Evaluation of Integrated Mass Drug Administration for Neglected Tropical Diseases in Madaoua District, Niger Público

Abstract

Neglected Tropical Diseases (NTDs) are a group of debilitating illnesses that affect the lives of more than one-sixth of the world's population. Preventive chemotherapy partnered with health education is the primary strategy in the control and elimination of NTDs. In December 2012, the Niger Ministry of Health carried out an integrated mass drug administration (MDA) with the goal of eliminating lymphatic filariasis (LF) and trachoma and controlling soil-transmitted helminthiasis (STH) and schistosomiasis. Six months after the MDA, a coverage and knowledge, attitudes and practices (KAP) survey was carried out in the Madaoua district, Niger using the WHO-recommended two staged probability cluster survey design. In each of the selected households, coverage data were collected from all persons, while the KAP survey was administered to one randomly-selected adult (≥ 14 years). A total of 293 households in 30 villages participated in the surveys, with 1711 persons interviewed for coverage and 291 adults for KAP. Overall, 80.2% (95% CI: 78.2-82.1) of those surveyed reported taking at least one medication. Surveyed coverage of Ivermectin (60.0%; 95% CI: 57.1-62.9), albendazole (71.3%; 95% CI: 69.0-74.3) and praziquantel (65.6%; 95% CI: 62.8-68.4) was significantly lower than the reported coverage (96.9%, 96.9%, and 86.0%, respectively), while the reported coverage for azithromycin (72.2%) was confirmed by the survey (71.8%, 95 CI: 69.3-74.1). KAP respondents reported that they had heard of LF (66.0%), STH (93.8%), schistosomiasis (72.2%) and trachoma (86.6%), but only 24.0%, 51.8%, 56.2% and 57.9%, respectively, knew at least one symptom. Of 46 respondents who had heard of LF, only 2 respondents (4.3%) knew it was transmitted via a mosquito, and of those who had heard of schistosomiasis, 70.9% believed that one is infected by the sun or heat. There was no significant association between participation in the MDA and knowledge of the NTDs. Knowledge of someone with a NTD did increase the odds of participation: men who knew someone with hydrocele were 4.3 times (95% CI: 4.1-4.4) more likely to take medication. MDA participation appeared not to be affected by the low level of knowledge. With the exception of Ivermectin, drug-specific coverage was adequate.

Table of Contents

Table of Contents

Table of Contents ..........................................................................................................................................vi

List of Tables ...............................................................................................................................................viii

List of Figures ................................................................................................................................................ix

Acronyms .......................................................................................................................................................x

Chapter 1: Introduction ....................................................................................................................................1

1.1 Introduction and Rationale ...................................................................................................................1

1.2 Problem Statement .............................................................................................................................3

1.3 Purpose Statement .............................................................................................................................5

1.4 Research Objectives............................................................................................................................5

1.5 Significance Statement .......................................................................................................................5

Chapter 2: Comprehensive Review of the Literature ...............................................................................................6

2.1 Introduction: Global burden ..................................................................................................................6

2.2 Sub-Saharan Africa and Niger's NTD Burden .............................................................................................6

2.3 Overview of NTDs ...............................................................................................................................7

2.3.1 Soil-transmitted helminthes (STH) ...............................................................................................7

2.3.2 Schistosomiasis .......................................................................................................................8

2.3.3 Lymphatic Filariasis (LF) ............................................................................................................9

2.3.4 Trachoma .............................................................................................................................10

2.4 Preventive Chemotherapy (PCT) ..........................................................................................................10

2.4.1 Integration ...........................................................................................................................11

2.5 Benefits of Mass Drug Administration ....................................................................................................12

2.6 History of Preventive Chemotherapy in Niger ..........................................................................................12

2.7 Coverage ........................................................................................................................................13

2.8 Purpose of Surveys ..........................................................................................................................13

Chapter 3: Methodology .................................................................................................................................15

3.1 Sampling ........................................................................................................................................15

3.2 Questionnaires ................................................................................................................................15

3.3 Survey teams and training .................................................................................................................16

3.4 Ethical considerations .......................................................................................................................16

3.5 Data Analysis ..................................................................................................................................17

Chapter 4: Results ........................................................................................................................................18

4.1 Coverage Survey .............................................................................................................................18

4.2 Knowledge, Attitudes, and Practices (KAP) Survey .................................................................................19

4.2.1 Lymphatic Filariasis (LF) Knowledge ..........................................................................................20

4.2.2 Soil-transmitted Helminthiasis (STH) Knowledge ..........................................................................23

4.2.3 Schistosomiasis Knowledge .....................................................................................................26

4.2.4 Trachoma Knowledge .............................................................................................................29

4.2.5 Additional KAP Questions ........................................................................................................32

Chapter 5: Discussion, Conclusions and Recommendations ....................................................................................35

5.1 Discussion ......................................................................................................................................35

5.2 Conclusions ....................................................................................................................................37

5.3 Recommendations ............................................................................................................................38

References ..................................................................................................................................................40

Appendix 1: Random Walk Method ....................................................................................................................44

Appendix 2: Sample Coverage Survey Form ........................................................................................................48

Appendix 3: Knowledge, Attitudes and Practices Questionnaire ..............................................................................49

Appendix 4: Adult Verbal Consent Script (French version) .....................................................................................59

Appendix 5: Verbal Consent Script for an Adult on Behalf of a Child (French version) ..................................................60

Appendix 6: Verbal Consent Script for Children Aged 6-18 years (French version) ......................................................61

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palavra-chave	KAP survey Niger Mass Drug Administration Neglected Tropical Diseases Coverage survey
Committee Chair / Thesis Advisor	Mathieu, Els, CDC
Committee Members	McFarland, Deborah A, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) CDC National or regional non-profit organization (e.g., American Cancer Society)

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