Low Praziquantel Treatment Coverage for Schistosoma mansoni in Mayuge District, Uganda, Due to the Absence of Treatment Opportunities, Rather Than Systematic Non-Compliance

Abstract

The World Health Organization (WHO) recommends praziquantel mass drug administration (MDA) to control schistosomiasis in endemic regions. We aimed to quantify recent and lifetime praziquantel coverage, and reasons for non-treatment, at an individual level to guide policy recommendations to help Uganda reach WHO goals. Cross-sectional household surveys (n = 681) encompassing 3208 individuals (adults and children) were conducted in 2017 in Bugoto A and B, Mayuge District, Uganda. Participants were asked if they had received praziquantel during the recent MDA (October 2016) and whether they had ever received praziquantel in their lifetime. A multivariate logistic regression analysis with socio-economic and individual characteristics as covariates was used to determine factors associated with praziquantel uptake. In the MDA eligible population (≥5 years of age), the most recent MDA coverage was 48.8%. Across individuals’ lifetimes, 31.8% of eligible and 49.5% of the entire population reported having never taken praziquantel. Factors that improved individuals’ odds of taking praziquantel included school enrolment, residence in Bugoto B and increasing years of village-residency. Not being offered (49.2%) and being away during treatment (21.4%) were the most frequent reasons for not taking the 2016 praziquantel MDA. Contrary to expectations, chronically-untreated individuals were rarely systematic non-compliers, but more commonly not offered treatment.

Anthelminthic treatment receipt and its predictors in Lake Victoria fishing communities, Uganda: Intervention coverage results from the LaVIISWA cluster randomised trial

“…Reasons for this are unclear, but could be due to concerns about taking during pregnancy or a belief that they are less likely to have schistosomiasis due to less frequent or obvious lake contact [ 26 ]. Our results contrast with studies from other settings that have found little difference in treatment receipt by age and, or gender [ 16 , 17 ], instead finding that factors such as socio-economic status and sanitation had greater predictive utility; unfortunately we did not collect information on these variables on the treatment registers in our study so could not investigate them further. Further qualitative work is needed to provide insight and understanding of these patterns.…”

“…Absence during treatment rounds was by far the most common reason for not receiving MDA. This is consistent with findings from Mayuge District in Uganda [ 16 ], where non-receipt of treatment was more likely to be due to not being offered treatment rather than systematic non-compliance. In our trial, every effort was made to advertise the forthcoming treatment and offer multiple opportunities of receiving it, but despite this, coverage remained sub-optimal.…”

“…Reassuringly, analysis of this “non-mobile” subgroup suggested that very few individuals persistently missed every single treatment round, whether due to absence or refusal. Studies in neighbouring districts in Uganda have found a similarly low level of systematic noncompliance [ 16 , 28 ]. This suggests that further repeated visits over an extended period may have utility for increasing coverage, although it is important to note that this “non-mobile” subgroup may not be representative of all residents of these fishing communities.…”

“…At the community level, casual employment practices, lower symptom knowledge, lower risk perception, and increased experience of side effects have all been associated with lower coverage [ 14 , 15 ]. At the individual and household levels, lower socio-economic status, belonging to the minority tribe, and poorer sanitation have been associated with reduced MDA coverage in Uganda, with conflicting results on whether longer term residence in the community leads to higher or lower coverage [ 16 , 17 ]. Identification of groups particularly at risk of non-receipt is important for informing complementary, targeted, treatment provision strategies.…”

Lessons Learned in Conducting Mass Drug Administration for Schistosomiasis Control and Measuring Coverage in an Operational Research Setting

“…4 Problems with both measuring MDA coverage and achieving targets have been reported previously. [5][6][7] The Schistosomiasis Consortium for Operational Research and Evaluation (SCORE) was launched in 2008 with funding from the Bill & Melinda Gates Foundation to contribute to the evidence base for programmatic decision-making related to schistosomiasis control and elimination. The SCORE research portfolio includes studies related to topics such as control and elimination of schistosomiasis, diagnostic test development and validation in real-world settings, and changes in schistosome population genetics in response to drug pressure.…”