EN
A community-based study investigated the acceptability, utilization, and barriers to adopting rectal artesunate (Plasmotrim Rectocap 50 and 200 mg) for malaria management among parents of 905 children under five years, 113 Primary Healthcare Practitioners, and 74 Patient Medicine Vendors across 183 rural communities in eight local government areas (LGAs) of Ogun State, Nigeria. Ethical approvals were obtained, and data collection included structured questionnaires and interactive sessions with parents, Primary Healthcare Practitioners, and Vendors to gather demographic data, utilization trends, and perceptions. Data obtained were entered into MS Excel 2016 and analysed using SPSS version 20 to test for an association. Machine learning techniques, including Random Forest, Support Vector Machine (SVM), and Logistic Regression, were applied to analyse data, identify patterns, and optimize predictive modelling. Results showed that 87.6% of parents had not used suppository drugs for malaria treatment, and 100% had not used rectal artesunate for their children, though they expressed universal acceptance (100%), high satisfaction (99.5%), and perceived effectiveness (100%). 87.6% of medical practitioners had not used suppository drugs, and 92.9% had not used rectal artesunate for children. However, 94.7% indicated willingness to adopt it, citing satisfaction (94.7%) and effectiveness (92%). Among vendors, 64.9% had not sold suppository drugs, and 95.9% had not sold rectal artesunate, though 83.9% expressed willingness. Comparative analysis across LGAs revealed variability in utilization (50-80%) and acceptability (65-85%). Machine learning models achieved high predictive performance. Random Forest demonstrated 85% accuracy (AUC: 0.89) for efficacy prediction, SVM achieved 82% accuracy (AUC: 0.86) for utilization prediction, and Logistic Regression showed strong performance for acceptability (78%, AUC: 0.82) and treatment preference (80%, AUC: 0.83). SHAP analysis identified key predictors, including child’s age, socio-economic status, and prior suppository use. Explainable AI (XAI) insights recommended targeted interventions, such as parental education, healthcare worker training, and subsidies to address barriers.