Nigeria

Areas eligible for SMC and areas where SMC is implemented in 2020

Photo: SMC implementation areas in Nigeria 2020

Cycle

Children 3 - 59 months targeted

Children 3 - 59 months reached

Efficiency

Cycle 1

12,966,187

13,151,949

101%

Cycle 2

13,007,567

13,647,954

105%

Cycle 3

13,021,827

13,283,504

102%

Cycle 4

13,021,827

13,376,143

103%

Data from the NMCP of Nigeria

Monitoring of coverage completeness

Photo: Toby Madden / MMV

Monitoring of coverage

  • Lot Quantity Assurance Survey (LQAS) is carried to monitor the first three cycles. This is done at the end of each cycle. The key performance indicator is the proportion of eligible children treated with SMC among the total number of eligible children
  • An end of round coverage survey is done after the end of the 4th cycle and asks questions after the treatment of eligible child in the fourth and third cycle


Monitoring for compliance

  • Monitored through the LQAS and end of year coverage survey. The key indicator is the percentage of children who received the 2nd and 3rd doses on respective survey

Evaluating efficacy

  • The current approach to monitoring SMC effectiveness is the use of routine health records on malaria indicators
  • Comparison between SMC intervention sites and propensity-matched control sites
  • Comparison of malaria indicators pre- post SMC intervention

Successes, opportunities, challenges and solutions in the 2020 SMC season

Successes

  • Strategic and targeted advocacies led to increased commitment and financial contributions by states
  • The use of electronic data collection for supervision aided prompt feedbacks and identification challenged areas
  • Working with security personnel was used to ensure safety of personnel and commodities
  • Simplified SMC training manual (flip chart) was easier to understand and incorporated COVID 19 preventive measures
  • Mis-information relating to SPAQ adverse effects were promptly managed by States executives via the media i.e live shows, radio/TV call-in programmes
  • Integration with LLINs distribution campaign in Zamfara state


Way forward

  • Improved targeted advocacies at all levels
  • Use electronic data collection in other aspects of the campaign
  • Increase involvement of security agencies
  • Adopt the use of the simplified training manual for future SMCs
  • States to continue to engage local media houses to manage any likely mis-information/rumors associated with SMC
  • Continue to explore opportunities for integration with other PH interventions.
  • Planning for integration of interventions to commence early.


Challenges

  • Disrupted supplies of SPAQ & other antimalarials for implementation
  • Virtual coordination, trainings etc was adopted to replace in-person activities.
  • Non-adherence to COVID-19 prevention protocols
  • SPAQ shortages & delayed arrival due to global supply chain disruption
  • Stock out of RDTs and ACTs in some HFs necessitating emergency redistribution
  • Insecurity issues
  • Peculiar terrain in some areas with accessibility issues
  • Migrant and displaced population affected the planning
  • Delayed payment of personnel
  • Low reporting ADRs
  • Security challenges that limited supervisory activities and smooth implementation in some communities due to bandits activities across LGAs
  • Clashes of implementations with other activities e.g. RMNCAH week, Immunization, etc


Proposed solutions

  • Early placement of orders and commencement of supply pipelines
  • Consider hybrid approaches for activities
  • Increase sensitization on the need for observance of COVID 19 preventive measures at all levels
  • Early placement and arrival in country of SPAQ
  • Strengthened partnership with Meteorological agency(NIMET)
  • Alternative supply of RDTs & ACTS by the States to cover gaps
  • Coordinate implementation with security agencies
  • Micro planning to consider migrant population areas
  • Active Surveillance on Pharmacovigilance by Health
  • Increase collaborations with security agencies to provide security

Research priorities

  • Co-implementation of long lasting insecticide treated nets (LLIN) Distribution with seasonal malaria chemoprevention (SMC) delivery in a Northern Nigerian State
  • Optimization of SMC coverage 2020-2023

Partners

  • Philanthropic funding through Malaria Consortium
  • European and Developing Countries Clinical Trials Partnership
  • BMGF