Population coverage and factors associated with participation following a mass drug administration of azithromycin for trachoma elimination in Amhara, Ethiopia

• Type of Material: Article
• Authors: Caleb D. Ebert, Emory University; Tigist Astale, The Carter Center; Eshetu Sata, The Carter Center; Mulat Zerihun, The Carter Center; Andrew W. Nute, The Carter Center; Aisha E. P. Stewart, The Carter Center; Demelash Gessese, The Carter Center; Gedefaw Ayenew, The Carter Center; Zebene Ayele, The Carter Center; Berhanu Melak, The Carter Center; Melsew Chanyalew, The Amhara Regional Health Bureau; Bizuayehu Gashaw, The Amhara Regional Health Bureau; Zerihun Tadesse, The Carter Center; E. Kelly Callahan, The Carter Center; Samuel Jenness, Emory University; Scott D. Nash, The Carter Center
• Language: English
• Date: 2019-04-01
• Publisher: Wiley: 12 months
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1111/tmi.13208
• Title of Journal or Parent Work: Tropical Medicine and International Health
• ISSN: 1360-2276
• Volume: 24
• Issue: 4
• Start Page: 493
• End Page: 501
• Grant/Funding Information: Lions Clubs International Foundation, the U.K. Department of International Development, the Noor Dubai Foundation and the William H. Donner Foundation.
• Keywords: Public, Environmental & Occupational Health; trachoma; LYMPHATIC FILARIASIS; coverage survey; ethiopia; Tropical Medicine; MORTALITY; Life Sciences & Biomedicine; SAFE strategy; CAMPAIGN; mass drug administration; PROGRAM; Science & Technology
• Research Categories: Chemistry, Pharmaceutical; Health Sciences, Public Health

Abstract

Objectives: 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. We explored factors associated with individual MDA participation at the individual, head of household and household levels in Amhara, Ethiopia. Methods: We conducted four district-level, multilevel cluster random coverage surveys to collect data on self-reported MDA participation and predictors. Random-effects logistic regression modelling was used to identify correlates of MDA participation while adjusting for nesting of individuals at the household and village level. Results: The district-level self-reported participation in the trachoma MDA ranged from 78.5% to 86.9%. Excellent and fair health status (Odds ratio [OR] = 5.77; 95% Confidence interval [CI]: 3.04, 10.95; OR = 7.08; 95% CI: 3.47, 14.46), advanced knowledge of the MDA campaign (OR = 2.93; 95% CI: 2.04, 4.21) and knowledge of trachoma (OR = 1.60; 95% CI: 1.17, 2.19) were all positively associated with MDA participation. When excluding heads of household from the model, correlates retained similar positive associations to participation, in addition to the head of household participation (OR = 3.34; 95% CI: 2.46, 4.54). Conclusions: To increase the impact of MDA campaigns, MDA mobilisation strategies—including comprehensive trachoma and azithromycin messaging and MDA campaign awareness—should target heads of household, those in poorer health and older age groups.