Mass drug administration campaigns: Comparing two approaches for schistosomiasis and soil-transmitted helminths prevention and control in selected southern Malawi districts
Authors: Makaula Peter , Kayuni Sekeleghe Amos , Mamba Kondwani Chidzammbuyo , Bongololo Grace , Funsanani Mathias , Juziwelo Lazarus Tito , Musaya Janelisa , Furu Peter 
Published: March 2022

Preventive chemotherapy using mass drug administration (MDA) is one of the key interventions recommended by WHO, to control neglected tropical diseases. In Malawi, health workers distribute anti-helminthic drugs annually with most support from donors. The mean community coverage of MDA from 2018 to 2020 were high at 87% for praziquantel and 82% for albendazole, however posing a sustainability challenge once donor support diminishes. This study was conducted to compare use of the community-directed intervention (CDI) approach with the use of health workers in delivery of MDA. It was carried out in three districts, where cross-sectional, mixed-methods approach to data collection during baseline and follow-up assessments was used.

Knowledge levels were high for what schistosomiasis is (65% - 88%) and what STH are (32% - 83%); and low for what causes schistosomiasis (32% - 58%), causes of STH (7% - 37%), intermediate organisms for schistosomiasis (13% - 33%) and types of schistosomiasis (2% - 26%). At follow-up, increases in praziquantel coverage were registered in control (86% to 89%) and intervention communities (83% to 89%); decreases were recorded for control (86% to 53%) and intervention schools (79% to 59%). Assessment of the costs for implementation of the study indicated that most resources were used at community (51%), health centre (29%) and district levels (19%). The intervention arm used more resources at health centre (27%) and community levels (44%) than the control arm at 2% and 4% respectively. Health workers and community members perceived the use of the CDI approach as a good initiative and more favorable over the standard practice of delivering MDA.

The use of the CDI in delivery of MDA campaigns against schistosomiasis and STH is feasible, increases coverage and is acceptable in intervention communities. This could be a way forward addressing the sustainability concern when donor support wanes.

Trial Registration

PACTR202102477794401

Author summary

World Health Organization recommends mass drug administration (MDA) as a key control measure against neglected tropical diseases. In Malawi, community-based health workers distribute drugs for schistosomiasis and soil-transmitted helminths (STH) annually, using mostly donor support which raises concern on the programme sustainability without such support. This study compared the use of the local community people as volunteers in delivery of effective MDA against schistosomiasis and STH, defined as community-directed intervention (CDI) approach, with current standard practice of using community-based health workers. The MDA coverage in both groups was noted to be high, with community-based health workers, volunteers, community leaders and people welcoming the CDI approach as good, convenient, acceptable and satisfactory initiative. Therefore, this CDI approach is a positive and sustainable move towards successful delivery of MDA against schistosomiasis and STH in endemic and limited resource settings, using local community volunteers.