Community Informed Approach for Designing Seasonal Malaria Chemoprevention Delivery in Semi-Nomadic Population in Turkana Central Sub-County, Kenya: Results from Baseline Mixed-Methods Study

Following the expansion of the World Health Organizations guidelines on eligibility for the seasonal malaria chemoprevention (SMC), the government of Kenya prepared to implement SMC for a first time in Turkana Central Sub-County in 2024. To inform design of SMC, we conducted a baseline qualitative and quantitative study. Using a stratified cluster sampling approach, we enrolled 198 households with children 6 months - 5 years old, and tested all individuals one year and older using a Rapid Diagnostic Test (RDT) and polymerase chain reaction (PCR). We carried out 82 key informant interviews, 31 focus group discussions with community health workers, elders, and caretakers of children, and 60 In-depth interviews with caretakers. Malaria prevalence was 21% [9%-42%] as reported by RDT and 21% [11%-38%] by PCR. Prevalence varied across villages, with the highest positivity of 73% by PCR. While SMC was perceived positively, challenges identified included physical access (households far from village centers, pastoralists, children living in the streets); stigma (children living with disabilities, households with members struggling with alcohol use); and acceptability (traditionalists, highly educated households). This study found that while malaria burden is high in the region, SMC may be a feasible approach to reduce its burden and transmission. However, implementation of SMC should be tailored, with a combination of centralized distribution supplemented by door-to-door and outreach to pastoralists and people in the interior. Using existing grassroots structures, such as Tree of Men and religious and group leaders, and intensive mobilization will be critical for success of this intervention.