A mixed-methods study of the scale-up and delivery of Seasonal Malaria Chemoprevention in pastoralist communities of northwest Kenya

Seasonal Malaria Chemoprevention (SMC) is a promising intervention for Turkana, Northern Kenya, where malaria transmission is highly seasonal. Traditional malaria control methods, such as indoor residual spraying (IRS) and insecticide-treated nets (ITNs), are impractical due to the populations semi-nomadic lifestyle, temporary dwellings, sparse settlements, and limited access to health facilities. In 2024, following the WHOs updated guidance on SMC use, this intervention was implemented in Turkana Central for the first time, involving five monthly cycles of sulphadoxine-pyrimethamine with amodiaquine (SPAQ). To assess the programs feasibility, a mixed-methods study was conducted at the end of the campaign. Survey data from a randomly selected, representative sample of 449 households with 680 eligible children were analyzed using multi-level logistic regression to compare partial versus complete SMC adopters, accounting for clustering. It was supplemented by qualitative interviews involving 45 caregivers to explore barriers and facilitators to SMC adoption. The campaign achieved notable success, with 97% of children receiving at least one SMC cycle (95% CI: 94-99%), and 71% receiving all 5 cycles (95% CI: 66-75%), primarily through door-to-door delivery. The quality of delivery was evident, as 99% of caregivers reported direct observation of the first dose and proper instructions for subsequent days. Adherence to day 2 and 3 medication remained high at 95% (95% CI: 93.5-98.1). Regression analysis suggested that households familiar with their Community Health Promoter (CHP) and who communicated SMC information had lower odds of missing cycles. In contrast, children from wealthier families showed a 93% higher odds of missing cycles. Qualitative findings revealed that positive caregiver experiences with SMC effectiveness drove continuation, while late adoption was linked to illness/ineligibility, uncertainty, and rumors. Overall, these findings indicate that high and sustained SMC coverage is feasible in marginalized settings through adaptive delivery strategies and leveraging of trusted CHP networks, establishing a scalable model for similar mobile populations.