Seasonal Malaria Chemoprevention (SMC) Utilization among Children Under Five: A Systematic Review of Evidence from Sub-Saharan Africa

Abstract

Seasonal Malaria Chemoprevention (SMC) has been recognized as a key preventive strategy for reducing malaria morbidity and mortality among children under five in highly seasonal malaria transmission areas of Sub-Saharan Africa (SSA). Despite demonstrated effectiveness, the uptake and utilization of SMC vary across regions. This systematic review synthesizes evidence on determinants influencing SMC utilization among children under five in SSA. A comprehensive search was conducted across PubMed, Web of Science, Scopus, and Google Scholar for studies published between 2010 and 2025. Studies reporting factors associated with SMC coverage, adherence, and uptake were included. Findings indicate that determinants of SMC utilization include caregiver knowledge and attitudes, socio-economic status, health system factors, community engagement, seasonal timing of drug administration, and perceived efficacy and safety of SMC drugs. Barriers include lack of awareness, logistical challenges, cultural beliefs, and healthcare worker shortages. Interventions targeting education, community mobilization, and strengthening health systems are critical to improve SMC coverage. The review highlights the need for context-specific strategies to enhance equitable SMC delivery and reduce malaria burden among children under five in SSA.