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

Abstract

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.

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

“…The finding that children in households further from their primary water source were more likely to be PNT or EBA is probably indicative of some other unmeasured risk factor, for example, marginalisation within the community due to either household head or community leader choice, or a mixture of the two. Non-participation during MDA subsequent to participation in a previous MDA has been found to be associated with possible markers of marginalisation in another CRT [32]. Active trachoma has been found to be associated with lower socio-economic status (SES) and isolation of households from the community [33] so access to, or participation in, trachoma control activities could also be affected by these unmeasured factors.…”

Ocular Chlamydia trachomatis infection: elimination with mass drug administration

“…In one MDA setting in Tanzania, households with persistent non-participation had a higher burden of familial responsibility and seemed less connected within the community (74). Households who dropped out of MDA after participating in one round were more likely to have a male CTA and also be less well connected within the village (75). The authors concluded that additional days of distribution and lessening CTAs' travel time to their assigned households may prevent nonparticipation, and were key to high coverage.…”