Abstract
BackgroundThe most prevalent neglected tropical diseases are treated through blanket drug distribution that is reliant on lay community medicine distributors (CMDs). Yet, treatment rates achieved by CMDs vary widely and it is not known which CMDs treat the most people.MethodsIn Mayuge District, Uganda, we tracked 6779 individuals (aged 1+ years) in 1238 households across 31 villages. Routine, community-based mass drug administration (MDA) was implemented for schistosomiasis, lymphatic filariasis, and soil-transmitted helminths. For each CMD, the percentage of eligible individuals treated (offered and ingested medicines) with at least one drug of praziquantel, albendazole, or ivermectin was examined. CMD attributes (more than 25) were measured, ranging from altruistic tendencies to socioeconomic characteristics to MDA-specific variables. The predictors of treatment rates achieved by CMDs were selected with least absolute shrinkage and selection operators and then analyzed in ordinary least squares regression with standard errors clustered by village. The influences of participant compliance and the ordering of drugs offered also were examined for the treatment rates achieved by CMDs.ResultsOverall, only 44.89% (3043/6779) of eligible individuals were treated with at least one drug. Treatment rates varied amongst CMDs from 0% to 84.25%. Treatment rate increases were associated (p value< 0.05) with CMDs who displayed altruistic biases towards their friends (13.88%), had friends who helped with MDA (8.43%), were male (11.96%), worked as fishermen/fishmongers (14.93%), and used protected drinking water sources (13.43%). Only 0.24% (16/6779) of all eligible individuals were noncompliant by refusing to ingest all offered drugs. Distributing praziquantel first was strongly, positively correlated (p value < 0.0001) with treatment rates for albendazole and ivermectin.ConclusionsThese findings profile CMDs who treat the most people during routine MDA. Criteria currently used to select CMDs—community-wide meetings, educational attainment, age, years as a CMD, etc.—were uninformative. Participant noncompliance and the provision of praziquantel before albendazole and ivermectin did not negatively impact treatment rates achieved by CMDs. Engaging CMD friend groups with MDA, selecting CMDs who practise good preventative health behaviours, and including CMDs with high-risk occupations for endemic infections may improve MDA treatment rates. Evidence-based guidelines are needed to improve the monitoring, selection, and replacement of CMDs during MDA.
Highlights
The most prevalent neglected tropical diseases are treated through blanket drug distribution that is reliant on lay community medicine distributors (CMDs)
Chami et al BMC Medicine (2019) 17:69 (Continued from previous page). These findings profile CMDs who treat the most people during routine mass drug administration (MDA)
Participant noncompliance and the provision of praziquantel before albendazole and ivermectin did not negatively impact treatment rates achieved by CMDs
Summary
In Mayuge District, Uganda, we tracked 6779 individuals (aged 1+ years) in 1238 households across 31 villages. The influences of participant compliance and the ordering of drugs offered were examined for the treatment rates achieved by CMDs. Study area and MDA tracking Routine MDA was tracked from mid-July to mid-August in 2016 for 31 villages with an estimated 41,582 people eligible for treatment (Additional file 1: supplementary methods). The same vector control officers and one district health officer oversaw the study villages and were responsible for the training and monitoring of CMDs. The sub-counties were chosen based on (1) current eligibility for the routine round of MDA studied here, (2) ongoing distribution of the same set of drugs during MDA, (3) ongoing implementation of community-based MDA, and (4) having had the same number of previous rounds of MDA [17]. Prevalence of lymphatic filariasis in the study area is less than 5% [21]
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