Journal Article

Profiling the best-performing community medicine distributors for mass drug administration: a comprehensive, data-driven analysis of treatment for schistosomiasis, lymphatic filariasis, and soil-transmitted helminths in Uganda

Chami, Goylette F., Tukahebwa, Edridah M., Kabatereine, Narcis B.

2019

Overview

Background The 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. Methods In 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. Results Overall, 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. Conclusions These 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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Albendazole / Altruism / Analysis / Animals / Antiparasitic agents / Antiparasitic Agents - therapeutic use / Biomedicine / Chemotherapy / Child / Child, Preschool / Communities / Community Medicine - organization & administration / Community Medicine - standards / Community Medicine - statistics & numerical data / Coverage / Data processing / Delivery of Health Care - organization & administration / Delivery of Health Care - standards / Delivery of Health Care - statistics & numerical data / Distributors / Dosage and administration / Drinking water / Drug administration and dosage / Drug therapy / Drugs / Efficiency, Organizational / Elephantiasis, Filarial - drug therapy / Elephantiasis, Filarial - epidemiology / Elephantiasis, Filarial - transmission / Evidence-based medicine / Female / Filariasis / Health risks / Helminthiasis - drug therapy / Helminthiasis - epidemiology / Helminthiasis - transmission / Helminths / Households / Humans / Infant / Ivermectin / Lymphatic filariasis / Male / Mass drug administration / Mass Drug Administration - methods / Mass Drug Administration - standards / Mass Drug Administration - statistics & numerical data / Medicine / Medicine & Public Health / Middle Aged / Occupations / Patient compliance / Pharmaceutical industry / Praziquantel / Prevalence / Regression analysis / Research Article / Risk factors / Schistosomiasis / Schistosomiasis - drug therapy / Schistosomiasis - epidemiology / Schistosomiasis - transmission / Shrinkage / Social factors / Social network analysis / Social networks / Soil - parasitology / Soil-transmitted helminths / Sub-Saharan Africa / Tropical diseases / Uganda - epidemiology / Vector-borne diseases / Vendor relations / Water / Wholesale trade / Work Performance / Young Adult