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An overview of the major health problems mentioned by community members during focus group discussions in rural and urban study sites, Tanzania, listed according to priority with those considered more severe first
Source publication
Lymphatic filariasis is one of several neglected tropical diseases with severely disabling and stigmatizing manifestations that are referred to as 'neglected diseases of poverty'. It is a mosquito-borne disease found endemically and exclusively in low-income contexts where, concomitantly, general public health care is often deeply troubled and fail...
Context in source publication
Context 1
... the purpose of contextualizing MDA for lymphatic filariasis within the general experience of health and health care among community members, FGDs included a focus on participants' perception of the most common serious health problems they experience in the community (Table 1). Among health workers, the question was asked in order to find out if there was common ground with community members with regard to health problems and experience with provision of health services. ...Similar publications
Background: Lymphatic filariasis (LF) is an important public health and socio-economic problem in the world and it was identified as one of the six diseases, which could be targeted for elimination /eradication. Annual mass drug administration of DEC with selective vector control could result in the effective elimination of infection by interruptio...
Background
Understanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countri...
Background: India has adopted MDA strategy for elimination of lymphatic filariasis since 2004. It requires constant efforts on a nationwide scale particularly in the endemic areas for interruption of transmission of this neglected tropical disease. Aims & Objectives: This study aims to assess the coverage and compliance along with factors affecting...
Background: Lymphatic filariasis has been a major public health problem in India. Government of India during 2004 initiated Mass Drug Administration (MDA) with annual single dose of DEC tablets to all the population living at the risk of filariasis. Nalgonda is endemic district where MDA programme is undertaken every year to eliminate lymphatic fil...
Lymphatic filariasis is ranked as one of the leading causes of permanent and long-term disability and also oldest and most debilitating neglected tropical disease worldwide. Filariasis is caused by nematode endoparasitic worms transmitted to humans by various mosquito vectors. World Health Organization established Global Programme to Eliminate Lymp...
Citations
... Other reported program issues associated with poor 90 MDA compliance include drug shortages, insufficient time and human resources, inadequate training of 91 drug distributors, inappropriate selection of drug distributors, poor adverse event management, and 92 limited community engagement or coordination in MDA planning [5]. Failure to adequately engage 93 members of the health system and the community during MDA planning can adversely impact the 94 quality of MDA implementation and, therefore, lead to low levels of community participation [11,12]. 95 Conversely, strong community participation in the planning and implementation of MDAs has been seen 96 as key to the success of some campaigns, particularly in urban areas [13][14][15]. ...
Background
Achieving adequate mass drug administration (MDA) coverage for lymphatic filariasis is challenging. We sought to improve stakeholder engagement in MDA planning and improve subsequent MDA coverage through a series of microplanning workshops.
Methodology/Principal Findings
Prior to the 2018 MDA, Haiti’s Ministry of Public Health and Population (MSPP) and partners conducted 10 stakeholder microplanning workshops in metropolitan Port-au-Prince. The objectives of the workshops were to identify and address gaps in geographic coverage of supervision areas (SAs); review past MDA performance and propose strategies to improve access to MDA; and review roles and responsibilities of MDA personnel, through increased stakeholder engagement. Retrospective pre-testing was used to assess the effectiveness of the workshops. Participants used a 5-point scale to rank their understanding of past performance, SA boundaries, roles and responsibilities, and their perceived engagement by MSPP. Participants simultaneously ranked their previous year’s attitudes and their attitudes following the 2-day microplanning workshop. Changes in pre- and post-scores were analyzed using Wilcoxon-signed rank tests. A total of 356 stakeholders across five communes participated in the workshops. Participants conducted various planning activities including revising SA boundaries to ensure full geographic reach of MDA, proposing or validating social mobilization strategies, and proposing other MDA improvements. Compared with previous year rankings, the workshops increased participant understanding of past performance by 1.34 points (standard deviation [SD]=1.05, p<0.001); SA boundaries by 1.14 points (SD=1.30; p<0.001); their roles and responsibilities by 0.71 points (SD=0.95, p-<0.001); and sense of engagement by 1.03 points (SD=1.08, p<0.001). Additionally, drug coverage increased in all five communes during the 2018 MDA.
Conclusions/Significance
Participatory stakeholder workshops during MDA planning can increase self-reported engagement of key personnel and may improve personnel performance and contribute to achievement of drug coverage targets. Microplanning success was supported by MDA results, with all communes achieving preset MDA coverage targets.
... This could lead to negative perceptions about the MDA program. Several studies reviewed [27][28][29], showed that the fear of the side effect of the drug contributes to non-acceptability and non-compliance with the MDA program. This leads to a solidified negative community knowledge and perception about the harm of the MDA drug leading to poor intervention outcomes. ...
... This leads to a solidified negative community knowledge and perception about the harm of the MDA drug leading to poor intervention outcomes. The implementers are required to understand this perception to address them during the education before the drug distribution [27][28][29]. ...
Background
Studies on Mass drug administration (MDA) in Ghana targeting various diseases, have mostly focused on factors that affect coverage and compliance to MDA with limited focus on evidence regarding awareness and community perception of the program. Therefore, this study sought to provide empirical evidence on the knowledge of onchocerciasis, and awareness of and participation in the MDA among community members.
Methods
A community-based cross-sectional survey was conducted from August to October 2019 in communities within the Atwima Nwabiagya North District, Ghana. Data was collected from 2,008 respondents. Bivariate and multivariate logistic regression analyses were performed to measure the associations between socio-demographics, having heard of onchocerciasis and its prevention, and levels of awareness of the MDA program.
Results
A total of 1268 respondents (63.2%) were aware of the MDA program. The majority ofMost respondents (74.4%) were of the view that the information given about the program was not enough and 45.4% of the respondents had no idea about the relevance of the MDA program. Respondents who had ever heard about onchocerciasis prevention and persons who had previously participated in the MDA program were more likely to be aware of the MDA program during implementation (AOR = 2.32; 95% CI 1.79–3.01 and AOR = 9.31; 95% CI 7.06–12.26, respectively).
Conclusions
We observed a significant association between being aware of MDA campaigns and knowledge of onchocerciasis and its preventive methods, and participation in previous MDA campaigns. We recommend intensification and improvement of prevention campaigns regarding the onchocerciasis MDA program as key to ensuring increased MDA program participation.
... These findings align with the assertion that MDA accelerates elimination of NTDs by reducing the number of infections [23]. These perceived positive impacts of MDA activities have previously been reported by community members in Indonesia [24] and Tanzania [25]. In addition, community members appreciated the distribution of drugs by the CDDs, but wished to be better informed when drugs are available for distribution. ...
Introduction
The success of mass drug administration (MDA) campaigns to control and eliminate neglected tropical diseases (NTDs) in Ghana depends, to a large extent, on the essential role community drug distributors (CDDs) play. This study aimed to investigate community’s perceptions of CDDs’ roles, impact of CDDs’ work, challenges faced by CDDs, and views on resources required to enhance CDDs’ work to sustain MDA campaigns.
Methods
A cross-sectional qualitative study employing the use of focus group discussions (FGDs) with community members and CDDs in selected NTD endemic communities together with individual interviews with district health officers (DHOs) was conducted. We interviewed 104 people aged 18 and over, purposively selected, through eight individual interviews, and 16 focus group discussions.
Results
Participants in the community FGDs noted that health education and the distribution of drugs were the main roles of CDDs. Participants also perceived that the work of CDDs had prevented the onset of NTDs, treated symptoms of NTDs, and generally reduced the incidence of infections. In the interviews with CDDs and DHOs, lack of cooperation/non-compliance by community members, demands by community members, lack of working resources and low financial motivation were mentioned as the main challenges to the work of CDDs. Moreover, the provision of logistics and financial motivation for CDDs were identified as factors that will enhance their work.
Conclusions
Incorporating more attractive schemes will incentivise CDDs to improve output. Addressing the challenges highlighted is an important step for the work of CDDS to be effective in controlling NTDs in difficult-to-access communities in Ghana.
... According to the study ndings, MDA's success is not only based on coverage; it also depends on a myriad of social factors such as demographics, perceptions, and beliefs in a community that in uence the reaction to program implementation either facilitating or undermining its uptake. This con rms the ndings of (Ahorlu et al., Njomo et al., 2020;Kisoka et al., 2016). The ndings indicate that part of the community understood the program's bene ts and perceived that the annual uptake of the drugs prevents the disease encouraging them to participate yearly. ...
... However, CDDs also acted as motivation and as a cue to action for taking the drugs. Apart from drug distribution, the CDDs in Chiraa worked as educators for the MDA program, which contrasts with the ndings made in (Kisoka et al., 2016), where CDDs portrayed little knowledge of the disease causation and its transmission. ...
Background
Mass drug administration (MDA) is a means of delivering safe and affordable essential evidence-based interventions based on the principles of preventive chemotherapy, where various populations or sub-population groups are offered treatment without individual diagnosis. Several communities have been provided with MDA (i.e., Ivermectin and Albendazole) with the aim of eliminating Lymphatic Filariasis (LF) from Ghana. Notwithstanding the administration of 13 rounds of MDA from 2005 to 2019, the prevalence of LF as at 2020 in some communities is still high. The aim of this study is to explored perceptions about MDA acceptance for LF in Ghanaian communities.
Methods
A qualitative research design using a descriptive phenomenology and narrative inquiry was used in the study to either purposively or randomly select community members, patients, and community drug distributors in 12 communities in the Bono region of Ghana. In-depth interviews and focus group discussions were used to collect data. Interviews were transcribed verbatim and analyzed using thematic analysis in NVivo 12 software.
Results
The results show that chronic clinical symptoms of LF influenced community members’ perception and acceptance of the MDA intervention. Also, community members perceived that the acceptability and uptake of the MDA intervention could be improved by including patients in the programme, carrying out continuous education, and engaging in social mobilization activities in the communities.
Conclusions
There is an urgent need to educate and engage communities with regard to the critical role MDA intervention can play to eliminate LF from Ghana.
... 13 , 19 Low participation has been linked to individual, societal and health system challenges. 13 Studies report that individuals with low knowledge about LF are more likely not to participate in MDA. 14 , 20 This study also found that those with inadequate knowledge had low participation in the MDA program. Nevertheless, the socioeconomic status of the community also determines the level of MDA acceptability. ...
... 22 , 23 The WHO recommends using the community-directed intervention (CDI) strategy to increase the acceptability and participation of the community in MDA against NTDs. 13 CDI emphasizes the use of influential community people like religious leaders, community leaders, community political leaders and traditional healers to increase the knowledge and acceptability of MDA against NTDs. 24 CDI requires the use of CDDs who are recruited by the program, trained and given the authority to distribute the drugs. ...
... The influential people and CDDs must be knowledgeable on LF, STHI and the MDA's usefulness to be able to educate the community and respond to questions when distributing the drugs. 13 The observed poor participation of the community in MDA implies poor training and understanding by the health trainers. Due to these observations, the CDI approach may need to be reassessed for its effectiveness in our settings. ...
Background:
Although the WHO has made an effort to ensure optimal participation of the community in mass drug administration (MDA) against lymphatic filariasis (LF) and soil-transmitted helminth infections (STHIs), studies are still reporting suboptimal coverage. This study assessed the knowledge and participation of the community in MDA against LF and SHTIs in Tanzania to provide updates on its acceptability.
Methods:
A cross-sectional study was conducted in Dar es Salaam from December 2021 to February 2022 among market vendors. The information regarding demographic characteristics, knowledge and participation in MDA was collected using a questionnaire. Statistical Package for Social science version 26 was used for data analysis.
Results:
More than half of the participants demonstrated an adequate level of knowledge of LF and STHI, 212 (50.8%) and 267 (64%), respectively. Only 286 (68.5%) reported having heard about MDA against LF and STHIs, out of which 119 (42%) had taken the medication. Of those who disagreed to participate in MDA, 20 (50%) claimed to fear the side effects of the medication.
Conclusions:
This study found that the community has average knowledge and poor participation in MDA against LF and STHIs. Community sensitization is recommended to increase the participation of the community.
... CDDs commented on the massive workload associated with distributing the medicines house-to-house and how physically exhausting this work could be. This finding is unsurprising, as CDDs in rural communities are often assigned large coverage areas and are required to walk kilometers to reach their assigned households, a finding documented elsewhere [41,42]. Some of the CDDs commented on the opportunity costs associated with participating in the program. ...
... Aside from potentially bolstering CDDs' resilience, community selection of CDDs has been previously emphasized as being vital for sustaining community support for MDA and shaping community participation in the intervention [54]. Despite the repeatedly demonstrated benefits and successes of community-directed treatment distribution, communities are not always engaged in the planning and shaping of MDA implementation or the selection of CDDs [41,42,52]. Efforts to re-engage communities in the selection process could have implications for the well-being of CDDs in Uganda. ...
Volunteer community drug distributors (CDDs) have been vital to progress made in the elimination of onchocerciasis and lymphatic filariasis; two neglected tropical diseases amenable to preventive chemotherapy (PC-NTDs). However, formative work in Côte d’Ivoire and Uganda revealed that CDDs can encounter considerable challenges during mass drug administration (MDA). CDDs must be resilient to overcome these challenges, yet little is known about their resilience. This mixed-methods study explored the resilience of CDDs in Côte d’Ivoire and Uganda. The characteristics and experiences of 248 CDDs involved in the 2018 MDAs in Côte d’Ivoire (N = 132) and Uganda (N = 116) were assessed using a micronarrative survey. Thematic analysis of CDDs’ micronarratives was used to identify challenges they encountered during MDA. Resilience was assessed using the Connor-Davidson Resilience Scale 25 (CD-RISC-25). Variables from the micronarrative survey found to be individually associated with mean CD-RISC-25 score (P
... Health worker motivation and attitudes toward implementation may also influence progress toward program goals. Health workers and CDDs who believed that MDA reduced LF in the community had a positive attitude toward implementing the LF-MDA programs (9,23). Motivating factors for CDDs include gaining communication skills, community recognition and incentives, and perceived reduction in disease burden (9). ...
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.
... Some health staff described that community members were often unable or unwilling to do this due to their level of income and/or socioeconomic status and so avoided the CDD. With the high incidence of extreme poverty in the communities receiving MDA and possible deterrence [29][30][31], this leads us to question the viability of such an approach on equity and efficiency grounds and a potential risk to the achievement of NTD targets on equitable access to healthcare [10] Our observations of CDDs during their MDA activities identified that two tasks accounted for a large proportion of their time, namely measuring and drug administration, and record-keeping and registration. However, qualitative findings indicated that transportation for CDDs was also a challenge, and they found it difficult to move within communities to distribute drugs. ...
... Recall bias is inherent in any study relying on household surveys, and this study is no exception. The recruitment of female CDDs was challenging due to fewer females acting as CDDs in the study communities because of preexisting gender norms, competing domestic priorities, and reduced literacy levels compared to their male counterparts [29,30]. We also faced capacity challenges that affected the quality of some of the data collected. ...
Background
Preventive chemotherapy delivered via mass drug administration (MDA) is essential for the control of neglected tropical diseases (NTDs), including lymphatic filariasis (LF), schistosomiasis and onchocerciasis. Successful MDA relies heavily on community drug distributor (CDD) volunteers as the interface between households and the health system. This study sought to document and analyse demand-side (households) and supply-side (health system) factors that affect MDA delivery in Liberia.
Methods
Working in two purposively selected counties, we conducted a household MDA access and adherence survey; a CDD survey to obtain information on direct and opportunity costs associated with MDA work; an observational survey of CDDs; and key informant surveys (KIS) with community-level health workers. Data from the CDD survey and Liberian minimum wage rates were used to calculate the opportunity cost of CDD participation per MDA round. The observational data were used to calculate the time spent on individual household-level tasks and CDD time costs per house visited. KIS data on the organisation and management of the MDA in the communities, and researcher reflections of open-ended survey responses were thematically analysed to identify key demand- and supply-side challenges.
Results
More respondents were aware of MDA than NTD in both counties. In Bong, 39% (103/261) of respondents reported taking the MDA tablet in the last round, with “not being informed” as the most important reason for non-adherence. In Maryland, 56% (147/263) reported taking MDA with “being absent” at the time of distribution being important for non-adherence. The mean cost per CDD of participating in the MDA round was −$11.90 (median $5.04, range −$169.62 to $30.00), and the mean time per household visited was 17.14 min which equates to a mean opportunity cost of $0.03 to $0.05 per household visited. Thematic analysis identified challenges, including shortages of and delays in medicine availability; CDD frustration over costs; reporting challenges; and household concerns about drug side effects.
Conclusions
Improved adherence to MDA and subsequent elimination of NTDs in Liberia would be supported by an improved medicine supply chain, financial compensation for CDDs, improved training, healthcare workforce strengthening, greater community involvement, capacity building, and community awareness.
Graphical Abstract
... Similarly, there are also reports that problems of low compliance to MDA for LF are more providerinitiated than by individual recipients' perceptions and practices. Several reports have highlighted implementation challenges in MDA for LF programmes [33][34][35][36]. ...
... This was because some health workers had to travel from far leading to a delayed starting and an early ending so as to ensure that there was enough time to travel back to their respective residences. This is in line with studies carried out in Kenya and Tanzania where the health workers cited the training duration as inadequate [43,34]. Reported training times of one day was inadequate and hurried to prepare CDDs with the knowledge of the disease and distribution needed to complete their task. ...
The Kenyan Ministry of Health and its partners through the Division of Vector-Borne and Neglected Tropical Diseases, is in charge of the Lymphatic Filariasis Mass Drug Administration programme. This is implemented through the national, county, and sub-county neglected tropical diseases coordinators. The current study sought to understand the roles, challenges faced and suggestions of how program performance can be improved by the community health extension workers, county and sub-county neglected tropical diseases coordinators. Two wards of the Kaloleni sub-county; Kilifi County were purposively selected. In 2015, Kaloleni and Kayafungo wards had a treatment coverage of 58% and 54% respectively; 62% and 39% respectively in 2016, all below the recommended minimum treatment coverage of 65%. Qualitative data was collected through sixteen in-depth interviews with community health extension workers and two semi-structured interviews with the county and sub-county neglected tropical diseases coordinators. Data were analysed by QSR NVIVO version 10 according to identified themes. The study results show the various roles in planning and implementation of the program include; supply chain management; health information education communication and records management; health workforce training and management, leadership and governance, and service delivery. Challenges faced included insufficiency of drugs supplied and information education communication materials, the inadequacy of community drug distributors selected and trained, poor facilitation for training and supervision of community drug distributors, limited duration of the mass drug administration,
... The observed acceptability to MDAs may have differed if this result was known. However, evidence of the substantial levels of acceptance to mass administrations of drugs for neglected tropical diseases, despite of their adverse events [30], as well as to other malaria preventative tools, suggest that antimalarial MDAs may still be acceptable to the communities despite not leading to the full interruption of the disease. Third, findings are based on self-reported information, both based on future expectations and recalled experience. ...
Background
This study aimed to capture the acceptability prior to, during and after the implementation of the first year of MDA rounds conducted under the Magude project, a malaria elimination project in southern Mozambique.
Methods
This was a mixed-methods study, consisting of focus group discussions (FGDs) prior to the implementation of MDA rounds (September 2015), non-participant observations (NPOs) conducted during the MDA rounds (November 2015 –beginning of February 2016), and semi-structured interviews (SSIs) after the second round (end of February 2016). Community leaders, women in reproductive age, general members of the community, traditional healers and health professionals were recruited to capture the opinions of all representing key members of the community. A generic outline of nodes and codes was designed to analyze FGDs and SSI separately. Qualitative and quantitative NPO information was analyzed following a content analysis approach.
Findings
222 participants took part in the FGDs (n = 154), and SSIs (n = 68); and 318 household visits during the MDA underwent NPOs. The community engagement campaign emerged throughout the study stages as a crucial factor for the acceptability of MDAs. Acceptability was also fostered by the community’s general will to cooperate in any government-led activity that would reduce malaria burden, the appropriate behavior and knowledge of field workers, or the fact that the intervention was available free of charge to all. Absenteeism of heads of households was identified as the main barrier for the success of the campaign. The most commonly reported factors that negatively affected acceptability were the fear of adverse events, rumors of deaths, being unable to drink alcohol while taking DHAp, or the fear to take DHAp while in anti-retroviral treatment. Pregnancy testing and malaria testing were generally well accepted by the community.
Conclusion
Magude’s community generally accepted the first and second antimalarial MDA rounds, and the procedures associated to the intervention. Future implementation of antimalarial MDAs in southern Mozambique should focus on locally adapted strategies that engage the community to minimize absenteeism and refusals to the intervention.
