Gender, Age, and Equity in Mass Drug Administrations for the Control and Elimination of Neglected Tropical Diseases: A Cross-Sectional Study of Coverage in Burkina Faso, Malawi, and Uganda Open Access

Fleming, Monica (Spring 2018)

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Background: Neglected tropical diseases (NTDs) are diseases that cause illness and impose significant burden in over one billion people in the poorest communities in the world. Preventive chemotherapy, through mass drug administration (MDA), remains one of the most cost-effective strategies for NTD control and elimination. Achieving uniformly high treatment coverage in every MDA round is critical to ensure reservoirs of infection don’t remain among sub-groups of the population.


Objective: To assess whether MDA treatment is equitable across sub-groups of the population and understand the underlying factors contributing to disparities in treatment.


Methods: This study pooled data from coverage surveys that were conducted from 2014-2015 in selected lymphatic filariasis endemic districts in Burkina Faso, Malawi, and Uganda, four to six months after MDAs occurred. The outcomes of interest were program coverage by gender and age, and reasons for non-participation. Data were collected on individuals in household interviews. Households were sampled, and all individuals who were present at the time of the last MDA were surveyed. The data were used to calculate frequencies and proportions and chi-square test was used to indicate the difference in proportions among males and females in each age category.


Results: Program coverage differed by gender, and this relationship changed with age. Females reported higher coverage than males in all three countries. Coverage among females was approximately 1% higher in Burkina Faso, 7% higher in Malawi and 1% higher in Uganda. The difference was statistically significant in Burkina Faso (p = 0.04) and Malawi (p <.0001). Males and Females met coverage targets in Burkina Faso and Malawi overall; however, our assessment of coverage by gender and age identified sub-groups in Malawi, specifically adult males that did not meet the target threshold for coverage (80%). Coverage among males 30-39 years was 74% and 50+ years was 75%. Males accounted for the majority of non-participants overall and reported being away at the time of MDA as the most common reason for missing MDA.


Conclusions: Addressing reasons for non-participation among these sub-groups is critical for programs to achieve uniformly high treatment coverage necessary for NTD control and elimination goals.


Table of Contents





Table of Contents


I. Background. 1


A. Overview of Neglected Tropical Disease. 1


B.  Treatment and Prevention. 1


C. Preventive Chemotherapy. 2


D. Drug Coverage. 3


E.  Coverage Surveys. 4


F.  Threat to Control/Elimination Goals: Non-participants. 5


G. Goal/Objectives/Significance: 6


II. Manuscript 8


A. Introduction. 8


B.  Methods. 10


1. Study Setting. 10


2. Study Population. 11


a. Sampling Techniques. 11


b. Inclusion/Exclusion Criteria. 13


3. Data Sources. 17


a. Country Specific Surveys. 17


4. Study Measures. 18


5. Analysis. 19


C. Results. 20


1. Coverage. 21


2. Reasons for Non-participation. 28


3. Drug Distribution Location, Uganda. 31


4. Source of MDA information, Burkina Faso. 32


D. Discussion. 33


1. Strengths/Limitations. 35


2. Conclusions. 37


References. 38


III. Implications and Future Directions. 41


Appendices. 44


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