A Research Protocol to Investigate the Role of Patent Medicine Vendors in Childhood Malaria Management and Antibiotic Stewardship in Nigeria: An Implementation Science Study

**Background:** Patent medicine vendors (PMVs) are a primary source of care for childhood illnesses in Nigeria. Their practices in managing suspected malaria and dispensing antibiotics directly influence child health outcomes and antimicrobial resistance (AMR) containment, yet they are poorly characterised within implementation science frameworks.

**Purpose and objectives:** This protocol describes an implementation science study to investigate PMVs’ practices, knowledge, and the contextual factors influencing childhood malaria management and antibiotic dispensing in Nigeria. The primary objective is to identify determinants (barriers and facilitators) for implementing guidelines on appropriate malaria care and antibiotic stewardship among PMVs.

**Methodology:** A sequential mixed-methods design will be employed from 2024 to 2026. A cross-sectional survey of 300 PMVs in Enugu and Kano states will quantify practices and knowledge. This will be followed by 24 in-depth interviews and 6 focus group discussions with PMVs, caregivers, and community health workers to explore contextual and behavioural factors. Structured observational checklists will audit vendor-client interactions.

**Findings/Key insights:** Anticipated insights include the identification of key determinants for practice change. Preliminary engagements suggest PMVs’ dispensing practices are heavily influenced by caregiver demand and economic pressures, rather than clinical guidelines alone.

**Conclusion:** The study will generate a detailed situation analysis of PMV practices related to childhood malaria and antibiotics, providing an evidence base for their current role in community case management.

**Recommendations:** Findings will inform the co-design of a tailored, context-specific intervention package to improve PMV practices, intended for testing in a future implementation trial between 2025 and 2026.

**Key words:** antimicrobial resistance, malaria, drug sellers, private sector, mixed methods, qualitative research, Nigeria.

**Contribution statement:** This protocol provides a structured implementation science approach to a critical public health challenge, aiming to bridge the gap between national policy guidelines and real-world practice in community case management.