Factors associated with participation in mass drug administration of azithromycin for trachoma control in Amhara, Ethiopia Open Access

Abstract

Mass drug administration (MDA) with azithromycin is a core component of the WHO recommended strategy to eliminate trachoma as a public health problem, but low participation rates in MDA campaigns may undermine the effectiveness of this intervention. Following an azithromycin MDA in Amhara, Ethiopia in May 2017, we conducted multi-level cluster random coverage surveys in 4 districts to collect data on self-reported MDA participation and predictors. We then explored factors associated with individual MDA participation at the individual, head of household, and household levels. Random-effects logistic regression modeling was used to identify correlates of MDA participation while adjusting for nesting of individuals at the household and village level. A total of 100 villages were surveyed, from which we obtained data on 6613 participants from 1629 households. The district-level self-reported participation in the trachoma MDA ranged from 78.5% to 86.9%. We developed a model for all participants and found several positively-associated factors for MDA participation: excellent and fair health status (Odds Ratio [OR] = 7.3; 95% Confidence Interval [CI]: 2.6, 20.3; OR = 9.4; 95% CI: 3.1, 28.6), length of household’s residency (OR = 2.4; 95% CI: 1.3, 4.2), advanced knowledge of the MDA campaign (OR = 4.3; 95% CI: 2.6, 7.0), and knowledge of trachoma (OR = 1.67; 95% CI: 1.05, 2.67). A second model was run, which excluded heads of household and included head of household participation in the model. Factors associated with participation were similar to those found in the first model, in addition to the head of household participation (OR = 6.0; 95% CI: 3.9, 9.3). These results provide insight into the factors associated with MDA participation in Amhara, and suggest that heads of households hold a strong influence over household participation. To increase the impact of MDA campaigns, MDA mobilization strategies—including comprehensive trachoma and azithromycin messaging and MDA campaign awareness—should target heads of households, new residents, those in poorer health, and at older ages.

Table of Contents

Introduction...............................1

Methods....................................2

Study Location.....................2

Sample Size.........................3

Study Design.......................3

Data Collection.....................4

Measures.............................5

Statistical Analysis................5

Ethics..................................6

Results......................................6

Discussion.................................9

Recommendations................12

Limitations..........................12

Conclusions.........................13

Appendix..................................15

References...............................22

Supplemental Appendix..............26

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	trachoma Ethiopia mass drug administration
Committee Chair / Thesis Advisor	Nash, Scott, The Carter Center Jenness, Samuel, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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