A Retrospective Evaluation of Commodity Management of Sulphadoxine Pyrimethamine + Amodiaquine and Pharmacovigilance during Seasonal Malaria Chemoprevention Campaign in Nigeria

doi:10.21203/rs.3.rs-1593931/v1

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A Retrospective Evaluation of Commodity Management of Sulphadoxine Pyrimethamine + Amodiaquine and Pharmacovigilance during Seasonal Malaria Chemoprevention Campaign in Nigeria

https://doi.org/10.21203/rs.3.rs-1593931/v1

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Background: The seasonal malaria chemoprevention (SMC) campaign provides malaria preventive medicines to healthy eligible children aged 3-59 month in the Sahel region of Africa. The campaign has helped reduce malaria burden among this age group in sub-Sahara Africa, but inadequate data exist on its supply chain management and pharmacovigilance reporting. To better understand its challenges and uncover areas to direct existing resources for commodity security and reporting of medication safety, this research evaluates the commodity management of Sulphadoxine Pyrimethamine + Amodiaquine (SP+AQ), a drug of choice in SMC and pharmacovigilance reporting during the 2019 campaign in 5 Northern states in Nigeria.

Methods: A descriptive cross-sectional study design was used, with a total of 1,189 health facilities (HFs) selected using a multi-stage cluster sampling in Jigawa, Katsina, Sokoto, Zamfara and Yobe States. The health facilities (HFs) were assessed using a structured questionnaire for distribution practices, compliance to good storage practices, staff training in pharmacovigilance (PV) and availability of pharmacovigilance reporting forms. Data were collected using the SurveyCTO data collection tool.

Results: Overall, inventory tools were available in 92.2% of the HFs. HFs with non-updated inventory tools ranges from 3% in Jigawa to 23% in Sokoto. Delivery documents were not sighted in 22% and 19% of facilities in Katsina and Sokoto states respectively. Storage practices across the facilities were generally fair with the exception of a significant lack of risk mitigation tools like fire extinguishers, with its availability ranging from 9% in Yobe to 38.6% in Jigawa. An observation of sampled tools showed a significant number of entry errors and missing entries. PV forms were available in 84% of the HFs sampled and 91.6% had at least one personnel trained on PV which varied across the states from 95.6% to 67.7% for the reporting tools and 97.3% to 79.2% for health facility workers (HFWs) trained in Jigawa and Sokoto respectively.

Conclusions: Commodity management of SP+AQ during SMC implementation in Nigeria is less than optimum and can negatively impact on commodity security during the campaign. A focused capacity building of HFWs responsible for commodity management, provision of fire extinguishers and PV reporting tools will help address the observed gaps in addition to improved supply of commodity management tools to health facilities.

Seasonal Malaria Chemoprevention

Supply Chain

Commodity Management

Pharmacovigilance

Malaria is a major cause of morbidity and mortality globally, implicated in 10.0 deaths per 100,000 populations in 2019 [1]. The burden of malaria in Nigeria has been enormous for centuries with significant annual infant and maternal mortalities in addition to millions of reported cases. The 2020 World Malaria Report recently noted Nigeria as one of the 32 countries contributing to the high morbidity (27%) and mortality (23%) rate globally with the under 5 populations significantly affected [1].

In response to the high malaria burden, the Nigeria’s National Malaria Elimination Programme (NMEP) with support from bilateral organizations, donors and implementing partners is leading and coordinating malaria control efforts to reduce the morbidity and mortality associated with the disease, especially in children under 5, who are most vulnerable from this disease. A key component of this interventions is the seasonal malaria chemoprevention strategy which has been adopted and implemented in Nigeria since 2013, after World Health Organization’s (WHO) recommendation in 2012. Seasonal malaria chemoprevention (SMC) is defined as the “intermittent administration of full treatment courses of antimalarial medicine, sulphadoxine/pyrimethamine and Amodiaquine (SPAQ) to children in areas of highly seasonal transmission of malaria” [2]. It has been recommended by the WHO as an effective malaria prevention strategies for the under 5 population in the Sahel regions of Africa [2]. The number of children reached with at least one dose of SMC steadily increased, from about 0.2 million in 2012 to about 21.5 million in 2019 [1]. In line with this recommendation and adoption at the national level, Malaria Consortium (MC) one of the global leading implementers of SMC has been supporting the implementation in Nigeria, from two (2) Local Government Areas in Katsina in 2013 to 5 Northern States in 2019 [3].

Malaria Consortium, as part of its intervention programmes, supported SMC activities in Jigawa, Katsina, Sokoto, Yobe and Zamfara States in 2019 [4]. This support entails the procurement and supply chain management of SPAQ for the intervention in Nigeria. In the 2019 SMC campaign, over 12 million doses of SPAQ were procured for community distribution through door-to-door channels with the health facilities serving as a hub unit of operation and quality assurance. The management and distribution strategy were designed to fit into the National Malaria Commodity Logistics Management System (MCLMS). In organizing SMC campaign, large volumes of malaria commodities pass through the in-country pipeline to the end user.

The WHO in 2012 recommended that pharmacovigilance be instituted into the seasonal malaria chemoprevention campaign to ensure that beneficiaries are protected against adverse drugs reactions [5], and many countries have made such effort to institute and strengthen the once weak system in SMC [6, 7, 8]. Despite pharmacovigilance being one of the six core components of SMC, published studies on its evaluation in Nigeria where approximately 12.5 million children have been reached with SMC in Nigeria from 2013–2019, with 4.1 million of those children treated with SP + AQ in 2019 alone is inadequate [1].

There is need to evaluate the commodity management including the availability of safety reporting tools to ascertain that commodities are judiciously used, and accountability of commodities conform with laid down procedure for malaria commodity logistics. The study therefore aimed to evaluate the strengths and weaknesses of the supply chain system for the purpose of providing feedback for subsequent interventions, assess the level of accountability demonstrated in the management of SPAQ deployed, as well as the availability and compliance with pharmacovigilance process for drug safety during the 2019 SMC campaign in Northern Nigeria.

2.1 Conceptual Framework

2.1.1 Supply Chain Management During SMC Implementation

Supply chain management of Sulphadoxine Pyrimethamine + Amodiaquine (SP + AQ) during the seasonal malaria chemoprevention campaign utilizes health facilities as supervisory points for the mass drug distribution campaign which is also the primary location for the commodity management of SPAQ during the campaign. SPAQ 1 and SPAQ 2 are imported into the country from international manufacturer (currently GUILIN Pharmaceuticals in China, the only company with WHO prequalified SPAQ). These commodities are delivered to the state central medical stores of the implementing states where they are received and stored by the Store Pharmacists and officers working under the state ministry of health. SPAQ are then distributed directly to the health facilities or through the Local Government Areas at least two days before the commencement of each cycle. Commodities are stored within the health facilities and distributed to community drug distributors on a daily basis during each MDA cycle which usually last for four days each month. The commodities are being received and managed at the health facilities by the health facility officer in-charge. The community drug distributors move from house to house within assigned communities within the facility’s catchment area for mass drug administration to eligible children aged 3 to 59 months. SPAQ remaining with the community drug distributors at the end of each daily drug distribution will then be returned to the health facilities and reconciled with the health facility officer in charge. At the end of each SMC cycle, SPAQ remaining at the health facilities will be reversed back to the central medical stores for subsequent distribution to health facilities in the next SMC cycle. Compliance to the National Malaria Commodity Logistics Management System (MCLMS) in the management and documentation of commodities is critical to commodity security. With the health facilities serving as the major holder locations for the management and accountability of SPAQ during the SMC campaign, it is the desire of this project to assess the inventory and delivery tools availability, documentation completeness used in the management of these commodities across selected health facilities during the season malaria chemoprevention campaign in Northern Nigeria.

2.1.2 Pharmacovigilance during SMC implementation

Despite pharmacovigilance being a core component of SMC implementation as recommended by the WHO, published data on its evaluation on the program in Nigeria, where over four million eligible children benefited from SMC in 2019 alone is non-existent. SMC implementation includes a referral and reporting system for SMC-related adverse drug reaction from communities, involving health facilities (HFs) and National Agency for Food and Drug Administration and Control (NAFDAC) state offices. Malaria Consortium in collaboration with the Government of Nigeria trained health facility workers (HFWs) on PV before the start of the SMC campaign. Suspected adverse drug reactions are referred to the health facilities by the community drug distributors using the SMC referral form. A trained health facility worker assesses the referred cases and manage as appropriate or refer to secondary or tertiary facility. The completed PV form is then completed and submitted to the National Pharmacovigilance Centre in Abuja through the state offices of the National Agency for Food, Drug Administration and Control (NAFDAC) in the implementing states.

2.2 Study design

The study design is a descriptive cross sectional study design using a structure questionnaire, across states in Northern states of Jigawa, Sokoto, Katsina, Zamfara and Yobe of Nigeria where Malaria Consortium Implemented the 2019 Seasonal Malaria Chemoprevention Campaign.

2.3 Study location

The study was conducted in the Northern part of Nigeria where SMC was implemented in 2019. The Sahel states includes; Sokoto, Katsina, Yobe, Zamfara and Jigawa State. Health facilities in these states that serves as hub facilities for the 2019 round of seasonal malaria chemoprevention campaign serves as the study sites.

2.4 Site inclusion criteria

The study was carried out across health facilities and storage locations where SMC was implemented in 2019 in the 5 states in Northern Nigeria. Facilities that did not serve as hub facilities for SMC implementation were excluded from the study.

2.5 Sample size

The determination of sample size is based on WHO’s recommendations for conducting Service Availability and Readiness Assessment (SARA) and formula at 95% confidence level for which the corresponding value of Z is 1.96 with 5% margin of error.

SARA formula

$${{n=\left\{\right[(Z}^{2}\times p\times q)+{ME}^{2 }]÷[ME}^{2 }+{Z}^{2}\times p\times q/N\left]\right\} \times d$$

where n is the sample to be calculated,

Z² is the square of the normal deviate at the required confidence level,

ME is the margin of error,

p is the anticipated proportion of facilities with the attribute of interest which range from proportion of facilities with inventory tools, delivery documentation, compliance with good storage practice and the availability of pharmacovigilance reporting tools (which is assumed to 50%)

q is 1-p, and d is the design effect (which is 1 for stratified sampling)

2.6 Sampling

The study used cluster sampling method to ensure representativeness of facilities to be assessed. In determining specific LGA to visit in each state. At ward level, all wards in the LGA are considered for facility sampling to take care of variation in population-based commodity allocation to health facilities. Health facilities to be visited were sampled by selecting the facility with the highest commodity allocation and the remain quota for the ward selected randomly as seen in Table 1. Sites included in the visit are all State Central Medical stores and other holding points in the state; selected Health Facilities that were included in the end of cycle report in the 2019 seasonal malaria chemoprevention campaign.

Table 1

Showing number of sampled evaluation sites
State	No of Wards	No Health Facilities
Sokoto	177	293
Jigawa	194	298
Katsina	82	223
Yobe	39	92
Zamfara	96	283
Total	588	1,189

2.7 Pretest and validation of assessment tool

An evaluation tool was newly developed by Malaria Consortium Nigeria for the study and data collectors were recruited and trained on the tools. The questionnaires were assessed for content validity by two academic scholars consulting for this study and other technical experts within Malaria Consortium, who have expertise in the field of supply chain management and pharmacovigilance. This is to ascertain the comprehensiveness of the item-statements in the questionnaires vis-à-vis the study objectives, as well as ensuring that there are no ambiguous questions or statements. Subsequently, pretest/face validity of the questionnaires was administered by the now trained data collectors in 3 health facilities in each of the States, so as to ascertain the ease of comprehension of the question-items by would-be participants. Feedback from the pretest and validity assessments led to minor modifications in the questionnaires such as the rephrasing of some of the questions for better clarity and ease of interpretation during interview if need be.

2.8 Collection of data

The assessment tool captured audit questions on the management of SPAQ at the various storage locations and the availability of forms for reporting suspected adverse drug reactions. The tools entail assessment questions on the storage of SPAQ at the various storage locations with focus on the minimum desired storage conditions for Medicines in Nigeria. The surveyCTO data collection tool was used to gather the information from the field using Android device provided to the trained data collectors. Some of the available inventory tools such as the inventory control cards, delivery notes at the assessment sites were physically examined for evidence of entry errors and incomplete entries. This was done through physical observation and inspection for sign of defect which was then captured as pictures for further detailed examination.

2.9 Study outcomes/indicators

At the end of the study, the proportion of health facilities with updated inventory tools and delivery documentations will be estimated from the study in percentage. One of the indicators in this evaluation is the availability and use of delivery note and inventory control card to track distribution and storage of SPAQ Products. Observed defects and entry errors on inventory tools and delivery notes/RIRV will be highlighted and proportion of health facilities with ADR reporting forms and trained personnel expressed in percentage. Those data entry errors and incomplete entries that cut across the states would be highlighted for focused capacity building. The study will also provide insights into the level of compliance with good storage practice across the states focusing on key markers of good storage of medicines. Finally, the percentage of health facilities with pharmacovigilance reporting system evidenced by availability of pharmacovigilance forms and staffs trained on pharmacovigilance reporting will be another indicator from the study.

3.1 Availability and use of inventory control card for proper tracking and control of the distribution.

The study shows variation in the availability and use of inventory control cards (ICC). The study indicates a high level of availability of inventory control card across the states (ranging from 86% in Katsina to 97% in Jigawa) with a significant proportion of the HFs with their ICCs up to date. However, 22% of sites in Katsina and 23% in Sokoto showed that their ICCs were not updated at the time of the visits as shown in Figs. 1 and 2 respectively.

3.2 Availability of delivery documentations at the service delivery points

The study shows a high availability of waybill or requisition issues and receipt vouchers (RIRV) which are documented evidence of delivery of SPAQ to the health facilities. Yobe, Jigawa and Zamfara indicates over 90% availability of the delivery tools at the visited health facilities while Katsina shows about 22% of the sampled health facilities without adequate delivery documentations. The unavailability of the delivery document is lowest in Jigawa and Zamfara States (3%), and highest in Katsina (22%) as shown in Fig. 3 below.

3.3 Assessment of Compliance with good storage practice

This section assesses some of the key guidelines that indicate good storage practice such as the First Expire, First Out (FEFO), availability of fire extinguisher, clean storage spaces free from rodents and insects and secured with access only to authorized individuals and commodities stored separately from insecticides and chemicals. As seen in Fig. 4 below, the findings indicated the availability of pallets, shelves or table at storage locations ranging from 44% of HFs in Yobe being the lowest to 86.9% in Zamfara being the highest. Availability of fire extinguisher or sand bucket at storage location was found to be very low across the states, ranging from 6.8% of the sampled HFs in Katsina, 9% in Yobe, 19.5% in Sokoto, 23.4% in Zamfara and 38.6% in Jigawa being the highest among the 5 states. Compliance to good storage practices was found in indicators such as FEFO, storage of SPAQ separately from insecticides/chemicals, security of storage locations from unauthorized persons, away from direct sunlight and at room temperature (~ 70–100%).

3.4 Availability of Pharmacovigilance forms and staffs trained on adverse drug reaction reporting

This finding showed the availability of the pharmacovigilance reporting forms across states from 68% in Sokoto and Yobe to 88% in Jigawa State with 94%, 93%, 77%, 74% and 82% of those HF in-charges trained on the reporting of suspected adverse drug reactions in Jigawa, Katsina, Sokoto, Yobe and Zamfara State respectively. The availability of at least one other staff in the facility trained on ADR reporting ranges from 68% in Yobe State to 93% in Katsina, demonstrating an adequate number of trained personnel available to take up that responsibility in the absence of the HF officer in-charge. This can be seen in Fig. 5 below.

3.5 Key Observations on sampled delivery notes and inventory control cards across some of the visited sites

In the documents examined for the audit which include the delivery notes and the inventory control records, incomplete documentation and wrong entries were the common errors identified across the sampled sites as seen in Fig. 6,7,8 9 and 10. First incomplete documentation was observed on delivery note and batch numbers of SPAQ delivered at the health facilities were not adequately captured on the delivery documentations examined in some facilities. This is problematic because the absence of batch numbers may make tracing commodities difficult in case of defective commodities. For example, a commodity suspected to be causing serious adverse drug reactions may need to be traced and recalled minimizing its detrimental effect on the population. Another instance of incomplete documentation on delivery documents is the absence of date of delivery and authorized signatory which will impair commodity accountability as seen in Fig. 6.

Secondly, wrong entries were observed in some of the sampled inventory control cards. This includes capturing figures in the wrong column on the inventory control cards, a clear example is the quantity of SPAQ issued for training and SMC flag off entered into the issue column instead of the adjustment column which is the right column for SPAQ moved outside the store to destination other than to health facilities.

Seasonal Malaria Chemoprevention campaign in Nigeria involves door to door administration of SPAQ to eligible children aged 3–59 months by less skilled community drug distributors (CDDs) [4]. While the CDDs play an important role in drug distribution, supervising health facilities and the state central medical stores where commodities are temporally stored before deployment to the health facilities also play important roles in the management of the SPAQ used during the SMC campaign. This assessment evaluates the current state of the management of SPAQ during SMC implementation in Northern Nigeria as well as the pharmacovigilance system during the SMC campaign.

The study indicates less than 100% availability of stock keeping and transaction record across the implementing states with some states having more than 20% sites without inventory control cards and delivery documentations, indicating poor inventory management of SPAQ across the sites during the SMC campaign. The inventory control cards are required for the documentation of health products within the health facilities and serves as the sole tool for monitoring the movement of drug in and out of the health facilities and even within the health facilities [8, 9]. During SMC campaign these tools are also used to capture commodities issued to CDDs for administration to children within the communities. In the absence of these tools, SPAQ received into the health facilities and issued to the CDD may not be easily tracked for adequate documentation and accountability. Also, efficient stock management to identify stock out may be impaired without the inventory tools for capturing stock levels .The use of inventory tools is recommended by the Malaria Commodity Logistic Systems in Nigeria which is in line with the recommendation by international organizations even though such method have been described as having less impact in preventing stock out [9].

Compliance to protocols such as storage on pallets, temperature of storage and exposure to direct sunlight, presence of pests in storage areas and availability of fire protective devices which are core component requirements of good storage practice for maintaining the integrity of SPAQ during storage was not up to standard in about 50% of sites assessed in some of the states. The assessment revealed storage of SPAQ on bare floor in more than 50% of health facilities in Yobe, this may be suggested to be due to the ongoing Boko Haram insurgency that has negatively impacted the quality of infrastructure, human capital and healthcare services in the state. The storage practice may negatively affect the quality of the drug being distributed and expose the SPAQ to deleterious effects like damaged by high temperature [10, 11]. Also, more than 50% of health facilities assessed lacked fire extinguishers or its alternative thereby increasing the risk of damage by fire incident which ultimately translate to a higher risk in the management of SPAQ during the SMC campaign in Sahel region in Nigeria. This high risk is added to the increased risk involved in the management of SPAQ at the community level by less skilled community drug distributors who are responsible for the management of drug at the community level. Storage facilities in Yobe and Sokoto state were not free from rodents in more than 20% of health facilities indicating potential for damaged of the SPAQ in storage at these locations. These findings on the storage and inventory management of medicines are similar to a recent study on storage practice across public health facilities in Northern Nigeria which demonstrated poor compliance to good storage practices such as use of pallets, lack of fire extinguisher, unclean locations and poor restrictions to only authorized persons [12]. Generally, the storage practice in the management of SPAQ across the states is below the recommended standard which necessitates training of staffs on storage practices prior to the commencement of SMC campaign to ensure commodity accountability during the seasonal SMC round in the Sahel region.

The principle of management of drugs in storage involves first expired first out (FEFO), which means commodities are issued out first of a facility based on when they will expire [13] and the separation of damaged / expired commodities from useable drugs [8]. In this study more than 15% of facilities in Sokoto and Zamfara states do not follow the FEFO principle in issuing SPAQ to CDDs during the SMC cycle. Still, this finding is an improvement on observations in a previous study where most drug stores practice the archaic FIFO (first in first out) principle in Nigeria [14]. Poor adherence to this principle means a high tendency of SPAQ expiring before distribution. Also, more than 20% of health facilities visited do not separate expired and damaged blisters of SPAQ from useable once which may translate to issuing expired SPAQ to CDDs for administration o children within the communities. Damaged/loose blisters are common occurrence in SMC implementation because of replacement of blisters in the form of re-dose when tablet is vomited by a child during drug administration leading to blisters with missing tablets that are reversed back to the central medical stores. It is standard practice to separate these blisters and other damaged or expired blisters from useable blisters during storage for accurate stock keeping and inventory management.

Observation of some of the sighted tools shows clear evidence of wrong and or incomplete entries in these very important inventory tools. This finding indicates a clear evidence of poor documentation of SPAQ stored and used during SMC across some health facilities in Nigeria, and it’s a pointer to where more energy can be channel during trainings of health facility workers. These errors may negatively impact the ability to be accountable for all SPAQ deployed during SMC implementation. An example of this observation is the absence of batch numbers on the waybill used for distribution which may make batch traceability difficult especially when a batch is linked with PV and other quality issues and may make recall very difficult.

The study also shows the availability of Pharmacovigilance systems across a significant number of facilities visited, evident by the availability of PV form and staff trained on PV even though there is need for improvement in some states. Pharmacovigilance is an important component of SMC campaign, and it prioritizes the availability of a reliable system to monitor, identify and report suspected and actual incidences of adverse drug reaction to SPAQ deployed for SMC implementation which is aimed at ensuring the safety of the drug [2, 8, 15]. Pharmacovigilance activities in Nigeria are coordinated by the National Pharmacovigilance Centre (NPC) situated in the National Agency for Food and Drug Administration and Control and involves the use of PV tools [16–20]. The study examine two important core WHO pharmacovigilance process indicators of PV reporting forms and trained health facility staffs on PV which shows the availability of more than 60% of health facilities used for the SMC campaign having PV reporting forms with some states having more than 80% of facilities with PV reporting forms .While the availability of PV reporting forms is commendable across the states, it is alarming that some state have more than 30% of health facilities with no PV reporting forms indicating a very poor PV process indicator for these facilities. The poor PV process indicator characterized by the absence of PV reporting forms is a safety concern and point to a defect in the PV system in Nigeria which is similar to a study on PV system in southern Nigeria [17], which also showed poor availability of PV reporting forms at health facilities.

The study shows gaps within the commodity management and PV reporting systems during the Seasonal Malaria Chemoprevention Campaign in Nigeria. The persistence of these loopholes has grave implication on the accountability and safety of SPAQ used during the SMC implementation in the Sahel region of sub-Saharan Africa. These gaps point to the need for expanded and more comprehensive approach to evidence based capacity building strategies capable of improving the capacity of health workers at the facility levels directly involved in the management of SPAQ used during the campaign and or alter the SMC delivery strategies to use more skilled staff in the management of the commodity. Furthermore, despite the institutionalization of pharmacovigilance system in SMC in Nigeria, efforts are needed from the Government and implementing partners such that every HFW involved in the programme is trained on PV and improve on the availability of the reporting form at facility level such that every identified suspected adverse drug reaction is documented and submitted through the appropriate channel.

ADR: Adverse Drug Reaction

CDD: Community Drug Distributors

FEFO: First Expired, First Out

FIFO: First in, First Out

HF: Health Facility

HFWs: Health Facility Workers

ICC: Inventory Control Card

LGA: Local Government Area

MC: Malaria Consortium

MCLS: Malaria Commodity Logistic System

NAFDAC: National Agency for Food, Drugs Administration and Control

NMEP: National Malaria Elimination Programme

PV: Pharmacovigilance

RIRV: Requisition Issue and Receipt Voucher

SMC: Seasonal Malaria Chemoprevention

SPAQ: Sulphadoxine Pyrimethamine + Amodiaquine

WHO: World Health Organisation

Ethics approval and consent to participate:

Ethical approval for this study was received from the National Health Research Ethics Committee, Abuja , Nigeria.

Consent for publication:

Consent participation and publication was received from all participants whose data appears in this study, through the Publication Ethics Committee of the State Ministries of Health of the respective states.

Availability of data and material:

Data sharing not applicable to this article as no datasets were generated or analysed during the current study. Copies of the pharmacovigilance forms generated from the campaign, collated and shared with the National Agency for Food, Drug Administration and Control are available from the corresponding author on reasonable request.

Competing interests:

K.R., J.A., C.D., K.M., D.O., B.F., and O.O declare that they have no conflict of interest.

Funding:

The authors did not receive any finding for this study.

Authors’ Contribution:

K.R., B.F., and O.O conceptualized the study protocol, K.R wrote the first draft of the manuscript, J.A proofread and formatted the final manuscript, J.A., C.D, K.M., and D.O. participated in data collation and analysis, K.R., J.A., C.D., K.M., D.O., B.F., and O.O read and approved the manuscript.

Acknowledgment:

The State Ministries of Health and the State Malaria Elimination Programmes of Katsina, Kano, Yobe, Jigawa, Bauchi, Kebbi and Sokoto States are hereby acknowledged for their contributions to the Seasonal Malaria Chemoprevention programme in 2019.

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A Retrospective Evaluation of Commodity Management of Sulphadoxine Pyrimethamine + Amodiaquine and Pharmacovigilance during Seasonal Malaria Chemoprevention Campaign in Nigeria

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Abstract

Figures

1.0 Background

2.0 Methods

2.1 Conceptual Framework

2.1.1 Supply Chain Management During SMC Implementation

2.1.2 Pharmacovigilance during SMC implementation

2.2 Study design

2.3 Study location

2.4 Site inclusion criteria

2.5 Sample size

2.6 Sampling

2.7 Pretest and validation of assessment tool

2.8 Collection of data

2.9 Study outcomes/indicators

3.0 Results

3.1 Availability and use of inventory control card for proper tracking and control of the distribution.

3.2 Availability of delivery documentations at the service delivery points

3.3 Assessment of Compliance with good storage practice

3.4 Availability of Pharmacovigilance forms and staffs trained on adverse drug reaction reporting

3.5 Key Observations on sampled delivery notes and inventory control cards across some of the visited sites

4.0 Discussion

5.0 Conclusion

Abbreviations

Declarations

References

Status:

Version 1