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

2. 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: (page 18)

3. 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

4. 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

5. “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

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

7. 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.

8. Methodology
Mixed methodological approach with a quantitative component in which 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

9. General Knowledge on Malaria
Connecting with Communities.

10. 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.

11. 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.

12. Acceptability of Seasonal Malaria Chemoprevention.

13. 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

14. 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.

15. Drug Preparation & Administration

16. Drug Preparation & Administration

17. Intent of Using SMC in the Future

18. 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

19. 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

20. Preferred Communication Channels (Interpersonal communication)

21. Preferred Communication Channels (Interpersonal communication)

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

23. Information Source During Campaign

24. 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.

25. COMMUNITY ACCEPTANCE OF SEASONAL MALARIA CHEMOPREVENTION