Factors Associated with Non-Participation and Non-Adherence in Directly Observed Mass Drug Administration for Malaria in The Gambia

Abstract

IntroductionThe potential benefits of Mass Drug Administration (MDA) for malaria elimination are being considered in several malaria endemic countries where a decline in malaria transmission has been reported. For this strategy to work, it is important that a large proportion of the target population participates, requiring an in-depth understanding of factors that may affect participation and adherence to MDA programs.MethodologyThis social science study was ancillary to a one-round directly observed MDA campaign with dihydroartemisinin-piperaquine, carried out in 12 villages in rural Gambia between June and August 2014. The social science study employed a mixed-methods approach combining qualitative methods (participant observation and in-depth interviewing) and quantitative methods (structured follow-up interviews among non-participating and non-adhering community members).ResultsOf 3942 people registered in the study villages, 67.9% adhered to the three consecutive daily doses. For the remaining villagers, 12.6% did not attend the screening, 3.5% was not eligible and 16% did not adhere to the treatment schedule. The main barriers for non-participation and adherence were long and short-term mobility of individuals and specific subgroups, perceived adverse drug reactions and rumors, inconveniences related to the logistics of MDA (e.g. waiting times) and the perceived lack of information about MDA.ConclusionWhile, there was no fundamental resistance from the target communities, adherence was 67.9%. This shows the necessity of understanding local perceptions and barriers to increase its effectiveness. Moreover, certain of the constraining factors were socio-spatially clustered which might prove problematic since focal areas of residual malaria transmission may remain allowing malaria to spread to adjacent areas where transmission had been temporarily interrupted.

Factors associated with population coverage of targeted malaria elimination (TME) in southern Savannakhet Province, Lao PDR

“…Others who could not complete the participation (n = 9), gave reasons such as travelling, busy due to work and adverse events due to the medicine. Such explanations are consistent with those offered for partial or non-participation in past MDAs in the Gambia [ 19 – 21 ], Vietnam [ 14 ] and the Thai–Myanmar border regions [ 9 ]. The villagers’ reasons for partial or non-participation were discussed in meetings, and those who voiced concerns about MDA were sought out and provided with additional health education during house-to-house visits [ 16 ].…”

Rapid Ethnographic Assessment for Potential Anti-Malarial Mass Drug Administration in an Outbreak Area of Santo Domingo, Dominican Republic

“…3 and Box 1. This work further demonstrates the value of rapid ethnographic assessments to inform community engagement [12,18] and adds to previous research on motivations and barriers to MDA for malaria on Hispaniola [19] and elsewhere [20][21][22][23][24].…”

Community perceptions of targeted anti-malarial mass drug administrations in two provinces in Vietnam: a quantitative survey

“…There the researchers found travel, perceived adverse drug reactions and rumours, inconveniences related to the logistics of MDA (e.g. waiting times) and the perceived lack of information about MDA were critical reasons for non-participation [17, 21, 22]. While the research into factors related to the participation in mass administrations of anti-malarial drugs is somewhat limited there is a broad experience how to engage communities in other biomedical interventions including interventions against the transmission of HIV, tuberculosis, and vector-borne disease [23].…”