Implementing seasonal malaria chemoprevention in conflict-affected settings: experiences from Northern Bahr el Ghazal, South Sudan

Authors: Abubaker Rom Deng Ayuiel, Francis Okot, Jamshed Khan, Denis Mubiru, Atemthi D Dau, Amanya Jacob, Ezbon W Apary, Simon Peter Katongole, Aweno Norman

This qualitative study of 60 stakeholders involved in seasonal malaria chemoprevention (SMC) implementation highlighted the factors enabling SMC distribution in conflict-affected areas of South Sudan, as well as the main challenges faced. Findings underscore the need to target interventions in the face of resource constraints, and to enhance workforce capacity, communication and logistics infrastructure.

Introduction

South Sudan, a country with a high malaria burden, faces considerable health system challenges due to decades of civil war, which disrupt access to essential services. For three years, Malaria Consortium has implemented seasonal malaria chemoprevention (SMC) in Aweil South and Aweil West counties; however, coverage remains below optimal at 79 percent, falling short of established targets. This study examines the barriers and enablers to accessing and distributing SMC during the 2024 round.

Methods

A qualitative study design was used, involving 60 stakeholders involved in implementing SMC. Data were collected through 42 key informant interviews and 18 in-depth interviews with caregivers of eligible children who received all SMC doses or none, as well as those of ineligible children who received SMC. The data were analysed using deductive thematic analysis.

Results

Factors that enabled SMC distribution and access included government support, community trust, efficient logistics, integrated activities, access to vital information, involvement of Boma health workers, supervisor transportation and organised malaria management. The main challenges included shortages of healthcare workers, drug shortages, geographic and transportation difficulties, caregiver relocation, delayed referrals, and poor communication.

Conclusion

These findings underscore the necessity for targeted interventions to address resource constraints, enhance workforce capacity, communication, and logistics infrastructure, thereby ensuring sustainable SMC delivery in conflict-affected areas. Strengthening these areas will be crucial for maximizing the impact of SMC as a malaria prevention strategy in such environments.

Citation: Malaria Journal, 2026