nigeria. Methods: Focus group discussions and key informant interviews were used to gather caregivers, community leaders, fathers of children less than 24 months of age and health workers’ perspectives on PMC in Osun State, Nigeria. Thematic analysis was conducted using ATLAS.ti 24. Results: Participants reported acceptability of PMC delivered through expanded programme on immunization (EPI) platform. Acceptability was influenced by perceived effectiveness, child-friendliness and free health services as well as whether individuals accept conventional medicines and the delivery platform. On the other hand, lack of funds for transportation and the fear of side effects negatively affected PMC acceptability. Caregivers reported the attitudes of health workers towards the intervention influenced their acceptance or negative behaviour towards PMC. Religious leaders also accepted PMC as it did not contradict their faith. Conclusion: Several factors affect acceptability of PMC. To maximize acceptance that would lead to increased uptake of PMC, programmes should identify factors within their context that influence acceptability and employ appropriate strategies to maintain high acceptability.