A qualitative study to assess community barriers to malaria mass drug administration trials in the Gambia

Abstract

BackgroundMass drug administration (MDA) is a strategy widely used in the control of human parasitic diseases but has been rarely attempted with malaria, the most common and dangerous parasitic disease in humans. MDA is an intervention strategy that involves simultaneously dispensing treatment to an entire population in a given geographic area. With some areas in sub-Saharan Africa documenting a decline in malaria transmission, the feasibility of MDA to further reduce malaria transmission is being considered. Understanding community perceptions of such an activity is vitally important for the design of the study and gaining the support of participants in order to maximize compliance and adherence.MethodsA qualitative study to assess factors likely to influence community acceptance of MDA in the seasonal and low malaria transmission setting of The Gambia was conducted. Using in-depth interviews, the perceptions, knowledge and attitudes of medical personnel and community members who have undergone MDA trials in The Gambia were investigated.ResultsSeveral major themes emerged, namely: 1) the importance of timing of rounds of MDA doses for maximum participation; 2) the need to educate the target population with accurate information on the procedures, drug regimen, and possible side effects to enhance adherence; 3) the need for continuous sensitization meetings to maintain and increase uptake of MDA; and, 4) the importance for defining roles in the delivery and assessment of MDA, including existing healthcare structures.DiscussionTo increase the likelihood of participation in MDA trials in this setting, activities should be undertaken just before and during the rainy season when community members are less mobile. Importantly, fears regarding blood sampling and side effects of the drug regimen need to be addressed prior to the start of the trial and repeated throughout the study period. Accurate and frequent communication is essential, and village leaders should consistently be included in sensitization meetings to enhance community participation. Additionally, village healthcare workers should be included in training and implementation, with supervision by a fieldworker permanently posted in every few villages during the trial. Future collaboration with Senegal may prove important for enhanced elimination efforts in The Gambia.

Artemisinin combination therapy mass drug administration in a setting of low malaria endemicity: programmatic coverage and adherence during an observational study in Zanzibar

“…The post-MDA survey findings showed that the reasons for failure to complete the ACT doses were fear of side-effects such as abdominal pain, headaches, vomiting, dizziness, sneezing, muscular aches, fever, nausea and body malaise. Similar findings were observed in studies conducted in The Gambia where barriers of the MDA campaign included the perception and fear of the community members on the side-effects of the drugs and procedures [ 20 , 21 ]. These misconceptions by the participants and misunderstandings about the medication can contribute greatly to the lack of adherence to an MDA [ 22 ].…”

Implementer and recipient perspectives of community-wide mass drug administration for soil-transmitted helminths in Kwale County, Kenya

“…Our study also highlights the need for contextually-relevant community engagement strategies, which appear to be vital to uptake by promoting trust and demand. The importance of community engagement activities has been widely referenced in previous studies on MDAs for a number of diseases including malaria, schistosomiasis, and LF [25][26][27]. Beyond the well-documented need to address prevailing rumors and generate demand through imparting knowledge about the infection, our results indicate that community engagement can benefit both reach and uptake.…”

Community perceptions of targeted anti-malarial mass drug administrations in two provinces in Vietnam: a quantitative survey

“…There the researchers found travel, perceived adverse drug reactions and rumours, inconveniences related to the logistics of MDA (e.g. waiting times) and the perceived lack of information about MDA were critical reasons for non-participation [17, 21, 22]. While the research into factors related to the participation in mass administrations of anti-malarial drugs is somewhat limited there is a broad experience how to engage communities in other biomedical interventions including interventions against the transmission of HIV, tuberculosis, and vector-borne disease [23].…”