COMMUNITY ACCEPTANCE OF SEASONAL MALARIA CHEMOPREVENTION Joint Consultation on SMC 13-15 February, 2017 Ouagadougou, Burkina Faso

Common Vision: Role of communications for SMC. Fostering country and community ownership Reducing risks of misunderstanding and negative perceptions Ensuring adherence to SMC dose completion Source: http://www.who.int/malaria/publications/atoz/9789241504737/en/ (page 18)

Within ACCESS SMC, We Aimed to leadership and communities are informed and mobilized to support and participate, i.e. come to distribution points/allow distributors in their homes and accept SMC medicines (safe, easy and effective) Build TRUST stakeholders, communities and caregivers understand/value what SMC medicines can do (and not do) and how SMC campaign is delivered (distribution mode) Manage EXPECTATIONS caregivers understand how and when to administer SMC to their eligible children, including how to manage fever or side-effects after taking the medicines Ensure ADHERENCE Build TRUST: mobilize leadership and communities to support and participate, i.e. come to distribution points/allow distributors in their homes and accept SMC medicines (safe, easy and effective) Manage EXPECTATIONS: stakeholders, communities and caregivers understand/value what SMC medicines can do (and not do) and how SMC campaign is delivered Ensure ADHERENCE: caregivers understand how and when to administer SMC to their eligible children, including how to manage fever or side-effects after taking the medicines

Community Sensitization 2 Pronged Approach. Mass Media Awareness at stakeholders and community level of SMC, its purpose, and availability. Contribute in building momentum around malaria control in each country. Ensure SMC is shown as a complementary intervention to existing malaria control strategies Through: Community Radio PSAs Video on SMC Media toolkit and training for community-based stations Community Sensitization Build trust for SMC at the community level primarily though interpersonal communication Ensure uptake of SMC. Promote local ownership of SMC Through: Community fora Interactive radio shows Social mobilization events

“The How” 5 Pillars. Coordination at country and sub-country levels Advocacy Social mobilization before and during campaigns Behaviour change communication Monitoring, Evaluation and Research Harmonised malaria messaging Support and local ownership High uptake Malaria prevention & management behaviours increase/maintenance Improved communications’ programming

KABP Study conducted in Mali, Niger, Guinea & The Gambia

KABP Study Objective Period: 2016 Study Objective: To evaluate the knowledge, attitudes and practices of the community on seasonal malaria chemoprevention and factors affecting the uptake of the intervention. To provide a technical basis to formulate and implement a sustainable, and community-friendly communications strategy for SMC scale up.

Methodology Mixed methodological approach with a quantitative component in which 2 400 households (600 per country) were interviewed and a qualitative component with focus groups and in-depth individual interviews. Respondents: Primary: Mothers & caregivers Secondary: Heads of households Tertiary: Community workers & Opinion leaders Meso: Healthcare workers, SMC focal points, Nurses & Doctors

General Knowledge on Malaria Connecting with Communities.

Malaria Transmission, Prevention Methods & Symptoms Overall, populations do associate malaria to mosquito bites with close to 100% in Niger and 98,5% in Guinea. Mosquito nets and environmental sanitation remain the best known malaria prevention methods. More than 90% of mothers and caregivers interviewed cite the use of mosquito nets as a prevention method. Malaria symptoms are also well known by mothers and caregivers. The most cited symptoms are fever (94,5% in Guinea, 88,2 in The Gambia, 96,7% in Niger & 90,1% in Mali), headaches and vomiting.

Care Seeking Behavior Guinea: 47.6% of caregivers consult the day after the first symptoms. Only 38.3% take their child to a health facility at the first signs of malaria. The Gambia: The rate of use of health facilities in the first 24 hours after symptoms appearance is high (78.8%), especially in Central River Region (82.5%). Mali: Nearly six out of ten mothers and caregivers go to a health center within 24 hours after the first symptoms of malaria. However, more than one parent in ten uses traditional healers in general as well as in malaria. Two out of ten people consulted a traditional healer in the 6 months preceding the survey. Niger: 83,7% of mothers and caregivers go to a health center in the first 24 hours following the first symptoms.

Acceptability of Seasonal Malaria Chemoprevention.

Knowledge on SMC Item The Gambia Guinea Mali Niger Beneficiaries Goal 77,2% of mothers & caregivers know that SMC targets children aged between 3 to 59 months 93% of mothers & caregivers know that SMC targets children aged between 3 to 59 months 84% of mothers & caregivers know that SMC targets children aged between 3 to 59 months 94% of mothers & caregivers know that SMC targets children aged between 3 to 59 months Goal 94,7% of mothers know that SMC protects children from malaria 86,1% of mothers know that SMC protects children from malaria 72% of mothers know that SMC protects children from malaria 98,8% of mothers know that SMC protects children from malaria Treatment NR 82,1% know that the treatment is administered over 3 days during each cycle 85% know that the treatment is administered over 3 days during each cycle 98,8% know that the treatment is administered over 3 days during each cycle Protection 52,6% of mothers responded that SMC protects children during one month 25,8% of mothers responded that SMC protects children during one month 60,2% of mothers responded that SMC protects children during one month

SMC Awareness During the study, most respondents had already heard of SMC, over 80% in all countries except in Mali where 60% of the respondents knew of the campaign.

Drug Preparation & Administration

Drug Preparation & Administration

Intent of Using SMC in the Future

Barriers to Acceptability. For mothers & caregivers: Bitter taste of the treatment Mild adverse effects Difficult treatment preparation Treatment administration over several days and 4 cycles and necessary follow up Limited efficacy duration (28 days) For fathers: General sense of fatigue (vaccination campaigns – heavy health calendar) Confusion with other health campaigns (Polio, MCHWs, LLINs distribution) Rainy season - planting season – agricultural activities Rappel l’acceuil positif

Factors Facilitating Acceptability. Perceived treatment efficacy Treatment free of charge Qualitative information received from community health workers & radios Door-to-door strategy: Reinforces/facilitates interpersonal communication Allows more time with beneficiaries Builds sense of trust Community dialogues: Before cycle: town criers + community leaders (village heads + religious) During: interpersonal communication + town criers After: community outreach

Preferred Communication Channels (Interpersonal communication)

Preferred Communication Channels (Interpersonal communication)

Information Source Before Campaign The Gambia Niger Guinea Mali: Emissions radio 68,1%

Information Source During Campaign

Decision-Making Process Neighbors/Friends Husband's brothers Grand-parents/In-laws Mothers, Fathers & Caregivers Without appearing central, women play a decisive role. They ring the alarm since they are the child's primary caregiver, the ones who spend the most time with the child. Fathers also play a key role in terms of care seeking as they cover the costs.

COMMUNITY ACCEPTANCE OF SEASONAL MALARIA CHEMOPREVENTION Fara.ndiaye@speakupafrica.org +221 77 332 88 63 www.speakupafrica.org