Districts In Malawi Research Articles

Assessing language barriers in health facilities in Malawi

BackgroundLanguage barriers in healthcare lead to miscommunication between professionals and patients, thereby reducing the quality of and equitable access to healthcare. In African countries, the recognition and formal study of these barriers is severely limited despite Africa having more languages than any other continent. Our study investigates language barriers in healthcare facilities in Zomba district in Malawi, where three major local languages are spoken.MethodsWe employed a mixed methods approach and conducted a questionnaire-led study. Data were gathered at 22 health facilities, from 79 healthcare professionals and 312 outpatients using a semi-structured questionnaire. Findings were corroborated using document analysis to review legislation and policies, curriculum documents and patient notes.ResultsLanguage discordance emerged as a problem for professionals and patients. Both faced challenges due to vocabulary limitations for medical terms in English and Chichewa. Professionals did not receive training on how to effectively communicate medical concepts in local languages. Most patients did not speak English, which was used for all written records. Patient understanding of the information given to them verbally during consultations or in written health notes was very low, and this diminished their confidence in the diagnosis or treatment they received. Social factors including gender, age or patient experience, as well as patient literacy or perceived low literacy, poor rapport between healthcare professionals and patients, and a lack of privacy during consultations all exacerbated communication issues. Consequences of language barriers included unsatisfactory care experiences and compromised exchanges of health information. Strategies used by professionals to cope with these challenges were flexibility in the choice of language, reliance on physical checks and non-verbal communication indicators and the occasional use of ad-hoc interpretations.ConclusionLanguage barriers in healthcare facilities in Malawi have serious implications on the quality of healthcare provided. We propose solutions such as the development of dictionaries with phrases for symptoms and conditions, sensitisation courses that incorporate language considerations for both professionals and patients. Policies such as the provision of interpreters and staff allocation are discussed. We recognise that coordinated efforts at national and international levels are key to securing significant funding for effective interventions.

Surveillance of Excess Mortality Based on Community Perceptions of Funeral Frequency in Northern Malawi during the COVID-19 Pandemic.

Supplementary methods of mortality surveillance are needed in settings with incomplete death registration. Local perceptions of mortality levels might be useful indicators of excess deaths. Early in the COVID-19 pandemic, we developed a survey question asking respondents to evaluate the recent frequency of funerals in their community relative to a pre-pandemic baseline. We asked this question of more than 400 residents of Karonga district in Malawi, who were interviewed up to five times during a panel survey conducted by mobile phone between June 2020 and May 2021. The proportion of respondents reporting more funerals than usual in their community increased in early 2021, indicating excess mortality not otherwise detected by case-based surveillance and only partially visible in reports of inpatient deaths at health facilities. Systems assessing changes in perceptions of mortality can be rapidly established during an epidemic and may help detect excess deaths at local levels.

Understanding Crop Diversification Among Smallholder Farmers: Socioeconomic Insights from Central Malawi

In Eastern and Southern Africa (ESA), smallholder rain-fed systems are vital, yet they are challenged by land degradation, soil fertility decline, and climate risks. To address these challenges, crop diversification has been promoted as a potential pathway to enhance productivity, improve nutritional security, and offer a viable pathway out of poverty and hunger. This study explores crop diversification among 150 smallholder households in the Kasungu, Mchinji, and Lilongwe districts of Malawi, where the project Sustainable Intensification of Maize Legume Systems in East and Southern Africa (SIMLESA) has engaged the smallholder farmers in conservation agriculture (CA)-based sustainable intensification participatory research and development for seven years since 2010. This study used Simpson’s diversity index (SDI) to estimate crop diversification, and a multiple linear regression model (MLRM) to analyze how smallholder farmers’ socio-economic characteristics influence adoption. The findings show a prevalence of small farms of less than 1.5 hectares, with most farmers perceiving crop diversification as beneficial for soil fertility. Key adoption constraints include labor shortages and a lack of legume seeds. SIMLESA participants lead in crop rotations, with a 63% higher adoption rate, and show the highest crop diversity, with a 99% increase in farmers growing three crops and a 74% increase in those growing four crops compared to non-SIMLESA farmers. The SDI values were 0.39 for non-SIMLESA, 0.48 for SIMLESA neighbors, and 0.57 for SIMLESA participants. Access to NGO inputs, larger farm sizes, and participation in research programs were positively associated with diversification, while food insufficiency was negatively associated with its adoption. The study highlights the importance of integrating participatory research methods to promote development initiatives effectively.

"Kuteteza": A community-engaged COVID-19 Prevention and Protection Initiative in Southern Malawi.

The COVID-19 epidemic in Malawi involved almost 90,000 recorded cases and 2,638 deaths. In response to early concerns about vulnerable older people in rural areas, we developed 'Kuteteza': a COVID-19 mitigation response project. Clinicians, public health professionals, and researchers collaborated with government and district-level staff in two Southern Malawi districts. Interventions included supported 'shielding' of older people - minimising social mixing whilst having their daily needs supported. Additional mitigation strategies included provision of masks, handwashing stations, and soap. Government partnerships allowed additional support for vulnerable groups. We present the findings of a realist project evaluation, assessing the feasibility of this approach. We collated anonymised descriptive data on Kuteteza procedures and conducted qualitative structured observations in villages involved in the initiative. We carried out three focus groups involving community members, frontline health staff, and volunteers in each setting. These provided deeper insights into experiences of the pandemic and impacts of the intervention, including suggested opportunities during future outbreaks. The project involved 25 villages across two districts, with 1,087 people over the age of 60 voluntarily participating in 'shielding'. Supplies of food, water, and cooking fuel were mostly arranged within the family. In Kuteteza villages, the handwashing stations and soap were widely used, and there was awareness and some observance of COVID-19 prevention measures. The project, including the provision of supplies, was greatly appreciated by communities, but wider contextual constraints - namely widespread economic insecurity - presented persisting challenges. Suggestions for improvement largely concerned project enhancements and extensions. Through effective stakeholder engagement and contribution to national response strategy, the Kuteteza project helped raise COVID-19 awareness and supported populations at a critical time in the pandemic. Kuteteza approaches were welcomed locally and may be incorporated in future epidemic responses. Supported 'shielding' should be paired with government-led measures to mitigate economic hardship.

"Life mapping" exploring the lived experience of COVID-19 on access to HIV treatment and care in Malawi

Background The COVID-19 pandemic in Malawi exacerbated, existing public health challenges including access to HIV treatment and care services. “Life Mapping,” a component of the Citizen Science community-led project in Malawi, documented the lived experiences and perspectives of people living with HIV in the context of COVID-19. Methods Citizen Science Life Maps is a three-year qualitative, longitudinal project utilizing collaborative and participatory research methods through digital storytelling to document peoples’ daily lives. Twenty participants living with HIV were recruited between 2022 and 2023 in two central regional districts of Malawi and two urban areas. The participants were given mobile smart phones to document the impact of COVID-19 on HIV prevention and treatment services, HIV treatment literacy, mental health and the COVID -19 vaccine. Data was analyzed using a thematic analysis approach. Results Access to HIV prevention and treatment slowly recovered yet introducing multi-month anti- retroviral dispensing raised concerns. In the absence of mental health care services, participants were resourceful in seeking alternative ways to deal with mental health. However, state sponsored violence in relation to COVID-19 public health measures impacted negatively not only on mental well-being but also on HIV treatment adherence. Whilst most recognized the importance of the COVID-19 vaccine, especially for people living with HIV, myths, misinformation, and conspiracy theories around the vaccine persisted especially religious themed misinformation. Conclusions The relationship between misinformation and COVID-19 vaccine hesitancy is complex and medical and scientific approaches may not be sufficient to prevent misinformation. Fear and misinformation are likely attributed to global uncertainty during the pandemic and the speed at which vaccines were developed with minimal opportunity to prepare global communities.

Cultural determinants of COVID-19 vaccines misinformation in Malawi

This study investigates how global misinformation and local cultural factors shape public perceptions of COVID-19 in Malawi. While misinformation about the pandemic often originates from global sources like the Internet and social media, its impact is influenced by religious and cultural narratives that resonate differently across various demographics, including gender. These ‘cultural determinants’ amplify the influence of misinformation, leading to widespread vaccine hesitancy. The paper draws on findings from a study conducted in the Malawian districts of Zomba, Dowa, and Nkhata Bay. The study reveals how religious prophecies and apocalyptic symbols, such as the ‘666’ mentioned in the biblical Book of Revelation, are used to frame vaccines as malevolent, distorting public understanding and fuelling fears about COVID-19. The role of social media in spreading misinformation is particularly significant, given its ability to quickly disseminate content and engage users as both consumers and creators of information. Despite limited internet access in Malawi, misinformation spreads effectively through offline spaces, where cultural beliefs and mistrust in political leaders further propagate it. This study highlights the need for culturally sensitive public health communication strategies to address the fears and beliefs that drive misinformation and vaccine hesitancy in Malawi and similar contexts. Although misinformation and vaccine hesitancy are global challenges, the study highlights that misinformation in Malawi is culturally specific, localised, and appeals to fears, with distinct resonance across the male-female gender divide.

Simulation Model for a Sustainable Food Supply Chain in a Developing Country: A Case Study of the Banana Supply Chain in Malawi

Background: Sustainability in food supply chains is desired for production, logistics, and waste management. However, food supply chains (SCs) have complex systems that differ from other SCs. Managing such complexities is challenging for small and medium-sized enterprises (SMEs) due to their heightened constraints, such as limited resources and inadequate awareness. Despite the challenges, there is fragmented research, understanding, and approaches to assist SMEs. SC designs need to be adapted so that SMEs can navigate the challenges and avert high wastage. The main objective of this research was to identify the practices influencing sustainable SC designs in a developing country and create a simulation model to illustrate the potential benefits and challenges of promoting sustainability in the banana SC in Malawi. Methods: Mixed-methods research was utilised, employing a literature review, participant interviews, observations, and survey data collected from 353 participants from three districts in Malawi to gain insight into the banana SC problem, establish objectives, and develop a simulation model complemented by design science research. Results: The research identified awareness, collaboration, efficiency, governance, knowledge sharing, and resilience as sustainability practices in the case study banana SC, thus forming a sustainability model. Simulation results showed improvements in key performance indicators like shelf-life, lead-time, quality, throughput, and waste through SC operation reorganisation. Conclusions: Sustainable models must be tailored to the specific challenges inherent in developing food supply chains in developing nations. The development of the models has significant managerial implications, notably enhancing strategic planning, operational efficiency, risk management, alignment of sustainability goals, performance monitoring, stakeholder engagement, and resource optimisation.

Community Knowledge and Attitude on Community Led Total Sanitation after Open Defecation-Free Certification of Balaka District in Malawi

Community Knowledge and Attitude on Community Led Total Sanitation after Open Defecation-Free Certification of Balaka District in Malawi

Solar energy feasibility for power generation in lower shire districts: A case study of Chikwawa District

Background: Electricity availability is an essential part of both economic and non-economic activities in any country. Malawi being one of the developing nations experiences a lot of challenges both in its economic and non-economic activities due to unlimited levels of electric supply in its country. This inadequacy of limited supply has remained a challenge for a longer period of time to the effect that the country Malawi for a longer period of time has an overwhelming record of blackouts and load shedding. Consequently, this has affected in a negative way the economic activities of this nation such as low productivity in the production of goods and services making livelihood a difficult. Similarly, noneconomic activities such social interactions seem to be challenging due to lack of electricity. In this regard an investigation in determining new innovations towards electricity production remained one of the most important aspects in this county of Malawi. Method: This study was conducted in Chikwawa district, Malawi, to assess the feasibility of solar energy production. The methods used include temporal variability, correlation, trend, and spatial analysis to assess solar radiation, sunshine hours, and their distribution in the area. Result: As a result, the study was established with the purpose to assess feasible regions within the country of Malawi to innovate solar energy production to boost high levels of solar energy production. This study was conducted in the lower shire district and to be specific in Chikwawa district. The objectives of the feasibility in Chikwawa district included; assessing solar radiation and sunshine hours towards solar energy production, the spatial distribution of solar radiation and sunshine hours towards solar energy production, the trend of sunshine and solar radiation towards solar production and at the end to map the areas in Chikwawa District where solar energy production could be harnessed. Through the use of temporal variability, correlation analysis, trend analysis, and spatial analysis, the findings of this investigation established that harnessing solar energy is much more possible in areas of the lower shire which is the among others include Chikwawa district of Malawi as most areas currently in this region has less places with solar energy production but with high availability of solar radiation. Conclusion: For the fact that the findings reveal more feasible places to establish solar energy production, this study recommends commitment by government and private sector to greatly establish solar energy production units in this area whilst focusing on identifying other potential areas where solar energy production can be harnessed in Malawi. In this regard, this exposition has achieved its purpose of fostering renewable energy production through innovating and investing in solar energy production. Novelty/Originality of this study: This detailed spatial and temporal analysis study has identified optimal locations for solar energy production, providing a new approach to renewable energy planning in developing countries.

Evaluating the role that Care Groups play in providing breastfeeding and infant feeding support at community level: a qualitative study in Dedza district in Malawi

Background Promoting exclusive breastfeeding is a key nutrition policy objective in Malawi. This study assesses the role that Care Group Volunteers (CGVs) play in providing breastfeeding and infant feeding support at community level. Care Groups are a peer-to-peer learning approach, which has been part of Malawi’s nutrition policy since 2012, its role within community-level nutrition support remains under-researched. Methods In July 2021, we conducted 60 qualitative semi structured interviews in Dedza District with village leaders, Health Surveillance Assistants (HSAs), CGVs and district health officials, mothers with at least one child under two (n=36) who were purposively selected. All interviews were recorded, transcribed and translated into English and then analysed using qualitative data analysis software. Thematic analysis was used to elicit key themes. Results Only eight out of 36 women reported receiving breastfeeding support from care groups. All mothers reported receiving breastfeeding support at the health facility where they delivered their baby(ies) and some (n=24) also at ante-natal care clinics. In total, 18 interviewees reported interacting with the Care Groups, mostly during cooking demonstrations or receiving home visits. Little interaction was observed by interviewees between HSAs and CGVs and no evidence suggested coordination between HSAs and CGVs around (vulnerable) newborn baby visits, as described by one HSA. Conclusions This research shows that Care Groups, despite being well-known, remain an under-appreciated and un-integrated volunteer cadre. Policy reform in relation to Care Groups in Malawi is needed to improve volunteer engagement regarding breastfeeding and overall support of newborns and vulnerable infants.

Determinants of teenage pregnancy in Malawi: a community-based case-control study

BackgroundTeenage pregnancies are a global concern. Malawi is one of the countries with the highest teenage pregnancy rates despite government efforts to reverse the situation and yet studies on determinants of teenage pregnancy are rare with some factors remaining unexplored. Therefore, this study aimed to identify factors associated with teenage pregnancies in Malawi.MethodsThis was a community-based case-control study that used secondary data from the 2015-16 Malawi Demographic and Health Survey from all 28 districts of Malawi. The study population comprised women aged 20–24 who participated in the survey. The study ran from September 2021 to October 2022 and used a sample size of 3,435 participants who were all women aged 20–24 in the dataset who met the inclusion criteria. Data were analysed using Stata 16 software. Logistic regression analyses were used to determine factors. Variables with a P value of < 0.1 in the univariable analysis were included in the multivariable analyses, where statistical significance was obtained at a P value < 0. 05.ResultsData on 3435 participants were analysed. In multivariable analyses: no teenage marriage (AOR 0.13); secondary education (AOR 0.26); higher education (AOR 0.39); richest category of wealth index (AOR 0.51), use of contraception (AOR 3.08), domestic violence by father or mother (AOR 0.37) were found to be significant factors.ConclusionThis study identified determinants of teenage pregnancy. The government has to sustain and expand initiatives that increase protection from teenage pregnancy, reinforce the implementation of amended marriage legislation, introduce policies to improve the socioeconomic status of vulnerable girls and increase contraceptive use among adolescent girls before their first pregnancy. Further research is also recommended to resolve inconclusive results.

Improving healthcare delivery at a district hospital through teaching interns - A short report.

Every district in Malawi has at least two doctors managing the social and healthcare needs of the local population. The medical doctors at the district are involved in administrative work and have minimal time for clinical practice. As such in most district hospitals, clinical officers (COs) form the backbone of patient care provision. These are cadres that have a 3-year training in clinical medicine; they work side by side with medical assistants (MAs) and nurses. Apart from the Ministry of Health (MoH) workforce, the Department of Family Medicine (FM) of Kamuzu University of Health Sciences (KUHeS) has its main district site at Mangochi. Family physicians and residents from FM department assist in provision of mentorship and teaching to other cadres. Work-based learning requires various strategies and approaches. The experience reported here involves deliberate mentorship and support to enhance the learning of other cadres. Family medicine residents learn through the active participation in these sessions to become future consultants and leaders in primary health care.

Impact of four years of annually repeated indoor residual spraying (IRS) with Actellic 300CS on routinely reported malaria cases in an agricultural setting in Malawi.

Indoor residual spraying (IRS) is one of the main vector control tools used in malaria prevention. This study evaluates IRS in the context of a privately run campaign conducted across a low-lying, irrigated, sugarcane estate from Illovo Sugar, in the Chikwawa district of Malawi. The effect of Actellic 300CS annual spraying over four years (2015-2018) was assessed using a negative binomial mixed effects model, in an area where pyrethroid resistance has previously been identified. With an unadjusted incidence rate ratio (IRR) of 0.38 (95% CI: 0.32-0.45) and an adjusted IRR of 0.50 (95% CI: 0.42-0.59), IRS has significantly contributed to a reduction in case incidence rates at Illovo, as compared to control clinics and time points outside of the six month protective period. This study shows how the consistency of a privately run IRS campaign can improve the health of employees. More research is needed on the duration of protection and optimal timing of IRS programmes.

Analysis of factors influencing market participation among orange‐fleshed sweet potato smallholder farmers in southern region of Malawi: A case of RTC project

AbstractAgricultural markets remain major issue downgrading root and tuber crop farmers who form the mainstream of the agricultural producers in Malawi. Recent evidence however reveals that orange‐fleshed sweet potato (OFSP) (Ipomea batatas) is currently being sold in produce markets along with the non‐orange varieties, sometimes in differentiated form in Malawi. The main objective of this study was to examine factors affecting market participation of sweet potato farmers in southern region of Malawi. Using a double‐hurdle model, this paper analyzed both the factors affecting farmer decision to participate and the extent/intensity of participation in market. The first tier of the double hurdle focused on decision to participate in the market using probit model and the second tier addressed factors affecting intensity of participation using truncated normal regression model. The paper used data collected from 360 farmers in southern districts of Malawi. Out of 360, 146 farmers had grown OFSP in the season preceding the survey. Double hurdle results indicate that farm size, output, age of a farmer (household head), and early maturing trait significantly determined decision to participate in the market. Further, results on intensity of participation indicate that access to market training, farm size, asset value, and output positively determined the intensity and negatively determined by distance to main market and gender of a farmer (household head). Based on the research findings, higher output levels and early maturing trait were found to increase smallholder farmer market participation. It is therefore recommended that strategies aimed at increasing household capacity to produce surplus produce through market tailored extension messages and productivity enhancement technologies could be highly effective in fostering smallholders' participation in commercial markets. Again, enhanced capacity building of research institutions to breed sweet potato varieties based on market demand is pivotal for increased market participation. Furthermore, research suggests that improving smallholder farmers' access to market price information, asset value, and farm size can help increase their intensity in the market. Therefore, it is critical for policymakers to holistically comprehend these socioeconomic factors in order to address the issue of smallholder farm households' decisions about market participation and the degree to which they participate.

“Kuteteza”: A community-engaged COVID-19 Prevention and Protection Initiative in Southern Malawi

Background The COVID-19 epidemic in Malawi involved almost 90,000 recorded cases and 2,638 deaths. Data suggest that the Malawi epidemic developed largely in urban settings, but the extent of rural spread – exposing older adults in particular – is unclear. This concern led us, to develop the ‘Kuteteza’ partnership project: a community-based Public Health intervention involving the shielding of older adults and additional strategies to mitigate COVID-19 impacts in rural Malawi. We now present the results of a realist project evaluation. Methods Clinicians, Public Health professionals, and researchers collaborated with government and district level staff in two Malawi districts. After engagement with local structures, willing older adults (&gt;60 years) and their communities made arrangements for supported 'shielding'. Masks, handwashing stations, and soap were also provided, and government partnerships allowed additional support for vulnerable groups. Finally, context-responsive community engagement reinforced COVID-19 prevention during peak risk periods. Our realist evaluation included collation of anonymised descriptive data and qualitative structured observations and focus groups – involving community members and volunteers – in each setting. Results The project involved 25 villages. Multi-level stakeholder engagement was pivotal in developing and establishing the work, and strong District Health Office support was integral to implementation. Team members contributed to national meetings, aligning the project with national guidance and stakeholder actions. Established partnerships with relevant ministries resulted in the incorporation of shielding in the Malawi COVID-19 response plan. In Kuteteza villages, handwashing stations and soap were used, and there was awareness of COVID-19 prevention measures. Further experiences and evaluation results are presented, including learning points for future outbreak responses. Conclusions Through effective stakeholder engagement and contribution to national response strategy, the Kuteteza project raised awareness and supported populations at a critical time in the pandemic. These approaches can be incorporated in future epidemic and emergency responses.

Analyses of drinking water quality during a protracted cholera epidemic in Malawi - a cross-sectional study of key physicochemical and microbiological parameters.

Anecdotal evidence and available literature indicated that contaminated water played a major role in spreading the prolonged cholera epidemic in Malawi from 2022 to 2023. This study assessed drinking water quality in 17 cholera-affected Malawi districts from February to April 2023. Six hundred and thirty-three records were analysed. The median counts/100 ml for thermotolerant coliform was 98 (interquartile range (IQR): 4-100) and that for Escherichia coli was 0 (IQR: 0-9). The drinking water in all (except one) districts was contaminated by thermotolerant coliform, while six districts had their drinking water sources contaminated by E. coli. The percentage of contaminated drinking water sources was significantly higher in shallow unprotected wells (80.0% for E. coli and 95.0% for thermotolerant coliform) and in households (55.8% for E. coli and 86.0% for thermotolerant coliform). Logistic regression showed that household water has three times more risk of being contaminated by E. coli and two and a half times more risk of being contaminated by thermotolerant coliform compared to other water sources. This study demonstrated widespread contamination of drinking water sources during a cholera epidemic in Malawi, which may be the plausible reason for the protracted nature of the epidemic.

Using community-based, participatory qualitative research to identify determinants of routine vaccination drop-out for children under 2 in Lilongwe and Mzimba North Districts, Malawi

ObjectiveIn recent years, full childhood routine immunisation coverage has fallen by 5% to levels not seen since 2008; between 2019 and 2021, 67 million children were undervaccinated. We aimed to...

Characteristics of Patients Diagnosed with Tuberculosis in a Rural District of Malawi: A Retrospective Analysis of Secondary Data

Characteristics of Patients Diagnosed with Tuberculosis in a Rural District of Malawi: A Retrospective Analysis of Secondary Data

Gender and livelihood assets: Assessing climate change resilience in Phalombe district – Malawi

Access and use of livelihood assets are pertinent to recovery from impacts of climate change for rural households. This study investigated role of livelihood assets to recovery from the impacts of climate change for male and female headed households in Phalombe district in Malawi. Using exploratory sequential mixed methods design, qualitative data was collected using Participant Observation coupled with interviews in two successive phases. Quantitative data was collected using household questionnaire involving 217 households. Results show that erratic rainfall and floods are the main impacts of climate change in the study area. Male headed households have better access to human, financial and natural assets compared to female headed households. There is no significant difference on the recovery period from erratic rainfall for either type of household, but male headed households recover much more quickly from floods than female headed households. Results show that social assets are key to recovery from both erratic rainfall and floods for both male and female headed households. Natural assets contribute to recovery from erratic rainfall for male headed households while human assets are important for female headed households. Human assets are vital for recovery from floods for both male and female headed households while physical assets are important for male headed households. The study shows that enhancing social capital and developing human assets especially for female headed households can significantly contribute towards resilience to the impacts of climate change.

Mass drug administration campaigns: comparing two approaches for schistosomiasis and soil-transmitted helminths prevention and control in selected Southern Malawi districts

BackgroundMass drug administration is one of the key interventions recommended by WHO to control certain NTDs. With most support from donors, health workers distribute antihelminthic drugs annually in Malawi. Mean community coverage of MDA from 2018 to 2020 was high at 87% for praziquantel and 82% for albendazole. However, once donor support diminishes sustaining these levels will be challenging. This study intended to compare the use of the community-directed intervention approach with the standard practice of using health workers in delivery of MDA campaigns.MethodsThis was a controlled implementation study carried out in three districts, where four health centres and 16 villages in each district were selected and randomly assigned to intervention and control arms which implemented MDA campaigns using the CDI approach and the standard practice, respectively. Cross-sectional and mixed methods approach to data collection was used focusing on quantitative data for coverage and knowledge levels and qualitative data to assess perceptions of health providers and beneficiaries at baseline and follow-up assessments. Quantitative and qualitative data were analyzed using IBM SPSS software version 26 and NVivo 12 for Windows, respectively.ResultsAt follow-up, knowledge levels increased, majority of the respondents were more knowledgeable about what schistosomiasis was (41%-44%), its causes (41%-44%) and what STH were (48%-64%), while knowledge on intermediate host for schistosomiasis (19%-22%), its types (9%-13%) and what causes STH (15%-16%) were less known both in intervention and control arm communities. High coverage rates for praziquantel were registered in intervention (83%-89%) and control (86%-89%) communities, intervention (59%-79) and control (53%-86%) schools. Costs for implementation of the study indicated that the intervention arm used more resources than the control arm. Health workers and community members perceived the use of the CDI approach as a good initiative and more favorable over the standard practice.ConclusionsThe use of the CDI in delivery of MDA campaigns against schistosomiasis and STH appears feasible, retains high coverages and is acceptable in intervention communities. Despite the initial high costs incurred, embedding into community delivery platforms could be considered as a possible way forward addressing the sustainability concern when current donor support wanes.Trial registrationPan-African Clinical Trials Registry PACTR202102477794401, date: 25/02/2021.