{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T14:57:57Z","timestamp":1791385077585,"version":"4.3.3"},"reference-count":30,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Seasonal malaria chemoprevention (SMC) with sulfadoxine\u2013pyrimethamine and amodiaquine (AQ) has been implemented in Africa since 2012 to prevent malaria among children ages 3 to 59 months old. As SMC expands to new regions, concerns are emerging about sustainability and quality of implementation. Successful SMC delivery depends on not only effective drug administration but also caregiver engagement, adherence to at-home AQ administration, retention of Child Record Cards, and overall malaria prevention practices. Although caregivers\u2019 perceptions of delivery quality as well as knowledge and trust of SMC may play critical roles in shaping these behaviors, these associations remain underexplored. We conducted secondary analyses of SMC delivery quality and its associations with key SMC outcomes using two cross-sectional end-of-round SMC coverage surveys in 11 Nigerian states in 2021 and 2022 (\n                    <jats:italic>N<\/jats:italic>\n                    = 22,122). Exploratory factor analysis identified a single latent factor representing perceived SMC delivery quality based on six items reflecting distributor behavior and quality of communication. Logistic regression models revealed significant positive associations between higher index scores and days 2 and 3 AQ adherence as well as Child Record Card retention. Higher delivery quality was associated with reduced caregiver refusal of SMC. Structural equation modeling showed that perceived SMC delivery quality had significant direct effects on all three outcomes, with indirect effects significant only for days 2 and 3 AQ adherence. Findings highlight that improving and monitoring caregiver-perceived SMC delivery quality is essential to sustaining SMC effectiveness and suggest the need for strengthened distributor training and community engagement.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0661","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T17:48:38Z","timestamp":1787680118000},"page":"778-784","source":"Crossref","is-referenced-by-count":0,"title":["Understanding the Dimensions of Caregiver-Perceived Seasonal Malaria Chemoprevention Delivery Quality in Nigeria: A Structural Equation Modeling Analysis of Door-to-Door Seasonal Malaria Chemoprevention"],"prefix":"10.4269","volume":"115","author":[{"given":"Tingkai","family":"Zhang","sequence":"first","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sikai","family":"Huang","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taiwo","family":"Ibinaiye","sequence":"additional","affiliation":[{"name":"Malaria Consortium Nigeria, Abuja, Nigeria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olusola","family":"Oresanya","sequence":"additional","affiliation":[{"name":"Malaria Consortium Nigeria, Abuja, Nigeria;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institute, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sol","family":"Richardson","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing, China;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"issue":"10265","key":"b1","series-title":"Lancet","first-page":"1829","article-title":"Effectiveness of seasonal malaria chemoprevention at scale in west and central Africa: An observational study","volume":"396","year":"2020"},{"issue":"9","key":"b2","series-title":"PLoS Med","first-page":"e1003727","article-title":"Effectiveness of seasonal malaria chemoprevention (SMC) treatments when SMC is implemented at scale: Case\u2013control studies in 5 countries","volume":"18","author":"Cairns","year":"2021"},{"issue":"2","key":"b3","series-title":"Cochrane Database Syst Rev","first-page":"CD003756","article-title":"Intermittent preventive treatment for malaria in children living in areas with seasonal transmission","volume":"2012","author":"Meremikwu","year":"2012"},{"issue":"5","key":"b4","series-title":"BMJ Glob Health","first-page":"e008021","article-title":"Impact of seasonal malaria chemoprevention on prevalence of malaria infection in malaria indicator surveys in Burkina Faso and Nigeria","volume":"7","author":"de Cola","year":"2022"},{"issue":"2","key":"b5","series-title":"Lancet Glob Health","first-page":"e199","article-title":"Seasonal malaria chemoprevention in the Sahel subregion of Africa: A cost-effectiveness and cost-savings analysis","volume":"9","author":"Gilmartin","year":"2021"},{"issue":"1","key":"b6","series-title":"Malar J","first-page":"400","article-title":"Effectiveness of seasonal malaria chemoprevention in three regions of Togo: A population-based longitudinal study from 2013 to 2020","volume":"21","author":"Bakai","year":"2022"},{"issue":"11","key":"b7","series-title":"PLoS Med","first-page":"e1002175","article-title":"Effectiveness of seasonal malaria chemoprevention in children under ten years of age in Senegal: A stepped-wedge cluster-randomised trial","volume":"13","author":"Ciss\u00e9","year":"2016"},{"key":"b8","article-title":"Seasonal Malaria Chemoprevention with Sulfadoxine\u2013Pyrimethamine Plus Amodiaquine in Children: A Field Guide.","year":"2023"},{"issue":"1","key":"b9","series-title":"Am J Trop Med Hyg","first-page":"20","article-title":"Systematic review and meta-analysis of seasonal malaria chemoprevention","volume":"110","author":"Thwing","year":"2024"},{"issue":"1","key":"b10","series-title":"Malar J","first-page":"131","article-title":"Predictors of accessing seasonal malaria chemoprevention medicines through non-door-to-door distribution in Nigeria","volume":"23","author":"Huang","year":"2024"},{"key":"b11","article-title":"Malaria Consortium\u2019s Seasonal Malaria Chemoprevention Program: Philanthropy Report 2021.","year":"2022"},{"issue":"1","key":"b12","series-title":"BMC Public Health","first-page":"1934","article-title":"\u201cI heard at home. The leader came by to inform.\u201d The role of community leaders and community distributors in promoting uptake of seasonal malaria chemoprevention in Nampula Province, Mozambique: A qualitative study","volume":"25","author":"Sitoe","year":"2025"},{"key":"b13","article-title":"Coverage and Quality of Seasonal Malaria Chemoprevention Supported by Malaria Consortium in 2021: Results from Burkina Faso, Chad, Mozambique, Nigeria, Togo, and Uganda.","year":"2022"},{"key":"b14","article-title":"Coverage and Quality of Seasonal Malaria Chemoprevention Supported by Malaria Consortium in 2022.","year":"2023"},{"issue":"4","key":"b15","series-title":"Health Commun","first-page":"419","article-title":"Relationships between media exposure and knowledge, attitude, and practice on HIV\/AIDS: A cross sectional survey of adolescent Islamiyya girls in Nigeria","volume":"35","author":"Hamid","year":"2020"},{"issue":"1","key":"b16","series-title":"BMC Public 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