Evaluating seasonal malaria chemoprevention coverage using the lot quality assurance sampling method in Niger

Abstract

Background Rapid data collection is paramount for monitoring and evaluating public health activities. Several techniques are used, including the Lot Quality Assurance Sampling (LQAS) method, which originated in the industrial sector and has many applications in the public health sector. The objective of this study was to demonstrate the application of the LQAS method to evaluate the coverage of seasonal malaria chemoprevention by classifying geographical areas according to their performance and whether the objectives were achieved. Methodology The data were collected by interviewing the mother or caregiver and by looking for evidence (completed SMC cards) of the administration of medicines. The sample included 50 children aged 3 to 59 months per health district, chosen in five localities (village/district) drawn at random, a rate of 10 children per locality. The decision value (D) is the value beyond which the batch is considered inadequate. When the lower decision threshold is 75% and the upper threshold is 90%, for a sample of 50 children, the decision value is 7. It is therefore not acceptable that, with a sample size of 50 children, more than 7 children did not receive treatment during the campaign. Results Applying LQAS rules to the data, we found that 100% (19/19) of districts were performing well in the first and fourth cycles of the SMC campaign, as reported by mothers and caregivers. In cycle 1, coverage was 99.47% (945/950), and the administration rate of the second and third doses was 98.4% (935/950) and 98% (931/950), respectively. In cycle 4, 99.3% (943/950) of children had received their first dose of treatment, and for the second and third doses, the administration rate was 99.4% (944/950) and 99,2% (942/950), respectively. Based on documented evidence (SMC card or Blister), 63% (12/19) of districts were performing well in cycle 1, and 63% (12/19) were performing well in cycle 4 of the SMC campaign. Conclusion This study demonstrates the feasibility of applying the LQAS method in the evaluation of chemoprevention coverage for seasonal malaria. The results suggest that all the districts are performing well for both rounds according to mothers’ reports, but according to the evidence, a certain number of districts are non-performing. This classification of zones helps guide interventions and inform appropriate strategies for each zone.