Mass drug administration targeting Onchocerca volvulus in Owabi catchment area in Ashanti Region, Ghana: Determinants of drug coverage and drug uptake.

Abstract

Introduction Achieving high Mass Drug Administration (MDA) coverage and drug uptake are pivotal in the efforts to eradicate onchocerciasis. The present study investigated the extent and predictors of ivermectin MDA coverage and uptake from the individual and healthcare providers' perspectives. The extent of ivermectin distribution and uptake, and the predictors of distribution and uptake were investigated in endemic communities in the Ashanti Region of Ghana. Methods A cross-sectional survey was conducted from August to October 2019 in communities within the Atwima Nwabiagya North District. A total of 2008 respondents were interviewed. Data was collected with REDCap mobile App which had an electronic version of the structured questionnaire. Descriptive data was presented in frequency tables, and bivariate and multivariate logistics regression analysis were performed to measure the associations between exposure variables and outcome variables which were received and uptake of MDA drugs. Results A total of 1284 (63.9%) respondents did not receive ivermectin during the 2019 MDA programme and more than half of them were not aware of the drug distribution (53.3%). The most common reasons for not ingesting the drug were fear of side effects (47.7%) and not trusting the drug distributors (20.0%). Respondents in the age group 48–57 years (AOR = 1.37; 95%CI: 1.01–2.67), Persons in the high wealth index (AOR = 1.40; 95%CI: 1.11–1.77), Being aware of the MDA programme (AOR = 6.67: 95%CI: 4.76–9.35), MDA being beneficial (AOR = 2.12; 95%CI: 1.54–2.92) participating in previous MDA (AOR = 5.44; 95%CI: 4.25–6.98) and having stayed in the communities for 10 years and above significantly increased the odds of receiving MDA drugs. Previous uptake of MDA drugs (AOR = 10.58; 95%CI: 5.78–19.38) and perception of the MDA drug as beneficial (AOR = 5.25; 95%CI: 2.55–10.82) increased the likelihood of ingesting drugs when received. Conclusion The main health system challenge was limited awareness creation regarding MDA. This seems to affect the optimal utilization of the ivermectin MDA intervention. MDA programmes against onchocerciasis eradication should be designed taking into account specific contextual factors to improve implementation outcomes.

Individual longitudinal compliance to neglected tropical disease mass drug administration programmes, a systematic review

“…Compliance increasing with age was noted by 12 studies. Specifically, compliance to treatment increasing with age was reported by Osei et al (2022) (53) (AOR 4.23 (95% CI: 0.84-21.19), adults aged >58, compared to 18-27 year olds), and Chisha et al (2020) (56) (AOR 1.45 (95% CI: 1.25-1.69), SAC aged 10–14, compared with to 5-9 year olds). Aza’ah et al (2020) (57) presented this phenomena via Chi-squared statistics, noting the proportion of age groups complying with MDA increased from 22.6% (95% CI: 16.3–30.4%) of 10-19 year olds, to 60.3% (95% CI: 53.1–67.1%) of participants aged ≥ 50 years (χ 2 = 64.1, df = 3, P < 0.0001), as did Minetti et al (2019) (38), who noted MDA participation increased with age (χ 2 = 8.75, df = 1, p = 0.003).…”

“…Prior knowledge of MDA was noted as significant by two studies, Asfaw et al (2021) (58) noted a 69% lower compliance to MDA, between prior awareness of date versus date and location of MDA activity (AOR 0.31 (95% CI: 0.12–0.82)), whilst Krentel et al (2016) (55) noted compliance increasing with prior awareness of MDA activity (AOR 2.59 (95% CI: 1.0-6.7)). The perception of drugs to be beneficial to participants was also noted to be significantly associated with increased compliance; (AOR 7.33 (95% CI: 4.13–13.02)) (34), (AOR 5.25 (95% CI: 2.55–10.82)) (53), and (AOR 10.74 (95% CI: 5.1-22.6)) (55). The perceived dedication and attitude of CDDs, as well as the protocols of height measurement were analysed by some authors, proving to be significant factors in increasing participant compliance.…”

“…A combination of cross-sectional and longitudinal compliance was reported by 13 studies, whereby compliance to a defined (43–50) or undefined (51–55) number of rounds were reported, alongside compliance at the latest round of MDA. Four of these studies defined compliance in line with the definitions considered for this review (45,51–53). Setting a high reporting standard, Osei et al (2022) (53), Oswald et al (2016) (20) and Krentel et al (2016) (55) provided comprehensive demographic and descriptive factors and associations with receiving, and swallowing MDA through bivariate and multivariate logistic regression analysis.…”

“…Four of these studies defined compliance in line with the definitions considered for this review (45,51–53). Setting a high reporting standard, Osei et al (2022) (53), Oswald et al (2016) (20) and Krentel et al (2016) (55) provided comprehensive demographic and descriptive factors and associations with receiving, and swallowing MDA through bivariate and multivariate logistic regression analysis. This high level of descriptive detail for coverage and compliance was rarely observed in the literature.…”

“…Six studies noted an increased odds of compliance based upon previous compliance, the treatment behaviour of systematic treatment. This phenomenon was presented with differing outlooks, varying between increased compliance based upon previous compliance (AOR 10.58 (95% CI: 5.78-19.38)) (53), willingness of future compliance by Tilahun and Fenta (2018) (34) (AOR 5.78 (95% CI:2.44–13.68)), and non-compliance related to previous non-compliance reported twice; (AOR 1.620 (95% CI: 1.051-2.497)) (38) and (AOR 9.18 (95% CI: 2.43-34.65)) by Dickson et al (2021) (50). Campillo et al (2021) (32) further developed the analysis, predicting the number of subsequent rounds required to clear treatment based upon current compliance to available rounds of MDA.…”