Understanding the characteristics of individuals requiring a proxy response for mass drug administration coverage surveys and the potential for recall bias Open Access

Jose, Rini (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/qn59q4695?locale=en
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Abstract

The success of mass drug administration (MDA) for neglected tropical diseases is dependent upon achieving adequate drug coverage, which is validated through household coverage surveys. Coverage surveys rely on respondent recall and often permit proxy responses, whereby another household member is allowed to respond on behalf of an absent individual. This study used data from coverage surveys for lymphatic filariasis in Malawi, Burkina Faso, and Uganda to determine the demographic characteristics of individuals for whom a proxy response was required and the extent to which a proxy response was associated with reported drug coverage. According to our results, teenagers and young adults (11 - 25 years) were more likely to be absent during the coverage survey and require a proxy response, compared with older adults. Similarly, males were more likely to require a proxy response than females. Adults who were eligible to receive MDA for lymphatic filariasis (i.e. everyone, excluding women who are pregnant or in the first week of breastfeeding and the severely ill) were more likely to be absent and require a proxy response than individuals who were ineligible for MDA. A multivariate analysis found that individuals for whom a proxy response was provided had 1.5199 times the odds of being recorded as having swallowed the drugs compared to self-reporting individuals, controlling for age and sex (95% CI (1.0308, 2.2409)). This finding is surprising, given that individuals who are unavailable at the time of a coverage survey may also have been unavailable at the time of MDA, and suggests that proxy respondents may be inflating drug coverage. This finding could be explained in part by the fact that self-reporting individuals are more likely to have been ineligible to receive MDA and thus are expected to have lower coverage; however this does not account for the entire increase in odds. This study highlights the possibility for recall bias in proxy responses to MDA coverage and suggests that further research in necessary to determine the best method for obtaining information on drug coverage when individuals are absent.

Table of Contents

Chapter I: Literature Review................................................1

Chapter II: Manuscript......................................................9

Abstract............................................................9

Introduction.......................................................10

Methods............................................................12

Results............................................................15

Discussion.........................................................22

References.................................................................28

Tables.....................................................................31

Chapter III: Summary, Public Health Implications, Future Directions.......38

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