Background Despite evidence of its safety and efficacy in preventing infant malaria, Sierra Leone is the only country worldwide to have deployed the WHO-recommended Perennial Malaria Chemoprevention (PMC) strategy at the country level. The MULTIPLY project is evaluating extending PMC into the second year of life and strengthening PMC delivery through outreach services. We aimed to assess the acceptability and feasibility of this pilot approach among Health Care Workers (HCWs).

Methods This was a cross-sectional mixed methods study conducted from January-February 2022 in three districts (Bombali, Port Loko and Tonkolili). A self-administered questionnaire was used among 144 HCWs and 42 CHWs actively involved in under-5 care in selected facilities (n=25). In addition, in 9 selected facilities of Bombali district, structured observations were conducted, 9 facility in-charges responded to a semi-structured individual interview as well as 13 HCWs and 4 key informants. Descriptive analysis was performed on the quantitative data, qualitative data was analyzed thematically, followed by a mixed methods analysis.

Results Respondents had good knowledge (score 16.4 out of 21) of the causes, symptoms and prevention of malaria. Most (93.5%) perceived PMC as an effective strategy. PMC integration alongside routine immunization was perceived as reducing HCW and caregiver costs and time-associated burden. HCWs trusted that PMC expansion through increased doses would lead to improved health outcomes. However, several existing logistical and structural barriers were documented, including stock-outs of drugs and vaccines, unavailability of supplies for PMC administration, transportation for caregivers accessing facilities and HCWs delivering outreach services, and the anticipated increase in workload due to additional reporting tools.

Conclusion HCWs reported positive experiences and perceptions of PMC integrated alongside routine immunisations and the overall anticipated acceptability of the pilot strategy. Findings suggest that innovative implementation strategies will be key to overcoming the feasibility barriers identified.