Implementer and recipient perspectives of community-wide mass drug administration for soil-transmitted helminths in Kwale County, Kenya

Abstract

Soil-transmitted helminthiases (STH) are one of 17 neglected tropical diseases (NTDs) earmarked for control or elimination by 2020 in the WHO's Roadmap on NTDs. Deworming programs for STH have thus far been focused on treating preschool and school-aged children; however, there is a growing consensus that to achieve elimination of STH transmission, programs must also target adults, potentially through community-wide mass drug administration (MDA). There is currently a gap in the literature on what components are required to deliver community-wide MDA for STH in order to achieve high intervention reach and uptake. Nested within the TUMIKIA Project, a cluster randomized trial in Kenya evaluating the effectiveness of school-based deworming versus community-wide MDA, we collected qualitative data from program implementers and recipients in eight clusters where community-wide MDA was delivered. Data collection included semi-structured in-depth interviews (n = 72) and focus group discussions (n = 32). A conceptual framework for drug distribution was constructed to help build an analysis codebook. Case memos were developed for each top-level theme. Community-wide MDA for STH was perceived as a complex intervention with key administrative and social mobilization domains. Key actionable themes included: (1) developing an efficient strategy to allocate reasonable workload for implementers to cover all targeted households; (2) maximizing community drug distributors' motivation through promoting belief in the effectiveness of the intervention and providing sufficient financial incentives; (3) developing effective capacity building strategies for implementers; and (4) implementing a context-adapted community engagement strategy that leverages existing community structures and takes into consideration past community experiences of MDAs. Transitioning from STH control to elimination goals requires significant planning and action to ensure community-wide MDA is delivered with sufficient reach and uptake. We

A Qualitative Study Exploring Barriers, Facilitators and Solutions to Equitable Coverage of Preventive Chemotherapy Towards the Control and Elimination of Neglected Tropical Diseases in South Omo Zone, Nomadic Setting of Southern Ethiopia: Stakeholders’ Perspectives and Experiences

“…The health system should support CDDs to keep their motivation through incentives and supervision. This agrees with the ndings of systematic reviews and studies done in Kenya and Bangladesh [21][22][23][24].…”

“…Equity in health indicates that ideally everyone should have a fair opportunity to attain their full health potential, and no one should be disadvantaged from attaining this potential [22]. Hence, in this study, equity is de ned as anyone eligible for PC should not be left behind from accessing and use of PC.…”

Patterns of individual non-treatment during multiple rounds of mass drug administration for control of soil-transmitted helminths in the TUMIKIA trial, Kenya: a secondary longitudinal analysis

“…As previously shown in the TUMIKIA trial and other studies, community engagement during MDA programmes can address perceptions about safety, effectiveness, and need for repeated treatment, and build trust and the demand for treatment. 6 , 7 , 8 , 15 , 24 …”

“…Before each round of treatment, community mobilisation activities took place that included forums with chiefs, ward administrators, and community health assistants, and meetings held by and door-to-door visits made by village elders. 15 Participants received directly observed treatment with 400 mg albendazole provided through the WHO donation programme to the Government of Kenya by GlaxoSmithKline (London, UK). Rounds one and three were provided in Jul 20–30, 2015, and May 26–June 3, 2016, respectively.…”

Epidemiology of soil-transmitted helminths following sustained implementation of routine preventive chemotherapy: demographics and baseline results of a cluster randomised trial in southern Malawi

“…This raises a challenging decision for policy makers and researchers alike: whether control programmes should continue to try and sustain the elimination of STH morbidity, or pivot towards expanding coverage to the entire community with the target of elimination of STH infection [49]. Building on evidence from Kenya in which community-wide MDA was more effective and feasible approach to reducing the prevalence and intensity of hookworm relative to school-based deworming over the course of two years [50,51], the Deworm3 trial [15,52] which this survey sits within, aims to address whether such a strategy could be effective, feasible and costeffective [53]. 1: Individual and household-level characteristics of (i) community (census) survey participants registered in delineated study clusters in total, disaggregated by socio-economic status, and disaggregated by sex; and (ii) parasitological survey participants in total; in Namwera, Mangochi district, Malawi in 2018.…”