Factors associated with adherence to the unsupervised daily dose of seasonal malaria chemoprevention in Builsa North District, Upper East Region of Ghana

Background: Since 2015, seasonal malaria chemotherapy (SMC) with amodiaquine–sulfadoxine-pyrimethamine (AQ-SP) has been implemented during the high malaria transmission season in three regions of Ghana. Adherence to the SMC is a critical determinant for successfully protecting children < 5 years. In Ghana, the SMC implementation was started in 2015. Objective: This study aimed to determine the level of adherence to SMC and the associated factors among caregivers in Builsa North District. Methods: We conducted a cross-sectional study in four sub-districts in the Builsa North District. The 435 participants were recruited via balloting using a random sampling procedure. Simple and multiple logistic regressions were performed to determine associations between SMC adherence and the independent variables, with all results interpreted at a 95% confidence level. Results: The SMC adherence rate among the caregivers in the Builsa North District was 95.63% (n = 416/435) with an awareness level of 97.94% (n = 427/435). The reasons reported for non-adherence were the child's refusal of the drug (38.88%, n = 7/18), the child vomiting the drug (33.33%, n = 6/18), the occurrence of an illness within the period of medication (15.38%, n = 3/18) and forgetting to give the subsequent doses (12.82%, n = 2/18). About half (49.31%, n = 214/435) of caregivers had a good knowledge of malaria, while 66.51% (n = 290/435) had a fair knowledge of SMC. Significant predictors of SMC on multiple logistic regression were the place of residence [adjusted odds ratio (aOR) = 3.59, 95% confidence interval (CI) = 1.02 –12.56]; caregivers’ dissatisfaction (aOR = 0.10, 95% CI = 0.01 – 0.74), and being informed by a friend (aOR = 0.04, 95% CI = 0.01 – 0.51). Conclusion: This study found a very high adherence rate to SMC in Builsa North District. The key factors associated with SMC adherence were being aware of SMC through non-health professional sources, place of residence, and caregivers' satisfaction with the previous SMC campaign.