Seasonal Malaria Chemoprevention Coverage in Hard-to-reach Populations in Turkana, Northern Kenya

Malaria is a growing concern in northern Kenya where moderate to high incidence has been documented. The area is harsh, arid and communities are highly mobile, sleep outside and have poor access to health services. Malaria transmission in Turkana is seasonal; 30% of cases occur in children under five years and 65% occur between June and October. This calls for non-traditional prevention methods like Seasonal Malaria Chemoprevention (SMC), which is the intermittent administration of full treatment courses of malaria medicine during high seasons to prevent malaria. Until 2022, SMC was used only in the Sahelian countries of Africa. Like the Sahel, Turkana experiences strong seasonality of malaria making SMC a promising prevention method. During the 2024 peak malaria season, SMC was administered, in five monthly cycles, for three days a cycle, to all eligible children aged 3-59 months in Turkana Central. It was delivered door to door, at fixed points, mobile fixed points and outreaches. At the end of the round, we conducted a cross-sectional survey whose primary aim was to ascertain coverage across the cycles. Data on coverage, acceptability and adherence were collected in 450 sampled households. There were 733 eligible children in the households; the majority were male (53%); mean age was 33 months. Most of the children (97%) received at least one cycle of SMC while 71% received all 5. Partial coverage was observed in 27% of the children. Reasons for not receiving SMC included travel (10%), distance to fixed distribution points and illness on SMC days (10%). Community acceptance of SMC was high, with only 8.7% of non-recipients citing safety or benefit concerns. Adherence to day 2 and day 3 doses was 95%. Side effects were infrequent (12.4%) and included fever, vomiting, diarrhea and rash. Increasing fixed points, outreach sites and incorporating malaria case management could improve coverage and ensure febrile children are treated promptly so that they are eligible for subsequent cycles. SMC is a feasible and safe intervention in Northern Kenya. Optimizing coverage would ensure children are protected through the high-risk period of transmission.