Gender norms and mass deworming program access in Comé, Benin: A qualitative assessment of gender-associated opportunities and challenges to achieving high mass drug administration coverage

Abstract

The World Health Organization's Neglected Tropical Disease Roadmap has accelerated progress towards eliminating select neglected tropical diseases (NTDs). This momentum has catalyzed research to determine the feasibility of interrupting transmission of soil-transmitted helminths (STH) using community-wide mass drug administration (MDA). This study aims to identify potential gender-specific facilitators and barriers to accessing and participating in community-wide STH MDA, with the goal of ensuring programs are equitable and maximize the probability of interrupting STH transmission. This research was conducted prior to the launch of community-wide MDA for STH in Comé , Benin. A total of 10 focus group discussions (FGDs) were conducted separately among 40 men, 38 women, and 15 community drug distributors (CDDs). Salient themes included: both men and women believe that community-wide MDA would reduce the financial burden associated with self-treatment, particularly for low income adults. Community members believe MDA should be packaged alongside water, sanitation, and other health services. Women feel past communitywide programs have been disorganized and are concerned these distributions will be similar. Women also expressed interest in increased engagement in the implementation of future community-based public health programs. Men often did not perceive themselves to be at great risk for STH infection and did not express a high demand for treatment. Finally, the barriers discussed by CDDs generally did not align with gender-specific concerns, but rather represented concerns shared by both genders. A door-to-door distribution strategy for STH MDA is preferred by women in this study, as this platform empowers women to participate as health decision makers for their family. In addition, involving women in planning a1111111111 a1111111111 a1111111111 a1111111111 a1111111111

Factors Associated with Deworming Medication Utilization among Pregnant Women in Benin: Evidence from the Demographic and Health Survey

“…This finding may be explained by other studies [ 24 , 36 , 37 ], which point to the geographic disparities in access to healthcare services in SSA. In analyzing a deworming program in Benin, Geyer et al found that the overwhelming rural context of Comé served as a barrier to effective mass drug administration delivery, as most resources were concentrated in the urban areas [ 14 ]. Similarly, it has also been suggested that long distances to healthcare centers in many regions, such as Borgou, Collines, and Atakora, may explain the low uptake of deworming medication [ 24 ].…”

“…As a result of these efforts, the DeWorm3 Project was established to assess the feasibility of using mass drug administration to interrupt the transmission of soil-transmitted helminths (STHs), using study sites in Benin, along with India and Malawi [ 13 ]. The success of this intervention hinged on both high levels of treatment coverage and high levels of compliance [ 14 ]. While progress has been made through mass drug administration campaigns of donated medicines, these campaigns targeted and prioritized children in endemic regions over women of reproductive age [ 15 ].…”

Protecting the neglected from disease: the role of gender, health equity and human rights in the fight against neglected tropical diseases

“…A focus group in Benin, discussing gender-specific barriers to MDA programmes, noted that men sometimes do not see themselves at risk, and therefore have less demand for, for example, deworming, while women reported to seek increased involvement in MDA programmes. They concluded that door-to-door community-wide MDA programmes may improve general coverage, while at the same time "empower women by facilitating increased decision making" on behalf of their families (Geyer et al, 2020). However, the success of these programmes highly depends on the local gender roles, as in northern Nigeria drug distributors are sometimes unable to hand out PC when the man, as the head of the family, is not present in the house, meaning the entire family misses out on the preventive medication even in a door-to-door communitywide MDA programme (Burki, 2020).…”

“…Tailor programmes to gender-specific factors and include women in design of programmes: Understanding daily schedules of all genders will help when designing effective health programmes (Ozano et al, 2020). As previously mentioned, decentralised treatment and prevention programmes, such as door-to-door drug distribution, usually favour women more than a centralized approach does (Agbo et al, 2019;Geyer et al, 2020). This has to do with the household labour and responsibility that women have to their household, they are likely irreplaceable and often face consequences when needing to access healthcare for themselves.…”

“…Awareness of groups being heterogenous might "help prevent programmes that inadvertently reproduce existing inequalities and injustices" (Wenham et al, 2020). Including women in health programmes has often been beneficial to the efficacy of the programmes by being a source for reaching missed groups, and should be encouraged (Geyer et al, 2020;Okwa, 2007). Examples of this are vector control programmes that are often more selfsustaining and effective when created by women, which contributes to gender equity, as well as the involvement of women in sanitation programmes (Rahman et al, 1996;Thys et al, 2015;Wenham et al, 2020).…”