Background Children under five years are at high risk for malaria illness and death. In 2022 WHO updated and expanded its recommendation for Perennial Chemoprevention of Malaria (PMC), i.e. the delivery of regular doses of sulphadoxine-pyrimethamine (SP), integrated within existing Expanded Immunization Programmes (EPI), to prevent malaria in children under 2 years of age living in moderate-to-high transmission settings. We assessed the anticipated community acceptability of a pilot PMC intervention implemented in Massinga District (Mozambique).

Methods We conducted a mixed methods study between June and July 2022. We collected 56 KAP questionnaires with healthcare workers (HCWs) of the 15 participating facilities and 32 recorded semi-structured interviews with HCWs, caregivers, and community healthcare workers (CHWs). For quantitative data, we performed descriptive statistics. Qualitative data were transcribed, analyzed, and synthesized through rapid qualitative analysis.

Results All respondents agreed on the heavy burden of malaria in children. Most HCWs (51.8%) HCWs were aware that malaria in children could be prevented through tablets (experience from SP in pregnant women). Administering PMC during a vaccination session was perceived as easy and feasible by 92.9% of HCWs. HCW agreed there is high (89.3%) care-seeking behavior in case of fever. However, 60.7% agreed that distance and lack of transport are barriers to accessing health facilities. Overall, the integration of PMC in routine EPI services was perceived as relevant. Community members reported trusting healthcare interventions and HCWs. Caregivers expressed their willingness to participate in active peer mobilization while community members emphasized the need for continuous community engagement to enhance acceptability and influence initially reluctant caregivers.

Conclusion PMC in children was perceived as acceptable by HCWs and different community actors, as a strategy to prevent malaria and avoidable care seeking. Structural and logistical barriers were anticipated. Involving key community members in active mobilization was perceived as paramount.