Community Drug Distributor Knowledge, Attitudes, and Motivation Surrounding Mass Drug Administration for Soil-Transmitted Helminths in India

Abstract

Background: DeWorm3 is an ongoing multi-country community-based cluster-randomized trial assessing the feasibility of interrupting transmission of soil-transmitted helminths (STH) with community-wide mass drug administration (cMDA). In Tamil Nadu, India, community drug distributors (CDDs) worked with DeWorm3 field staff to counsel community members and deliver door-to-door deworming treatment. As CDDs were likely to influence successful delivery of cMDA, we describe drivers of CDDs' knowledge, attitudes, and motivation toward delivery of cMDA.Methods: In this convergent mixed-methods study, a questionnaire on STH and cMDA was administered to 104 CDDs and 17 focus group discussions (FGDs) were conducted. Key outcomes in the quantitative and qualitative analyses included CDDs' knowledge about STH and cMDA and attitudes toward cMDA for STH. Univariate and multivariable logistic regression analyses were performed to determine the strength of associations between independent and outcome variables. The FGDs were analyzed using a priori thematic coding.Results: CDDs who completed at least secondary school education [adjusted odds ratio (aOR): 2.71, 95% CI: 1.16–6.33] and had prior experience in health programs (aOR: 2.72, 95% CI: 1.15–6.44) were more knowledgeable about STH and cMDA. CDDs belonging to the scheduled castes and scheduled tribes (aOR: 2.37, 95% CI: 1.04–5.39), and to households engaged in a skilled occupation (aOR: 2.77, 95% CI: 1.21–6.34) had a more positive attitude toward cMDA for STH. The FGDs showed that while there were myths and misconceptions about STH, many CDDs believed that the adult population in their communities were infected with STH, and that a door-to-door drug delivery strategy would be optimal to reach adults.Conclusions: Educational and socioeconomic backgrounds and experience in health programs should be considered while designing CDD trainings. Along with cMDA delivery for STH, as CDD do share community myths and misconceptions around STH, they should be proactively addressed during the CDD training to strengthen competency in counseling.

Impact of adverse events during community-wide mass drug administration for soil-transmitted helminths on subsequent participation–a Theory of Planned Behaviour analysis

“…A positive attitude (� median composite score) towards cMDA was significantly higher among the most disadvantaged households who belonged to SC/ST. Another earlier study by our team demonstrated that a higher proportion of CDDs who belong to SC/ST households have a positive attitude towards cMDA [39]. The likelihood of perceived risk to STH infections may be higher among SC/ST households as they have poor water and sanitation facilities and less access to healthcare [40].…”

Deworming and micronutrient status by community open defecation prevalence: An observational study using nationally representative data from India, 2016–2018

“…Participation in deworming and therefore coverage of targeted populations is influenced by several factors such as gender, socioeconomic status, population density, school attendance, local religious and cultural beliefs, awareness of helminth infections, and trust in public health campaigns [71,72]. Community engagement and sensitization activities need to be tailored to address these factors in the form of media announcements, social media, or local dissemination by trained and motivated community drug distributors (including schoolteachers) prior to national deworming campaigns [73,74]. Furthermore, sanitation and deworming alone are insufficient to address micronutrient deficiencies among children in India.…”