Delivery of Seasonal Malaria Chemoprevention With Enhanced Infection Prevention and Control Measures During the COVID-19 Pandemic in Nigeria, Burkina Faso and Chad: A Cross-sectional Study

Abstract

\n IntroductionSeasonal malaria chemoprevention (SMC) is a WHO-recommended intervention for children aged 3-59 months living in areas of high malaria transmission to provide protection against malaria during the rainy season. Operational guidelines were developed, based on WHO guidance, to support countries to mitigate the risk of coronavirus disease 2019 (COVID-19) transmission within communities and among community distributors when delivering SMC.MethodsA cross-sectional study to determine adherence to infection prevention and control measures during two distribution cycles of SMC in Nigeria, Chad and Burkina Faso. Community distributors were observed receiving equipment and delivering SMC. Adherence across six domains was calculated as the proportion of indications in which the community distributor performed the correct action. Focus group discussions were conducted with community distributors to understand their perceptions of the infection prevention and control measures and barriers and facilitators to adherence.ResultsWe observed community distributors in Nigeria (n=259), Burkina Faso (n=252) and Chad (n=266) receiving infection prevention and control equipment and delivering SMC. Adherence to infection prevention and control indications varied. In all three countries, adherence to mask use was the highest (ranging from 73.3% in Nigeria to 86.9% in Burkina Faso). Adherence to hand hygiene for at least 30 seconds was low (ranging from 3.6% in Nigeria to 10.3% in Burkina Faso) but increased substantially when excluding the length of time spent hand washing (ranging from 36.7% in Nigeria to 61.4% in Burkina Faso). Adherence to safe distancing in the compound ranged from 5.4% in Chad to 16.4% in Nigeria. In Burkina Faso and Chad, where disinfection wipes widely available compliance with disinfection of blister packs for SMC was low (17.4% in Burkina Faso and 16.9% in Chad). Community distributors generally found the infection prevention and control measures acceptable, however there were barriers to optimal hand hygiene practices, cultural norms made social distancing difficult to adhere to and caregivers needed assistance to administer the first dose of SMC.ConclusionAdherence to infection prevention and control measures for SMC delivery during the COVID-19 pandemic varied across domains of infection prevention and control, but was largely insufficient, particularly for hand hygiene and safe distancing. Improvements in provision of equipment, early awareness raising and adaptations to make infection prevention and control measures more feasible to implement could increase adherence.