A Baseline Mixed–Methods Study to Inform Seasonal Malaria Chemoprevention Delivery in a Semi-Nomadic Population in Turkana, Kenya

After the expansion of the World Health Organization's guidelines on eligibility for the seasonal malaria chemoprevention (SMC), the government of Kenya prepared to implement SMC for a first time in Turkana Central Subcounty in 2024. To inform the design of SMC, we conducted a baseline qualitative and quantitative study. Using stratified cluster sampling, we enrolled 198 households with children of ages 6 months to 5 years and tested all individuals six months and older using a rapid diagnostic test (RDT) and polymerase chain reaction (PCR) for Plasmodium falciparum. We performed 78 key informant interviews; 31 focus group discussions with community health workers, elders, and caretakers of children; and 60 in-depth interviews with caretakers. Prevalence of P. falciparum infection was 21% (9-42%) by RDT and 21% (11-38%) by PCR. Prevalence varied across villages, with the highest positivity of 73% by PCR. Although SMC was perceived positively, the identified challenges included physical access (households far from village centers, pastoralists, children living in the streets), stigma (children living with disabilities, households with members struggling with alcohol use), and acceptability (traditionalists, highly educated households). Despite the high malaria burden in the region, SMC may be a feasible approach to reduce its burden and transmission. However, implementation of SMC should be tailored, combining centralized distribution with door-to-door delivery and outreach to pastoralists and people living in the interior. Using existing grassroots structures, such as pastoralist leadership structures and religious and group leaders, and intensive mobilization will be critical for success of this intervention.