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Profiling Nonrecipients of Mass Drug Administration for Schistosomiasis and Hookworm Infections: A Comprehensive Analysis of Praziquantel and Albendazole Coverage in Community-Directed Treatment in Uganda.


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Authors

Chami, Goylette F 
Kontoleon, Andreas A 
Bulte, Erwin 
Fenwick, Alan 
Kabatereine, Narcis B 

Abstract

BACKGROUND: Repeated mass drug administration (MDA) with preventive chemotherapies is the mainstay of morbidity control for schistosomiasis and soil-transmitted helminths, yet the World Health Organization recently reported that less than one-third of individuals who required preventive chemotherapies received treatment. METHODS: Coverage of community-directed treatment with praziquantel (PZQ) and albendazole (ALB) was analyzed in 17 villages of Mayuge District, Uganda. National drug registers, household questionnaires, and parasitological surveys were collected to track 935 individuals before and after MDA. Multilevel logistic regressions, including household and village effects, were specified with a comprehensive set of socioeconomic and parasitological variables. The factors predicting who did not receive PZQ and ALB from community medicine distributors were identified. RESULTS: Drug receipt was correlated among members within a household, and nonrecipients of PZQ or ALB were profiled by household-level socioeconomic factors. Individuals were less likely to receive either PZQ or ALB if they had a Muslim household head or low home quality, belonged to the minority tribe, or had settled for more years in their village. Untreated individuals were also more likely to belong to households that did not purify drinking water, had no home latrine, and had no members who were part of the village government. CONCLUSIONS: The findings demonstrate how to locate and target individuals who are not treated in MDA. Infection risk factors were not informative. In particular, age, gender, and occupation were unable to identify non-recipients, although World Health Organization guidelines rely on these factors. Individuals of low socioeconomic status, minority religions, and minority tribes can be targeted to expand MDA coverage.

Description

Keywords

coverage, mass drug administration, schistosomiasis, soil-transmitted helminths, sub-Saharan Africa, Adolescent, Adult, Albendazole, Animals, Anthelmintics, Chemoprevention, Child, Disease Transmission, Infectious, Female, Hookworm Infections, Humans, Male, Medication Adherence, Population Groups, Praziquantel, Rural Population, Schistosomiasis, Uganda

Journal Title

Clin Infect Dis

Conference Name

Journal ISSN

1058-4838
1537-6591

Volume Title

62

Publisher

Oxford University Press (OUP)
Sponsorship
Wellcome Trust (083931/Z/07/Z)
Isaac Newton Trust (MINUTE 1540(v))
Imperial College London
Wellcome Trust (100891/Z/13/Z)
This work was supported by the Vice Chancellor’s Fund of the University of Cambridge, the Schistosomiasis Control Initiative, the Wellcome Trust (Programme grant 083931/Z/07/Z to D.W.D), and the Netherlands Organization for Scientific Research (N.W.O. grant 452-04-333 to E.B.).