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Akinsolu FT, Abodunrin OR, Olagunju MT, Adewole IE, Ola OM, Abel C, Sanni-Adeniyi R, Rahman NO, Akanni OO, Njuguna DW, Soneye IY, Salako AO, Ezechi OC, Varga OE, Akinwale OP. Health workers' perspectives on school-based mass drug administration control programs for soil-transmitted helminthiasis and schistosomiasis in Ogun State, Nigeria. PLoS One 2024; 19:e0302509. [PMID: 38718082 PMCID: PMC11078364 DOI: 10.1371/journal.pone.0302509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Soil-transmitted helminthiasis (STH) and schistosomiasis (SCH) are among the most prevalent neglected tropical diseases (NTDs), affecting 1.5 billion globally, with a significant burden in sub-Saharan Africa, particularly Nigeria. These diseases impair health and contribute to socio-economic challenges, especially in children, undermining educational and future economic prospects. The 2030 NTD Roadmap highlights Mass Drug Administration (MDA) as a critical strategy for controlling these NTDs, targeting vulnerable populations like school-age children. Despite some successes, challenges persist, indicating the need for deeper insights into program implementation. This study focuses on the perspectives of health workers implementing MDA in selected local government areas (LGAs) of Ogun State, Nigeria, aiming to identify challenges and enablers that align with the broader NTD 2030 goals. METHODOLOGY/PRINCIPAL FINDINGS The study used a qualitative research approach involving focus group discussions and in-depth interviews with health workers engaged in neglected tropical disease control programs in Ogun State, Nigeria, between July and September 2022. A semi-structured questionnaire guided the exploration of ideas, and the data were analyzed using the QRS Nvivo 12 software package. The study found that the school-based MDA control program's efficacy largely relies on strong collaborations and partnerships, particularly with educators, community heads, and other stakeholders. These alliances and strategic communication methods, like town announcements and media campaigns, have been pivotal in reaching communities. However, the program does grapple with hurdles such as parental misconceptions, limited funds, insufficient staffing, and misalignment with the Ministry of Education. It is recommended to boost funding, foster early stakeholder involvement, enhance mobilization techniques, and consider introducing a monitoring card system similar to immunization. CONCLUSIONS/SIGNIFICANCE The MDA Integrated Control Programs for STH and SCH in Ogun State schools demonstrate a holistic approach, integrating knowledge, collaboration, communication, and feedback. Health workers have shown commitment and adeptness in their roles. However, achieving maximum efficacy requires addressing critical barriers, such as parental misconceptions and funding challenges. Adopting the recommended strategies, including proactive communication, increased remuneration, and introducing a tracking system, can significantly enhance the program's reach and impact. The involvement of all stakeholders, from health workers to community leaders and parents, is essential for the program's sustainability and success.
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Affiliation(s)
- Folahanmi T. Akinsolu
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Lagos State, Nigeria
| | - Olunike R. Abodunrin
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
- Department of Planning and Research, Lagos State Health Management Agency, Lagos, Lagos State, Nigeria
| | - Mobolaji T. Olagunju
- Department of Epidemiology and Biostatistics, Nanjing Medical University, Nanjing, China
| | - Ifeoluwa E. Adewole
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
| | - Oluwabukola M. Ola
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
| | - Chukwuemeka Abel
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
| | | | - Nurudeen O. Rahman
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Olukunmi O. Akanni
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
| | - Diana W. Njuguna
- School of Nursing, Dedan Kimathi University of Technology, Nyeri, Kenya
| | - Islamiat Y. Soneye
- Department of Public Health, Ogun State Ministry of Health, Ota, Ogun State, Nigeria
| | - Abideen O. Salako
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Lagos State, Nigeria
| | - Oliver C. Ezechi
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Lagos State, Nigeria
| | - Orsolya E. Varga
- Department of Public Health and Epidemiology, University of Debrecen, Debrecen, Hungary
| | - Olaoluwa P. Akinwale
- Department of Public Health, Lead City University, Ibadan, Oyo State, Nigeria
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Lagos State, Nigeria
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Phillips AE, Ower AK, Mekete K, Liyew EF, Maddren R, Belay H, Chernet M, Anjulo U, Mengistu B, Salasibew M, Tasew G, Anderson R. Association between water, sanitation, and hygiene access and the prevalence of soil-transmitted helminth and schistosome infections in Wolayita, Ethiopia. Parasit Vectors 2022; 15:410. [DOI: 10.1186/s13071-022-05465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 09/03/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
The Geshiyaro project is a 5-year intervention to assess the impact of community- and school-based water, sanitation, and hygiene (WaSH) interventions on reducing infection with soil-transmitted helminths (STH) and schistosome parasites in combination with deworming in Wolayita zone, Ethiopia.
Methods
A population-based, cross-sectional census and parasitological mapping activity was conducted between 2018 and 2019. Individuals in the census were identified using either a registered study ID card or biometric fingerprint to enable linkage of their household WaSH data with baseline STH and schistosome prevalence for risk analysis.
Results
Prevalence of STH was 15.5% for any STH species, 9.47% for Ascaris lumbricoides, 1.78% for Trichuris trichiura, and 7.24% for hookworm. Intestinal schistosomiasis (Schistosoma mansoni) infection prevalence was 0.85% by Kato Katz, 21.6% by POC-CCA trace positive (Tr +), and 13.3% trace negative (Tr-). Microhaematuria was 2.77%, with 0.13% of people examined with S. haematobium eggs detected by urine filtration. At the household level, increased (> 30 min) time taken to collect drinking water, sharing a latrine, and lack of handwashing facilities were all associated with a greater risk of A. lumbricoides, hookworm, and S. mansoni infection. Not disposing of infant stool at the household and clothes washing/recreational freshwater contact were significantly associated with higher risk of schistosomiasis infection. Aggregating WaSH data at the community level showed odds of A. lumbricoides, hookworm, and T. trichiura infection were significantly lower as both community sanitation coverage and access to improved drinking water improved.
Conclusions
The principal finding of this study is that lack of access to WaSH, such as improved drinking water and shared toilet and hand-washing facilities, were linked to an increased risk of infection with STH and schistosome parasites. These associations are difficult to establish at an individual household level because of wide variability in access between houses but are detectable when coverage is aggregated at the community level. Maintenance of WaSH facilities as well as increased access within the whole community is important in influencing the community-wide prevalence of infection with STH and schistosome parasites.
Graphical Abstract
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Alasmar A, Kong AC, So AD, DeCamp M. Ethical challenges in mass drug administration for reducing childhood mortality: a qualitative study. Infect Dis Poverty 2022; 11:99. [PMID: 36114588 PMCID: PMC9482260 DOI: 10.1186/s40249-022-01023-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Mass drug administration (MDA) of medications to entire at-risk communities or populations has shown promise in the control and elimination of global infectious diseases. MDA of the broad-spectrum antibiotic azithromycin has demonstrated the potential to reduce childhood mortality in children at risk of premature death in some global settings. However, MDA of antibiotics raises complex ethical challenges, including weighing near-term benefits against longer-term risks—particularly the development of antimicrobial resistance that could diminish antibiotic effectiveness for current or future generations. The aim of this study was to understand how key actors involved in MDA perceive the ethical challenges of MDA. Methods We conducted 35 semi-structured interviews from December 2020–February 2022 with investigators, funders, bioethicists, research ethics committee members, industry representatives, and others from both high-income countries (HICs) and low- and middle-income countries (LMICs). Interview participants were identified via one of seven MDA studies purposively chosen to represent diversity in terms of use of the antibiotic azithromycin; use of a primary mortality endpoint; and whether the study occurred in a high child mortality country. Data were analyzed using constructivist grounded theory methodology. Results The most frequently discussed ethical challenges related to meaningful community engagement, how to weigh risks and benefits, and the need to target MDA We developed a concept map of how participants considered ethical issues in MDA for child mortality; it emphasizes MDA’s place alongside other public health interventions, empowerment, and equity. Concerns over an ethical double standard in weighing risks and benefits emerged as a unifying theme, albeit one that participants interpreted in radically different ways. Some thought MDA for reducing child mortality was ethically obligatory; others suggested it was impermissible. Conclusions Ethical challenges raised by MDA of antibiotics for childhood mortality—which span socio-cultural issues, the environment, and effects on future generations—require consideration beyond traditional clinical trial review. The appropriate role of MDA also requires attention to concerns over ethical double standards and power dynamics in global health that affect how we view antibiotic use in HICs versus LMICs. Our findings suggest the need to develop additional, comprehensive guidance on managing ethical challenges in MDA. Graphical Abstract ![]()
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Depriving Out-of-School Children of Deworming Tablets for Soil-Transmitted Helminth Infection in Bangladesh: The Irony of a School-Based Deworming Programme. Trop Med Infect Dis 2022; 7:tropicalmed7030035. [PMID: 35324582 PMCID: PMC8955424 DOI: 10.3390/tropicalmed7030035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022] Open
Abstract
Since 2008, Bangladesh has had a school-based deworming programme to combat soil-transmitted helminth (STH) infection among school-aged children (SACs). Existing programmes have trouble reaching SACs, especially those out-of-school (OSCs). This study evaluated deworming coverage among school going children (SGCs) and OSCs in two Nilphamari sub-districts. It also evaluated community knowledge on STH control and deworming coverage in both areas for all SACs. Saidpur (intervention) and Kishoregonj (control) sub-districts, in Nilphamari, were surveyed in December 2019. The survey included SACs and their parents. Among SGCs, the intervention group (89.0%) had higher deworming coverage than the control group (75.5%). In the intervention group, 59.9% of OSCs received the deworming tablet versus 24.6% in the control group. Community involvement activities including door-to-door visits, courtyard gatherings, and miking benefited both SACs and their primary caregivers. SACs living in the intervention region, awareness of the last pill distribution date, and caregivers observing BRAC workers in action, were linked to SAC deworming coverage. Re-strategizing the deworming programme to include the OSCs is vital and suggests timely action. Building community awareness and periodic epidemiological assessment can further facilitate an improved drug intake.
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