Access to Health Facilities for Under-Fives with Fever in Togo
- This article delves into the effectiveness and implementation of Seasonal Malaria Chemoprevention (SMC) strategies in Togo, focusing on data collected and analyzed to understand its impact on child...
- Data was gathered from end-of-round SMC coverage surveys, specifically following the final annual cycle of SMC delivery, which is cycle 4, conducted each October in Togo.
- The surveys focused on three northern regions of Togo: Centrale, kara, and Savanes, encompassing 19 districts where SMC was actively delivered.
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seasonal Malaria Chemoprevention (SMC) Impact in Togo: A Detailed Report
Table of Contents
This article delves into the effectiveness and implementation of Seasonal Malaria Chemoprevention (SMC) strategies in Togo, focusing on data collected and analyzed to understand its impact on child health.
Understanding the Study Population
Data was gathered from end-of-round SMC coverage surveys, specifically following the final annual cycle of SMC delivery, which is cycle 4, conducted each October in Togo. Independent investigators, commissioned by Malaria Consortium in Togo, carried out these surveys. The data collection occurred between December 10–20 in 2020, October 22–30 in 2021, and October 10–20 in 2022.
The surveys focused on three northern regions of Togo: Centrale, kara, and Savanes, encompassing 19 districts where SMC was actively delivered. Togo initiated SMC in 2013, with support from Malaria Consortium starting in 2020. The study area, situated at the intersection of tropical savannah and semi-arid Sahelian climatic zones, experiences notable seasonality of malaria transmission.
In 2021, estimates indicated that approximately 489,389 children aged 3–59 months across these three regions were eligible for SMC per monthly delivery cycle, representing about 19.9% of the total population.
Survey Methodology
The surveys aimed for a sample size of 2000, achieved by sampling 10 households in 200 communities. Communities were randomly selected from a national sampling frame, with a probability proportional to the population size in each community. Households were then sampled using a simple random method from local household lists and included if they had one or more eligible children aged 3–59 months.
Within each household, a roster of all eligible children was created. One child was randomly selected via the data collection application, and all survey questions were directed towards that child, their primary caregiver, and their household.
Data Collection Process
Data collection occurred offline using Survey CTO version 2.70 on mobile devices, managed by pairs of data collectors. The collected data was uploaded daily to a remote server. To ensure consistency and accuracy, data collectors underwent standardized training, including field testing. The SurveyCTO platform included built-in logic checks to flag inconsistent responses during data entry, prompting clarification when necessary. Survey responses were recorded using pre-defined categories.
Distance data was sourced from the national survey sampling frame, based on Ministry of Health estimates of travel distances between communities and their assigned local health facility. This data was then merged with household-level data. A local data manager monitored data daily for potential quality issues. GPS validation ensured that data input locations matched visited households, and hidden variables tracked the time taken for individual questions during household interviews.
Inclusion and Exclusion Criteria
the study included children aged 3–59 months at the start of the annual SMC round who resided in the study provinces of Togo at any point during the SMC round.Children who were HIV-positive, had known allergies to sulfa drugs, or whose caregivers did not consent to participate were excluded from the sample.
Key Study variables
The primary dependent variable was children’s access to health facilities, specifically whether the child attended a health facility after experiencing fever.This question was posed only if caregivers reported that their child had experienced a fever within the 30 days preceding the distribution of SP and AQ in cycle 4 (October of each year). The outcome was binary: yes or no.
Caregivers who reported that their children did not attend health facilities were asked to provide reasons, with response categories including:
- “clinic to expensive”
- “clinic too far”
- “fever considered not serious”
- “caregiver preferred alternative treatment”
- any othre reason
Independent variables considered as potential predictors of health facility access were grouped into child, caregiver, and household characteristics:
- Child sex (male/female)
- Child age at the time of the survey (< 1 year/1 year/2 years/3 years/4 years/5 years)
- Caregiver self-reported literacy (literate/illiterate)
- Caregiver age (< 20 years/20–29 years/30–39 years/40–49 years/50–59 years/≥ 60 years)
- Caregiver sex (male/female)
- Caregiver level of education (none or only pre-primary/informal or religious/primary/secondary/higher education)
- Head of household literacy (yes/no)
- Aged 3–59 months at the start of the annual SMC round.
- resided in the study provinces of Togo at any point during the SMC round.
- HIV-positive status.
- Known allergies to sulfa drugs.
- Caregivers did not consent to participate.
- December 10–20 in 2020
- October 22–30 in 2021
- October 10–20 in 2022
- Sampling 10 households in 200 communities.
- Randomly selecting communities from a national sampling frame, with a probability proportional to the population size in each community.
- Sampling households using a simple random method from local household lists.
- Including households if they had one or more eligible children aged 3–59 months.
- data collectors received standardized training, including field testing.
- SurveyCTO platform included built-in logic checks to flag inconsistent responses during data entry.
- survey responses were recorded using pre-defined categories.
- A local data manager monitored data daily for potential quality issues.
- GPS validation ensured that data input locations matched visited households.
- Hidden variables tracked the time taken for individual questions during household interviews.
- “Clinic too expensive”
- “Clinic too far”
- “Fever considered not serious”
- “Caregiver preferred alternative treatment”
- Any other reason
- Child sex (male/female)
- child age at the time of the survey (< 1 year/1 year/2 years/3 years/4 years/5 years)
- Caregiver self-reported literacy (literate/illiterate)
- Caregiver age (< 20 years/20–29 years/30–39 years/40–49 years/50–59 years/≥ 60 years)
- Caregiver sex (male/female)
- Caregiver level of education (none or only pre-primary/informal or religious/primary/secondary/higher education)
- Head of household literacy (yes/no)
Seasonal malaria Chemoprevention (SMC) in Togo: Your Questions Answered
This article provides thorough answers to frequently asked questions about the Seasonal Malaria Chemoprevention (SMC) program in Togo, including details about the study population, data collection methods, key variables, and more.
General Questions About SMC in Togo
What is Seasonal Malaria Chemoprevention (SMC)?
Seasonal Malaria Chemoprevention (SMC) is a strategy used to prevent malaria in children during the peak malaria transmission season by administering antimalarial drugs at monthly intervals.
Were in Togo was SMC actively implemented in the study?
SMC was actively implemented and studied in three northern regions of Togo: Centrale, Kara, and Savanes, encompassing 19 districts.
When did Togo initiate SMC?
Togo initiated SMC in 2013. Malaria Consortium began providing support for the program in 2020.
Study Population and Demographics
Who was eligible for SMC in Togo, according to the 2021 estimates?
In 2021, estimates indicated that approximately 489,389 children aged 3–59 months across the three northern regions of Togo were eligible for SMC per monthly delivery cycle. This represented about 19.9% of the total population in those regions.
What were the inclusion criteria for children participating in the study?
The study included children who met the following criteria:
What were the exclusion criteria for children participating in the study?
Children were excluded from the study if they met any of the following criteria:
data Collection and Methodology
How was data collected for the SMC impact study in Togo?
Data was gathered from end-of-round SMC coverage surveys following the final annual cycle (cycle 4) each October. Self-reliant investigators commissioned by Malaria Consortium in Togo conducted these surveys.
When was the data collected for the study?
Data collection occurred during the following periods:
What was the sample size and sampling method used in the surveys?
The surveys aimed for a sample size of 2000, achieved by:
How was data quality ensured during the collection process?
To ensure data quality:
What tool was used for data collection?
Data collection occurred offline using Survey CTO version 2.70 on mobile devices.
Key Study Variables
What was the primary dependent variable in the study?
The primary dependent variable was children’s access to health facilities, specifically whether the child attended a health facility after experiencing fever. This was a binary outcome (yes/no) based on caregiver reports of fever in the 30 days preceding the distribution of SP and AQ in cycle 4 (October of each year).
What reasons were caregivers asked to provide if their children did not attend health facilities after experiencing fever?
Caregivers were asked to provide reasons from the following categories:
What independent variables are considered?
Independent variables considered as potential predictors of health facility access were grouped into child, caregiver, and household characteristics:
Summary Table
| Aspect | Details |
|---|---|
| Study Area | Centrale, Kara, and Savanes regions of Togo (19 districts) |
| target Population | Children aged 3–59 months |
| data Collection Period | december 2020, october 2021, October 2022 |
| Data collection Method | End-of-round SMC coverage surveys using Survey CTO |
| Primary Dependent Variable | Child’s access to health facilities after experiencing fever |
| Key Independent Variables | Child, caregiver, and household characteristics (age, sex, literacy, education) |