DISCUSSION
malaria, nausea, helminths, vomiting
ADVERSE EVENTS, MALARIA, SCHISTOSOMIASIS, MALARIA, DISEASES
Senegal has been implementing SMC and MDA for STH and schistosomiasis as separate vertical mono-disease control programs since 2008 and 2009, respectively. Seasonal Malaria Chemoprevention was first evaluated in Senegal in 2008 before its eventual adoption by the WHO for implementation across the Sahel region in 2012.Our findings showed that coadministration of anthelminthic and SMC drugs was acceptable to the children, their parents/caregivers, and the implementing team. These findings are consistent with the results of similar studies that have assessed the acceptability of antimalarialAll study participants raised concerns about the side effects associated with the bitter taste of amodiaquine and praziquantel, which led to severe nausea and vomiting in a minority of children. Previous studies have documented the increased incidence of these adverse events with amodiaquineTrust and confidence in government-sponsored health programs came out strongly as the major factor that influenced the acceptability of the integrated malaria–helminth preventive approach deployed in this study. A high level of trust in government and health institutions has been reported in many studies to correlate with high uptake of interventions and improved health-seeking behaviors.Refusal and/or rejection of the combined drugs was reported among children who were in the 10- to 14-year age group. On exploration of the factors driving this behavior, it was discovered that peer influence and lack of sensitivity to adolescent sexuality played a significant role. Studies have reported similar findings on how normative beliefs and the behavioral influence of the interactions among peers have hindered young people from utilizing health services because of the fear of stigmatization and gossip.The program managers and healthcare workers provided encouraging insights on the feasibility of a harmonious integration of SMC and MDA for STH and schistosomiasis control. This submission was probably driven by the perceived benefits of cost-cutting and improved efficiency in operational planning and implementation of an integrated control program for malaria and helminths. Although these efforts will involve national and international harmonization and coordination of the activities of partnerships devoted to control or elimination of the two major diseases,Our study had a few limitations. The opinions and views expressed by participants in this study were shaped largely by their sentiments on the effectiveness of SMC program in the community and in Senegal as a whole. A key challenge arose in separating the participants’ opinions about the integrated anthelminthic–SMC approach from the component of the SMC intervention because the two were closely linked in this study. Given that the study participants had not experienced an integrated malaria–helminth treatment approach before this study implementation, it was also difficult to clearly separate their views on the integrated approach from similar MDA campaigns that took place previously in the community. Also, a preponderance of male participants in this study might have reduced the information on the lived experiences of mothers who usually played the socially ascribed roles of primary caregivers in most African communities. Nevertheless, our approach of using different interviewing techniques helped to minimize the response bias that might have undermined the findings of this study.In conclusion, we report the findings of the first study that has explored the providers and caregivers’ acceptability of an integrated malaria–helminth treatment approach within the context of a clinical trial in Senegal. Overall, the approach was well accepted by the study participants, but concerns about the taste and smell of amodiaquine and praziquantel need to be addressed to optimize the uptake of the integrated control program. Also, culturally appropriate strategies need to be put in place to cater for the inclusion of children aged 10 to 14 years if the integrated malaria–helminth control program is to become an international policy.