Seasonal malaria chemoprevention uptake among caregivers of children under five in Abuja, Nigeria: a mixed-methods study of awareness, determinants, barriers and facilitators

<title>Abstract</title> <p>Background Seasonal malaria chemoprevention (SMC) reduces malaria risk among children under five, but its impact depends on effective uptake. This study examined SMC uptake and the factors influencing participation among caregivers in Abuja, Nigeria. Understanding these factors is essential for improving SMC uptake and programme effectiveness. Methods A mixed-methods cross-sectional study was conducted among caregivers of children under five in Abuja. Quantitative data (n = 317) were collected using an interviewer-administered questionnaire, while qualitative data were obtained through six focus group discussions (n = 27). Quantitative data were summarized descriptively, with predictors of SMC uptake identified using multivariable logistic regression (p &lt; 0.05). Qualitative data were analyzed using thematic analysis. Results Most (81.7%) caregivers had heard of SMC but only 60.6% reported uptake. Caregivers who had heard of the SMC programme had substantially higher odds of reporting uptake (AOR = 17.95, 95% CI: 6.96–46.27). Caregivers with health insurance coverage also had higher odds of SMC uptake (AOR = 1.95, 95% CI: 1.03–3.70), whereas employed caregivers had lower odds of uptake than unemployed caregivers (AOR = 0.24, 95% CI: 0.13–0.44).Qualitative findings highlighted persistent information gaps, inconsistent drug availability, inconvenient distribution schedules, and concerns about side effects as barriers to uptake. Home delivery, perceived effectiveness, and reduced transportation and access-related costs were reported as facilitators. Conclusion Despite relatively high awareness of SMC, substantial gaps in participation remained. Strengthening community sensitization, ensuring reliable drug supplies, providing flexible distribution strategies, and improving caregiver education on expected side effects could enhance SMC participation in malaria-endemic settings.</p>