The examination of factors impacting spitting or vomiting among children under five years of age during seasonal malaria chemoprevention: A quantitative study in Burkina Faso, Chad, Nigeria and Togo

Abstract

Background Since 2012, the World Health Organization has recommended seasonal malaria chemoprevention (SMC) with sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) for children aged 3–⁠59 months in areas with marked seasonality in malaria transmission. Full ingestion of SMC medicines without spitting or vomiting during a complete three-day course is critical to ensure SMC effectiveness and avoid increased antimalarial resistance. Although evidence suggests that spitting or vomiting is not rare, there is limited analytical evidence on potential factors associated with spitting or vomiting. Methods We utilized data from SMC coverage surveys conducted in Burkina Faso, Chad, Togo and Nigeria between 2020 and 2022. Episodes of spitting or vomiting were defined as children spitting out most of the dose or vomiting the entire dose within 30 min after administration on Day 1 by community distributors (CDs) as reported by primary caregivers. We conducted a cross-sectional study through mixed-effects logistic regression specified with socioeconomic variables, and caregiver knowledge of SMC, to identify factors associated with spitting or vomiting. Results The proportion of spitting or vomiting ranged from 1.81% in Nigeria to 4.36% in Chad. The odds of spitting or vomiting were lower if children were administered medicines under directly CD-supervised administration and primary caregivers had a high degree of knowledge of SMC. Spitting or vomiting were negatively associated with caregiver adherence to AQ administration and caregiver reporting of children’s adverse reactions to SMC medicines. Over half of the children did not receive a replacement dose from CDs who spit out or vomited most (or almost all) of the doses. Redosing was positively associated with caregiver educational attainment, caregiver knowledge of SMC, and directly supervised administration. Conclusions The direct CD-supervised administration of SPAQ can facilitate and strengthen community engagement strategies to enhance the appropriate administration and full ingestion of SMC medicines by the SMC delivery protocol.