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Table 3 Summary of supportive factors and potential challenges for consideration in the design of the SMC intervention

From: The use of formative research to inform the design of a seasonal malaria chemoprevention intervention in northern Nigeria

Supportive factors Potential challenges
Malaria is seen as a community priority Role of CCGs and scope of services offered unclear across community and health facility levels
Communities have a good understanding of the signs and symptoms of malaria, ways of preventing malaria, and the biological groups most at risk A range in skills and experience in the management of malaria among CCGs
Wide support for a community level distribution of drugs Health facility staff perceive CCGs to provide low quality of care
Community level support for and trust in CCGs Weak referral linkage between community and health facility levels
Close proximity of CCGs to beneficiaries which could enable high intervention coverage and facilitate effective follow-up and monitoring of adverse events Community referral action potentially hindered by perception of inadequate skills among health facility staff, inconsistent ACT supply and potential cost of transport and malaria treatment
High levels of community acceptability of ACT Differing opinions on the most effective distribution approach—fixed-point or household-to-household
Supportive supervision system between health facility and CCGs established (though weak in some areas) A lack of consensus over the suggested management of the intervention and potential roles of the health facility and community leadership
High levels of trust in community traditional and religious leadership, and general consensus that they should play a pivotal role in mobilization for the programme Low storage capacity at the community level
Community leadership frequently involved in disseminating health information to their communities and so have basic health knowledge and local information dissemination systems are established Potential security issues relating to the distribution of drugs at the community level
Simple, visual communication materials written in local languages could be well accepted Varying levels of capacity for effective reporting among CCGs
  Low levels of community literacy (particularly among women) which may inhibit understanding of any written guidance or communication materials as well as record keeping capacity
Potential suspicions of ‘outside’ interventions, exacerbated by negative associations with the polio campaign