Abstract
Mass drug administration (MDA) with antibiotics is a key component of the SAFE strategy for trachoma control. Guidelines recommend that where MDA is warranted the whole population be targeted with 80% considered the minimum acceptable coverage. In other countries, MDA is usually conducted by salaried Ministry of Health personnel (MOH). In Plateau State, Nigeria, the existing network of volunteer Community Directed Distributors (CDD) was used for the first trachoma MDA. We conducted a population-based cluster random survey (CRS) of MDA participation to determine the true coverage and compared this to coverage reported from CDD registers. We surveyed 1,791 people from 352 randomly selected households in 24 clusters in three districts in Plateau State in January 2011, following the implementation of MDA. Households were enumerated and all individuals present were asked about MDA participation. Household heads were questioned about household-level characteristics and predictors of participation. Individual responses were compared with the CDD registers. MDA coverage was estimated as 60.3% (95% CI 47.9–73.8%) by the survey compared with 75.8% from administrative program reports. CDD registration books for comparison with responses were available in 19 of the 24 clusters; there was a match for 658/682 (96%) of verifiable responses. CDD registers did not list 481 (41.3%) of the individuals surveyed. Gender and age were not associated with individual participation. Overall MDA coverage was lower than the minimum 80% target. The observed discrepancy between the administrative coverage estimate from program reports and the CRS was largely due to identification of communities missed by the MDA and not reported in the registers. CRS for evaluation of MDA provides a useful additional monitoring tool to CDD registers. These data support modification of distributor training and MDA delivery to increase coverage in subsequent rounds of MDA.
Highlights
Trachoma, caused by infection with the bacterium Chlamydia trachomatis, is the leading cause of infectious blindness worldwide [1,2]
The World Health Organization recommends that mass drug administration for trachoma control reach a minimum of 80% of the target population
Previous evaluations of Mass drug administration (MDA) coverage have demonstrated that administrative reports can bias coverage estimates
Summary
Trachoma, caused by infection with the bacterium Chlamydia trachomatis, is the leading cause of infectious blindness worldwide [1,2]. Where trachoma is a public health problem, the World Health Organization (WHO) recommends the implementation of the full SAFE Strategy (Surgery, Antibiotic Therapy, Facial Cleanliness and Environmental Change). If the prevalence of clinical trachoma (grade trachomatous inflammation, follicular, known as ‘‘TF’’) exceeds 10% among children one to nine years of age, mass distribution of antibiotics is warranted at the district level (defined as an administrative unit of approximately 150,000– 250,000 persons). District-wide antibiotic distribution is implemented annually until the program reduces the prevalence of clinical signs of trachoma among children to below 10% [3]
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