It depends on how you tell: a qualitative diagnostic analysis of the implementation climate for community-wide mass drug administration for soil-transmitted helminth
Objectives Current soil-transmitted helminth (STH) morbidity control guidelines primarily target deworming of preschool and school-age children. Emerging evidence suggests that community-wide mass drug administration (cMDA) may interrupt STH transmission. However, the success of such programmes depe...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e061682.full |
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| author | Judd L Walson Saravanakumar Puthupalayam Kaliappan Sitara Swarna Rao Ajjampur Sarah Lawrence Khumbo Kalua Euripide Avokpaho Amy Roll Angelin Titus Yesudoss Jacob Marie Claire Gwayi-Chore Félicien Chabi Comlanvi Innocent Togbevi Abiguel Belou Elijan Providence Nindi Moudachirou Ibikounle Kumudha Aruldas Arianna Rubin Means |
| author_facet | Judd L Walson Saravanakumar Puthupalayam Kaliappan Sitara Swarna Rao Ajjampur Sarah Lawrence Khumbo Kalua Euripide Avokpaho Amy Roll Angelin Titus Yesudoss Jacob Marie Claire Gwayi-Chore Félicien Chabi Comlanvi Innocent Togbevi Abiguel Belou Elijan Providence Nindi Moudachirou Ibikounle Kumudha Aruldas Arianna Rubin Means |
| author_sort | Judd L Walson |
| collection | DOAJ |
| description | Objectives Current soil-transmitted helminth (STH) morbidity control guidelines primarily target deworming of preschool and school-age children. Emerging evidence suggests that community-wide mass drug administration (cMDA) may interrupt STH transmission. However, the success of such programmes depends on achieving high treatment coverage and uptake. This formative analysis was conducted to evaluate the implementation climate for cMDA and to determine barriers and facilitators to launch.Settings Prior to the launch of a cMDA trial in Benin, India and Malawi.Participants Community members (adult women and men, children, and local leaders), community drug distributors (CDDs) and health facility workers.Design We conducted 48 focus group discussions (FGDs) with community members, 13 FGDs with CDDs and 5 FGDs with health facility workers in twelve randomly selected clusters across the three study countries. We used the Consolidated Framework for Implementation Research to guide the design of the interview guide and thematic analysis.Results Across all three sites, aspects of the implementation climate that were facilitators to cMDA launch included: high community member demand for cMDA, integration of cMDA into existing vaccination campaigns and/or health services, and engagement with familiar health workers. Barriers to launching cMDA included mistrust towards medical interventions, fear of side effects and limited perceived need for interrupting STH transmission. We include specific recommendations from community members regarding cMDA distribution sites, personnel requirements, delivery timing and incentives, leaders to engage and methods for mobilising participants.Conclusions Prior to launching the cMDA programme as an alternative to school-based MDA, cMDA was found to be generally acceptable across diverse geographical and demographic settings. Community members, CDDs and health workers felt that engaging communities and tailoring programmes to the local context are critical for success. Potential barriers may be mitigated by identifying local concerns and addressing them via targeted community sensitisation prior to implementation.Trial registration number NCT03014167; Pre-results. |
| format | Article |
| id | doaj-art-1d4f2fc407764b648298eab6fea06658 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-1d4f2fc407764b648298eab6fea066582025-01-24T19:00:09ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2022-061682It depends on how you tell: a qualitative diagnostic analysis of the implementation climate for community-wide mass drug administration for soil-transmitted helminthJudd L Walson0Saravanakumar Puthupalayam Kaliappan1Sitara Swarna Rao Ajjampur2Sarah Lawrence3Khumbo Kalua4Euripide Avokpaho5Amy Roll6Angelin Titus7Yesudoss Jacob8Marie Claire Gwayi-Chore9Félicien Chabi10Comlanvi Innocent Togbevi11Abiguel Belou Elijan12Providence Nindi13Moudachirou Ibikounle14Kumudha Aruldas15Arianna Rubin Means16Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, KenyaThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, IndiaThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India1Newcastle University, UKBlantyre Institute for Community Outreach, Blantyre, MalawiInstitut de Recherche Clinique du Bénin, Abomey-Calavi, BéninDepartment of Global Health, University of Washington, Seattle, Washington, USAThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, IndiaThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, IndiaDepartment of Global Health, University of Washington, Seattle, Washington, USAInstitut de Recherche Clinique du Bénin, Abomey-Calavi, BeninInstitut de Recherche Clinique du Bénin, Abomey-Calavi, BeninInstitut de Recherche Clinique du Bénin, Abomey-Calavi, BeninBlantyre Institute for Community Outreach, Blantyre, MalawiInstitut de Recherche Clinique du Bénin, Abomey-Calavi, BéninThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India1 Department of Global Health, University of Washington, Seattle, Washington, USAObjectives Current soil-transmitted helminth (STH) morbidity control guidelines primarily target deworming of preschool and school-age children. Emerging evidence suggests that community-wide mass drug administration (cMDA) may interrupt STH transmission. However, the success of such programmes depends on achieving high treatment coverage and uptake. This formative analysis was conducted to evaluate the implementation climate for cMDA and to determine barriers and facilitators to launch.Settings Prior to the launch of a cMDA trial in Benin, India and Malawi.Participants Community members (adult women and men, children, and local leaders), community drug distributors (CDDs) and health facility workers.Design We conducted 48 focus group discussions (FGDs) with community members, 13 FGDs with CDDs and 5 FGDs with health facility workers in twelve randomly selected clusters across the three study countries. We used the Consolidated Framework for Implementation Research to guide the design of the interview guide and thematic analysis.Results Across all three sites, aspects of the implementation climate that were facilitators to cMDA launch included: high community member demand for cMDA, integration of cMDA into existing vaccination campaigns and/or health services, and engagement with familiar health workers. Barriers to launching cMDA included mistrust towards medical interventions, fear of side effects and limited perceived need for interrupting STH transmission. We include specific recommendations from community members regarding cMDA distribution sites, personnel requirements, delivery timing and incentives, leaders to engage and methods for mobilising participants.Conclusions Prior to launching the cMDA programme as an alternative to school-based MDA, cMDA was found to be generally acceptable across diverse geographical and demographic settings. Community members, CDDs and health workers felt that engaging communities and tailoring programmes to the local context are critical for success. Potential barriers may be mitigated by identifying local concerns and addressing them via targeted community sensitisation prior to implementation.Trial registration number NCT03014167; Pre-results.https://bmjopen.bmj.com/content/12/6/e061682.full |
| spellingShingle | Judd L Walson Saravanakumar Puthupalayam Kaliappan Sitara Swarna Rao Ajjampur Sarah Lawrence Khumbo Kalua Euripide Avokpaho Amy Roll Angelin Titus Yesudoss Jacob Marie Claire Gwayi-Chore Félicien Chabi Comlanvi Innocent Togbevi Abiguel Belou Elijan Providence Nindi Moudachirou Ibikounle Kumudha Aruldas Arianna Rubin Means It depends on how you tell: a qualitative diagnostic analysis of the implementation climate for community-wide mass drug administration for soil-transmitted helminth BMJ Open |
| title | It depends on how you tell: a qualitative diagnostic analysis of the implementation climate for community-wide mass drug administration for soil-transmitted helminth |
| title_full | It depends on how you tell: a qualitative diagnostic analysis of the implementation climate for community-wide mass drug administration for soil-transmitted helminth |
| title_fullStr | It depends on how you tell: a qualitative diagnostic analysis of the implementation climate for community-wide mass drug administration for soil-transmitted helminth |
| title_full_unstemmed | It depends on how you tell: a qualitative diagnostic analysis of the implementation climate for community-wide mass drug administration for soil-transmitted helminth |
| title_short | It depends on how you tell: a qualitative diagnostic analysis of the implementation climate for community-wide mass drug administration for soil-transmitted helminth |
| title_sort | it depends on how you tell a qualitative diagnostic analysis of the implementation climate for community wide mass drug administration for soil transmitted helminth |
| url | https://bmjopen.bmj.com/content/12/6/e061682.full |
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