Replication Study: Assessing the Efficacy of SMS Reminders and Community Drug Distributors for Seasonal Malaria Chemoprevention in Sokoto State, Nigeria

Seasonal malaria chemoprevention (SMC) is a key strategy for reducing malaria burden in children in the Sahel. Previous research in another region indicated that SMS reminders to community drug distributors (CDDs) could improve SMC coverage and adherence. This study replicated that investigation within the specific context of Sokoto State, Nigeria, where distinct logistical and sociocultural factors may influence outcomes. The purpose was to assess the efficacy of an intervention combining SMS reminders with CDDs for SMC delivery in Sokoto State. Objectives were to measure its impact on coverage (proportion of children completing all four monthly SMC cycles) and adherence (correct dosage administration), and to identify contextual factors influencing implementation. A quasi-experimental design compared intervention and control districts. In the intervention arm, CDDs received systematic SMS reminders prior to each monthly SMC cycle and for reporting. Coverage and adherence data were collected via household surveys and CDD records. Qualitative interviews with CDDs and caregivers explored implementation barriers and facilitators. The intervention did not produce a statistically significant increase in final-cycle coverage relative to the control. Coverage was 78% in the intervention arm versus 75% in the control. Qualitative data, however, indicated that SMS reminders improved CDDs' planning and were perceived as a supportive supervision tool. Major cited barriers included household mobility and stock-outs of essential non-malaria commodities. This replication suggests that the SMS reminder component, as implemented, may be insufficient to substantially increase SMC coverage in Sokoto's context. The intervention's value appears more aligned with supporting CDD workflow than directly driving higher coverage, underscoring the influence of local implementation challenges. Future SMC programmes should integrate mHealth tools with strengthened supply chains and strategies to reach mobile populations. Further research should investigate tailored, multi-component interventions addressing the specific systemic barriers identified. seasonal malaria chemoprevention, mHealth, SMS reminders, community health workers, implementation research, Nigeria, replication study This study provides evidence on the contextual transferability of an mHealth intervention for malaria control, highlighting the importance of local health system factors in determining the success of replicated public health strategies.