Evaluating Equity and Coverage in Mass Drug Administration for Soil-Transmitted Helminth Infections among School-Age Children in the Hard-to-Reach Setting of Southern Ethiopia

Abstract

Background: Soil-transmitted helminth (STH) infections are prevalent in most developing countries, including Ethiopia, with school-age children (SAC) at high risk of infection. In Ethiopia, despite substantial progress being made on mass drug administration (MDA) coverage for STH infections, its implementation is facing challenges in hard-to-reach areas. This study thus aimed at assessing equity and coverage in MDA and identifying factors associated with drug coverage for STH infections among SAC in the hard-to-reach setting of southern Ethiopia. Methods: A community-based cross-sectional survey was conducted in the North Ari district, South Omo Zone in July 2019. Sample size was estimated following WHO drugcoverage evaluation guidelines. Factors associated with drug uptake for STH infections were identified using multivariate logistic regression. Results: Of 956 SAC participating in this study, the overall MDA coverage for STH was found to be 27.5% (95% CI 24.7%-30.5%). The odds of having taken drugs were highest among school-enrolled children and in those who knew the purpose of MDA: about about double their counterparts. In contrast, the odds of drug uptake were lower by 69% among those who had got informed only when the drugs delivered and by 92% among those who needed to travel >30 minutes to reach drug-distribution points than their counterparts. Conclusion: Achieving effective and equitable MDA coverage is facing serious challenges in the hard-to-reach setting of southern Ethiopia. The very low (27.5%) and inequitable MDA coverage found in this study are associated with school nonenrollment, inaccessibility, and lack of information, awareness, and mobilization. Social mobilization should be scaled up to inform and create awareness in the community ahead of MDA. Further, school-based deworming in settings with low school enrollment needs a modified strategy to reach those in need of drugs.

Depriving Out-of-School Children of Deworming Tablets for Soil-Transmitted Helminth Infection in Bangladesh: The Irony of a School-Based Deworming Programme

“…However, the coverage in the intervention area for the OSCs was poor, and it was poorer still in the control area. Other authors reported similar findings from Bangladesh [ 9 , 12 , 16 ] and Ethiopia [ 14 ]. Given that SGCs are frequently the primary target of deworming programs, and there is a lack of protocol to integrate the OSCs [ 9 ], it is unsurprising that coverage is higher among the SGCs.…”

“…On the other hand, the reported coverage for SGCs and OSCs was significantly lower than the nationally reported coverage [ 8 ]. Previous research has found that reporting by pill distributors can sometimes result in over-reporting [ 9 , 14 ]. Because few informal educational institutions are listed in the local registry, those children are often excluded from school-based deworming [ 9 ].…”

“…In some cases, encouraging them to attend the deworming sessions through their school-going peers was effective [ 13 ]. However, the deworming coverage in those setting was reported as persistently low [ 14 ].…”

“…Reaching all school-aged children is vital for achieving STH control. It is also crucial to monitor the progress of the programme by conducting surveys among the risk groups, because the institutionally reported coverage data can give the wrong impression from time to time [ 14 ]. There has been a notable gap reported for deworming coverage among the school-going children (SGCs) and OSCs [ 3 , 12 ].…”

Ethical challenges in mass drug administration for reducing childhood mortality: a qualitative study

“…Bioethics research on MDA with antibiotics—especially when applied to reduce childhood mortality—is limited. Although ethical issues have been explored in other contexts, such as MDA for seasonal malaria chemoprophylaxis [ 30 ] or soil-transmitted helminths [ 31 ], MDA for childhood mortality is arguably distinct. To our knowledge, no empirical studies describe how critical decision-makers think about ethical concerns in MDA of antibiotics.…”