Coproduction of a mixed-method framework for the deprioritization of communities during insecticide-treated bed net mass campaigns in Kwara Nigeria

Abstract

Introduction Limited funding in the Global Fund Grant Cycle 7 prompted Nigeria’s National Malaria Elimination Programme (NMEP) to adopt a strategy to deprioritize the least vulnerable communities for malaria during bed net mass campaigns. A deprioritization approach piloted in Ilorin, the capital of Kwara state, in collaboration with the NMEP, the state malaria control program, and implementing partners is presented. Methods We employed a mixed-method approach to identify communities where bed net distribution would not take place during the 2023 Ilorin mass campaign. Ten combinations of variables, including test positivity rates among under-five children, settlement classification, enhanced vegetation index, and distance to water bodies, were utilized to generate a malaria risk score and rank wards accordingly. Deprioritized wards were then selected, and after settlement classification, deprioritized communities were identified. Results The multi-stakeholder dialogue provided valuable insights into the most suitable variables for settlement classification and highlighted the limitations of each variable. As a result, two wards, Are 2 and Akanbi, were chosen for deprioritization, and criteria for selecting deprioritized communities were established. Characteristics distinguishing formal, informal, and slum settlements were identified and used to adapt a checklist for the classification of 188 communities within Are 2 and Akanbi 4. Ultimately, 13 communities characterized as formal settlements were deprioritized. Conclusions The process of deprioritizing communities necessitates stakeholder involvement to evaluate analysis outputs, especially in settings with limited data availability and uncertain data quality. We demonstrate how this can be accomplished and emphasize that ongoing evaluations will inform future enhancements to this framework and related processes. Moreover, there is a need for enhanced surveillance systems to support a more comprehensive approach to intervention tailoring that is in line with WHO recommendations.