Mass administration of medicines in changing contexts: Acceptability, adaptability and community directed approaches in Kaduna and Ogun States, Nigeria

Abstract

Nigeria has the highest burden of NTDs in sub-Saharan Africa. Commitments to reach the control and elimination of many Neglected Tropical Diseases (NTDs), particularly those amenable to preventive chemotherapy (onchocerciasis, schistosomiasis, soil transmitted helminths, lymphatic filariasis and trachoma) by 2020 are detailed in the London declaration. Strategies to reach targets build on existing approaches, one of which is the use of community directed intervention (CDI) methods to deliver the mass administration of medicines (MAM). However, treatment using this approach has been inconsistent and there are questions about the acceptability and adaptability of these interventions during periods of programmatic, social, and political change. This paper explores the current strengths and weaknesses of CDI approaches in MAM delivery. We consider the acceptability and adaptability of existing MAM approaches to ensure equity in access to essential treatments. Using qualitative methods, we explore implementer perspectives of MAM delivery. We purposively selected programme implementers to ensure good programmatic knowledge and representation from the different levels of health governance in Nigeria. Data collection took place across two States (Kaduna and Ogun). Our results indicate that CDI approaches have underpinned many historic successes in NTD programme acceptance in Nigeria, specifically in Kaduna and Ogun State. However, our results also show that in some contexts, factors that underpin the success of CDI have become disrupted presenting new challenges for programme implementers. Capturing the tacit knowledge of health implementers at varying levels of the health system, we present the current and changing context of MAM delivery in Kaduna and Ogun States and consolidate a platform of evidence to guide future programme delivery and research studies. We situate our findings within the broader NTD literature, specifically, in identifying how our findings align to existing reviews focused on factors that shape individual acceptance of MAM.

Attendee’s awareness about preventive chemotherapy neglected tropical diseases (PC-NTD) control during the first world neglected tropical diseases day in Ekiti State, Nigeria

“…Our findings show that majority of the attendees have not seen anyone with bloody urine, swollen limbs, wormy stool and depigmented skin before. This observation is in line with the findings of [ 19 ] and may contribute to the reasons why community members perceive less need for MAM over time. Also, unlike NTD control programmes, sustained malaria control programme have been in existence for quite a longer period, and they have more field presence for interventions delivery such as distribution of insecticide treated bednets and intermittent preventive treatment to endemic regions than there are for NTDs control [ 33 ].…”

“…This study has thus revealed a low level of public perception of NTDs and their control activities among attendees of this event, this is similar to the perception reported among attendees of a job fair in Abuja, Nigeria [ 14 ]. Since sustainable promotional and awareness activities require substantial resources commitment and coordination [ 14 , 17 , 19 ]. Efforts aimed at improving awareness on NTDs, disease control programs and health promotional activities should therefore be modified on this context to ensure optimal communal participation both in rural and urban areas [ 35 ].…”

“…Donated medicines are delivered at large scale in a coordinated manner to risk groups in schools and households/communities via already established NTDs control programme architecture at sub-national/district levels [ 17 ]. This strategy known as mass administration of medicines (MAM) requires substantial commitment of both financial and human resources [ 18 ], and more importantly, effective communal participation in the bid to sustain progress towards established public health targets or goals [ 17 – 19 ]. However, there are pockets of evidence on the low public awareness about NTDs and efforts targeted at controlling it in Nigeria [ 14 , 20 – 23 ].…”

Eliminating onchocerciasis within the Meme River Basin of Cameroon: A social-ecological approach to understanding everyday realities and health systems

“…’ [11 , page 9] . The successes of MDA have been widely reported [ 11 , 12 ], however, for some regions of Sub-Saharan Africa, transmission of onchocerciasis continues and alternative strategies are being considered to reach onchocerciasis elimination [ 13 , 14 ]. The transmission, re-infection, diagnosis, treatment and prevention of onchocerciasis is dependent on the behaviour and livelihoods of individuals which is shaped by their physical, social, cultural, political, and economic environments [ 15 , 16 ].…”

“…The transmission, re-infection, diagnosis, treatment and prevention of onchocerciasis is dependent on the behaviour and livelihoods of individuals which is shaped by their physical, social, cultural, political, and economic environments [ 15 , 16 ]. Greater consideration of these factors and adaptation to ongoing and emerging challenges is required; these include: civil unrest, currently ongoing in the region of this study and security concerns in west Africa more generally; hard-to-reach rural populations; co-endemicity with Loiasis as is the case in the Meme River Basin; emerging epidemics and cross-border transmission, is necessary to progress the journey toward onchocerciasis elimination [ 13 , 17 ]. Thus, as many countries move towards elimination, new partnerships, collaboration and alternative approaches that respond to the realities of different contexts are required [ 18 ].…”