title: The use of formative research to inform the design of a seasonal malaria chemoprevention intervention in northern Nigeria.
abstract: Experience of seasonal malaria chemoprevention (SMC) is growing in the Sahel sub-region of Africa, though there remains insufficient evidence to recommend a standard deployment strategy. In 2012, a project was initiated in Katsina state, northern Nigeria, to design an appropriate and effective community-based delivery approach for SMC, in consultation with local stakeholders. Formative research (FR) was conducted locally to explore the potential feasibility and acceptability of SMC and to highlight information gaps and practical considerations to inform the intervention design.
  
  
  
  The FR adopted qualitative methods; 36 in-depth interviews and 18 focus group discussions were conducted across 13 target groups active across the health system and within the community. Analysis followed the 'framework' approach. The process for incorporating the FR results into the project design was iterative which was initiated by a week-long 'intervention design' workshop with relevant stakeholders.
  
  
  
  The FR highlighted both supportive and hindering factors to be considered in the intervention design. Malaria control was identified as a community priority, the community health workers were a trusted resource and the local leadership exerted strong influence over household decisions. However, there were perceived challenges with quality of care at both community and health facility levels, referral linkage and supportive supervision were weak, literacy levels lower than anticipated and there was the potential for suspicion of 'outside' interventions. There was broad consensus across target groups that community-based SMC drug delivery would better enable a high coverage of beneficiaries and potentially garner wider community support. A mixed approach was recommended, including both community fixed-point and household-to-household SMC delivery. The FR findings were used to inform the overall distribution strategy, mechanisms for integration into the health system, capacity building and training approaches, supportive interventions to strengthen the health system, and the social mobilization strategy.
  
  
  
  Formative research played a valuable role in exploring local socio-cultural contexts and health system realities. Both opportunities and challenges for the introduction of SMC delivery were highlighted, which were appropriately considered in the design of the project.
authors.affiliation: Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK. clarestrachan10@gmail.com.|London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. clarestrachan10@gmail.com.
authors.forename: Clare E
authors.initials: CE
authors.lastname: Strachan
authors.affiliation: Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK.|Department of Community Medicine, Kaduna State University, Kaduna, Nigeria.|EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal.
authors.forename: Musa
authors.initials: M
authors.lastname: Kana
authors.affiliation: Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Martin
authors.affiliation: Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK.
authors.forename: John
authors.initials: J
authors.lastname: Dada
authors.affiliation: Inspire Sustainable Development Agency, Baden Powel House, Buganda Road, Kampala, Uganda.
authors.forename: Naome
authors.initials: N
authors.lastname: Wandera
authors.affiliation: Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Marasciulo
authors.affiliation: Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Counihan
authors.affiliation: Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK.
authors.forename: Maxwell
authors.initials: M
authors.lastname: Kolawole
authors.affiliation: Katsina State Ministry of Health, State Secretariat Complex, IBB Way, Katsina, Nigeria.
authors.forename: Tanimu
authors.initials: T
authors.lastname: Babale
authors.affiliation: Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK.
authors.forename: Prudence
authors.initials: P
authors.lastname: Hamade
authors.affiliation: Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK.
authors.forename: Sylvia R
authors.initials: SR
authors.lastname: Meek
authors.affiliation: Malaria Consortium, Development House, 56-64 Leonard Street, London, EC2A 4LT, UK.
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Baba
mesh_terms: D018890:Chemoprevention / Q000379:methods*; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000379:methods* / Q000458:organization & administration*; D003150:Community Health Workers; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D014838:Volunteers
keywords: Community perceptions; Drug delivery; Formative research; Intervention design; Malaria; Nigeria; Preventive treatment; Qualitative; Seasonal malaria chemoprevention