An Assessment of Implementation of Mass Drug Administration for Prevention and Control of Schistosomiasis and Soil-Transmitted Helminths in Selected Southern Malawi Districts

Abstract

Background Mass drug administration (MDA) is one of the key interventions recommended by WHO for prevention and control of neglected tropical diseases. In Malawi, MDA is widely carried out annually since 2012 for prevention and control of schistosomiasis and soil transmitted helminths (STH). No study has been carried out to assess effectiveness of the approach and to document perceptions of health providers and beneficiaries regarding use of MDA. This study aimed to examine perceived strengths and weaknesses, successes and failures, as well as health providers’ and beneficiaries’ perspectives of implementing the strategy in Malawi. Methods As a cross-sectional implementation research, the study was carried out in three southern Malawi districts of Chiradzulu, Mangochi and Zomba. In each district, four health centres and 16 villages were randomly selected to participate. A mixed-methods approach to data collection focusing on quantitative data for coverage and knowledge, attitudes and practices assessments; and qualitative data for assessing perceptions of health providers and beneficiaries regarding MDA was used. Quantitative data were processed and analyzed using IBM SPSS software version 26 while qualitative data were analysed using NVivo 12 for Windows. Results Knowledge levels about schistosomiasis and STH in the districts varied according to disease aspects asked about. Majority are more knowledgeable about what schistosomiasis is (78%) and whether STH are treatable with drugs (97%); with least knowledgeable about the organism that transmits schistosomiasis (18%), types of schistosomiasis (11%) and what causes STH (20%). In 2018 and 2019 the districts registered high coverage rates for praziquantel and albendazole using community-based MDA (73%-100%) and using school-based MDA (75%-91%). Both the health authorities and community members perceived the MDA approach as good because it brings treatment closer to people. Conclusion With the high MDA coverage obtained in schools and communities, the implementation of MDA in the target districts is satisfactory. There are, however, several challenges including disproportionate knowledge levels, which are hampering progress towards attainment of the 2030 global NTD goals. There is a need for promotion of community participation and partnerships as well as implementation of other recommended interventions for sustainable prevention and control of schistosomiasis and STH.

Mass drug administration campaigns: Comparing two approaches for schistosomiasis and soil-transmitted helminths prevention and control in selected southern Malawi districts

“…This may have challenged the people in fully understanding these diseases, and for them to appreciate the importance of MDA and other control measures. The findings agree with other studies done in Malawi [7],…”

“…This may have challenged the people in fully understanding these diseases, and for them to appreciate the importance of MDA and other control measures. The findings agree with other studies done in Malawi [7], Philippines [27], Nigeria [28], Egypt [29], Cameroon [30], Papua New Guinea [31] and Turkey [32] demonstrating that despite implementation of numerous activities towards the control of NTDs, there was little sensitization of the general public in order to increase awareness of the diseases. The need to engage the public in schistosomiasis and STH prevention and control activities has become imperative in the context of morbidity reduction through MDA delivery and community participation.…”

“…The need to engage the public in schistosomiasis and STH prevention and control activities has become imperative in the context of morbidity reduction through MDA delivery and community participation. An increase in the awareness of community members regarding schistosomiasis and STH is important for them to play a central role and to engage actively in the prevention and control of these diseases [7].…”

“…A mixed-methods approach to data collection during baseline [7] and follow-up assessments was done focusing on quantitative data for coverage and cost estimates, and qualitative data for assessing perceptions of health providers and beneficiaries, and evaluating processes regarding interventions. Cross-sectional data collection methods were used during baseline and follow-up studies where all the necessary data for the study were similarly collected from intervention and control arms during baseline and follow-up assessments.…”

“…The study districts were selected purposively based on their level of co-endemicity with schistosomiasis and STH, and the comparative socio-economic, demographic and health indicators of the three districts [7]. In each district, four health centres and 16 villages within the catchment areas of the health centres were randomly selected to participate in the study.…”