Azithromycin Mass Treatment for Trachoma Control: Risk Factors for Non-Participation of Children in Two Treatment Rounds

Ssemanda, Elizabeth; Levens, Joshua; Mkocha, Harran; Muñoz, Beatriz; West, Sheila K.

doi:10.1371/journal.pntd.0001576

Cited by 21 publications

(22 citation statements)

References 21 publications

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“…We also observed persistent non-participation over time in annual MDAs, as seen elsewhere in a CRT setting [3]. Geographical clustering of non-participation represents a new finding and we found two different types of non-participators.…”

Section: Discussionsupporting

confidence: 83%

Non-Participation during Azithromycin Mass Treatment for Trachoma in The Gambia: Heterogeneity and Risk Factors

et al. 2014

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BackgroundThere is concern that untreated individuals in mass drug administration (MDA) programs for neglected tropical diseases can reduce the impact of elimination efforts by maintaining a source of transmission and re-infection.Methodology/Principal FindingsTreatment receipt was recorded against the community census during three MDAs with azithromycin for trachoma in The Gambia, a hypo-endemic setting. Predictors of non-participation were investigated in 1–9 year olds using random effects logistic regression of cross-sectional data for each MDA. Two types of non-participators were identified: present during MDA but not treated (PNT) and eligible for treatment but absent during MDA (EBA). PNT and EBA children were compared to treated children separately. Multivariable models were developed using baseline data and validated using year one and two data, with a priori adjustment for previous treatment status. Analyses included approximately 10000 children at baseline and 5000 children subsequently. There was strong evidence of spatial heterogeneity, and persistent non-participation within households and individuals. By year two, non-participation increased significantly to 10.4% overall from 6.2% at baseline, with more, smaller geographical clusters of non-participating households. Multivariable models suggested household level predictors of non-participation (increased time to water and household head non-participation for both PNT and EBA; increased household size for PNT status only; non-inclusion in a previous trachoma examination survey and younger age for EBA only). Enhanced coverage efforts did not decrease non-participation. Few infected children were detected at year three and only one infected child was EBA previously. Infected children were in communities close to untreated endemic areas with higher rates of EBA non-participation during MDA.Conclusions/SignificanceIn hypo-endemic settings, with good coverage and no association between non-participation and infection, efforts to improve participation during MDA may not be required. Further research could investigate spatial hotspots of infection and non-participation in other low and medium prevalence settings before allocating resources to increase participation.

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Section: Discussionsupporting

confidence: 83%

Non-Participation during Azithromycin Mass Treatment for Trachoma in The Gambia: Heterogeneity and Risk Factors

et al. 2014

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“…Specifically, a shorter number of days of distribution time and being assigned to a CTA living more than one hour from the furthest assigned household were associated with delayed participation. This finding is consistent with our other study of persistent non-participant households (child non-participants in both rounds of MDA) who also were more likely to be in programs that had two days distribution and assigned CTAs living more than an hour from the furthest assigned household 17 .…”

Section: Discussionsupporting

confidence: 92%

Community mass treatment with azithromycin for trachoma: Factors associated with change in participation of children from the first to the second round

Ssemanda

Mkocha²,

Levens

et al. 2015

Clinical Epidemiology and Global Health

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Background Mass drug administration (MDA) with azithromycin is an important part of trachoma control programs. Maintaining high participation among children is challenging. Aim We assessed factors identifying households with a child who changed participation from the first MDA to the second MDA compared to households where all children participated at both MDAs. Methods Two case-control comparisons were conducted in 11 Tanzanian communities, which underwent MDA in 2008 and 2009. The first case group (n=165) was a random sample of households with a child who changed from a 2008 non-participant to a 2009 participant (delayed participant). The second case group (n=165) was a random sample of households with a child who went from a 2008 participant to a 2009 non-participant (change to non-participant). Controls (n=330) were a random sample of households where all children participated in both rounds. Risk factors were assessed using questionnaires asked of children’s guardians. Logistic models with a random-intercept were used to estimate odds ratios and 95% confidence intervals. Results Households with delayed participation were more likely to be in communities with fewer treatment days (OR=2.98, 95% CI=1.80–4.92) and assigned to Community Treatment Assistants (CTA) with a wide area to cover (OR=1.88, 95% CI=1.09–3.23). Households with change to non-participation were more likely to live further from the distribution site (OR=3.17, 95% CI=1.19–8.46), have the guardian born outside the village with short-term residency (OR=2.64, 95% CI=1.32–5.31), and be assigned to a male CTA (OR=1.75, 95% CI=1.08–2.83). Conclusions Factors related to program accessibility were associated with delayed participation and maintaining participation.

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“…With coverage this high in children, there were very few children who were not treated at least once after three MDAs. In a study in these communities of persistent non- participation in MDA, Ssemanda et al found that only 2% of households contained children who did not participate in 2 MDAs [13]. By the third round of MDA, there may be little benefit to the extra effort required to achieve over 90% coverage.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Trial of Two Coverage Targets for Mass Treatment with Azithromycin for Trachoma

et al. 2013

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BackgroundThe World Health Organization recommends at least 3 annual antibiotic mass drug administrations (MDA) where the prevalence of trachoma is >10% in children ages 1–9 years, with coverage at least at 80%. However, the additional value of higher coverage targeted at children with multiple rounds is unknown.Trial Design2×2 factorial community randomized, double blind, trial.Trial methods32 communities with prevalence of trachoma ≥20% were randomized to: annual MDA aiming for coverage of children between 80%–90% (usual target) versus aiming for coverage>90% (enhanced target); and to: MDA for three years versus a rule of cessation of MDA early if the estimated prevalence of ocular C. trachomatis infection was less than 5%. The primary outcome was the community prevalence of infection with C. trachomatis at 36 months.ResultsOver the trial's course, no community met the MDA cessation rule, so all communities had the full 3 rounds of MDA. At 36 months, there was no significant difference in the prevalence of infection, 4.0 versus 5.4 (mean adjusted difference = 1.4%, 95% CI = −1.0% to 3.8%), nor in the prevalence of trachoma, 6.1 versus 9.0 (mean adjusted difference = 2.6%, 95% CI = −0.3% to 5.3%) comparing the usual target to the enhanced target group. There was no difference if analyzed using coverage as a continuous variable.ConclusionIn communities that had pre-treatment prevalence of follicular trachoma of 20% or greater, there is no evidence that MDA can be stopped before 3 annual rounds, even with high coverage. Increasing coverage in children above 90% does not appear to confer additional benefit.

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Azithromycin Mass Treatment for Trachoma Control: Risk Factors for Non-Participation of Children in Two Treatment Rounds

Cited by 21 publications

References 21 publications

Non-Participation during Azithromycin Mass Treatment for Trachoma in The Gambia: Heterogeneity and Risk Factors

Non-Participation during Azithromycin Mass Treatment for Trachoma in The Gambia: Heterogeneity and Risk Factors

Community mass treatment with azithromycin for trachoma: Factors associated with change in participation of children from the first to the second round

A Randomized Trial of Two Coverage Targets for Mass Treatment with Azithromycin for Trachoma

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