“I heard at home. The leader came by to inform”. The role of community leaders and community distributors in promoting uptake of seasonal malaria chemoprevention in Nampula Province, Mozambique: a qualitative study

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BACKGROUND: Seasonal malaria chemoprevention (SMC) is a highly effective intervention to prevent malaria in children, in high transmission areas that have seasonal peaks. Since 2020, SMC with sulfadoxine -pyrimethamine plus amodiaquine (SPAQ) has been implemented in northern Mozambique. During SMC campaigns community leaders are involved in the sensitisation and mobilisation of households prior to the start of the SMC round. This qualitative study explores perceptions among caregivers and other stakeholders of the importance of community leader and community distributor engagement for enhancing community knowledge, acceptance and uptake of SMC. METHODS: A qualitative study, consisting of focus group discussions (FGDs) and key informant interviews (KIIs), was conducted in four districts of Nampula province in northern Mozambique during two SMC campaign rounds. Focus group discussions were conducted with caregivers whose children received SMC, and implementers involved in delivering SMC. Key informant interviews were conducted with stakeholders actively involved in SMC implementation at national, provincial, and district levels. Participants were identified through purposive sampling. All FGDs and KIIs were conducted in Portuguese or Emakhuwa. Data were coded and thematically analysed using MAXQDA2022. RESULTS: Between April 2021 and June 2022, KIIs were conducted with community leaders (n = 11) and stakeholders at national (n = 8), province (n = 8) and district level (n = 4). Focus group discussions (FGDs) (n = 42) were conducted with caregivers (n = 152), community distributors (n = 70), community distributors' supervisors (n = 23) and health workers (n = 30). Findings showed there was unanimous recognition among caregivers, community distributors, and key stakeholders, of the critical role community engagement played during the SMC campaign. Caregivers reported obtaining information about SMC from local leaders, and that community distributors provided additional information and helped to build trust, and reduced anxiety and distrust towards the medication. Community leaders' participation during community distributors household visits was also reported to promote participant recruitment, fostering a sense of intervention ownership. Stakeholders believed that the active involvement of community leaders helped prevent misinformation about the SMC campaign. CONCLUSION: Involving community leaders in the mobilisation and distribution of interventions, such as SMC, helps to facilitate active participation from the community and result in greater acceptability and community uptake.

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