Gender norms and mass deworming program access in Comé, Benin: A qualitative assessment of gender-associated opportunities and challenges to achieving high mass drug administration coverage

Rachel E Geyer,Parfait Houngbégnon,Abiguel Elijan,Léopold Codjo Wèkè,Elodie Yard,Félicien Chabi,Arianna Rubin Means,Euripide Avokpaho,Susan Graham,Comlanvi Innocent Togbevi,Moudachirou Ibikounlé,Amy Roll,Mira Emmanuel-Fabula,Judd L Walson,Adrian J F Luty,Serene A Joseph

doi:10.1371/journal.pntd.0008153

Abstract

The World Health Organization’s Neglected Tropical Disease Roadmap has accelerated progress towards eliminating select neglected tropical diseases (NTDs). This momentum has catalyzed research to determine the feasibility of interrupting transmission of soil-transmitted helminths (STH) using community-wide mass drug administration (MDA). This study aims to identify potential gender-specific facilitators and barriers to accessing and participating in community-wide STH MDA, with the goal of ensuring programs are equitable and maximize the probability of interrupting STH transmission. This research was conducted prior to the launch of community-wide MDA for STH in Comé, Benin. A total of 10 focus group discussions (FGDs) were conducted separately among 40 men, 38 women, and 15 community drug distributors (CDDs). Salient themes included: both men and women believe that community-wide MDA would reduce the financial burden associated with self-treatment, particularly for low income adults. Community members believe MDA should be packaged alongside water, sanitation, and other health services. Women feel past community-wide programs have been disorganized and are concerned these distributions will be similar. Women also expressed interest in increased engagement in the implementation of future community-based public health programs. Men often did not perceive themselves to be at great risk for STH infection and did not express a high demand for treatment. Finally, the barriers discussed by CDDs generally did not align with gender-specific concerns, but rather represented concerns shared by both genders. A door-to-door distribution strategy for STH MDA is preferred by women in this study, as this platform empowers women to participate as health decision makers for their family. In addition, involving women in planning and implementation of community-wide programs may help to increase treatment coverage and compliance.

Highlights

The World Health Organization (WHO) estimates that 1.5 billion people are infected with soil-transmitted helminths (STH) globally, including hookworm species (Necator americanus and Ancylostoma duodenale), roundworms (Ascaris lumbricoides), and whipworms (Trichuris trichiura) [1]
Our findings suggest that door-to-door community-wide mass drug administration (MDA) may improve MDA treatment coverage by increasing access but may empower women by facilitating increased decision making on behalf of their regarding who is treated and where
community drug distributors (CDDs) generally identified only barriers and facilitators to MDA that were shared by both genders and may require more training to ensure MDA programs are equitable and effectively engage all at risk populations

Summary

Introduction

The World Health Organization (WHO) estimates that 1.5 billion people are infected with soil-transmitted helminths (STH) globally, including hookworm species (Necator americanus and Ancylostoma duodenale), roundworms (Ascaris lumbricoides), and whipworms (Trichuris trichiura) [1]. Current WHO guidelines focus on the control of STH-associated morbidities, targeting empiric treatment to individuals who disproportionally experience them, including school and preschoolaged children and women of reproductive age [4,5]. The WHO Neglected Tropical Disease (NTD) Roadmap and London Declaration have accelerated progress toward eliminating selected NTDs, and formalized long-term disease-specific goals for other NTDs [7,8]. This political momentum has catalyzed research initiatives such as the DeWorm Project, which aims to determine the feasibility of interrupting STH transmission using a community-wide MDA platform [9]. Gender and other intersectional aspects of equity in healthcare access can influence treatment coverage and compliance and, in effect, may impact the probability of transmission interruption [10,11,12,13]

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Results

Discussion

Conclusion