Barriers and Gaps on Utilization and Coverage of Mass Drug Administration Program against Soil-Transmitted Helminth Infection in Bangladesh; an Implementation Research.

Tilak Chandra Nath, dr. Elsa Herdiana Murhandarwati, M.Kes., Ph.D. and Dr. Dra. Retna Siwi Padmawati, MA.

2017 | Tesis | S2 Ilmu Kesehatan Masyarakat

Introduction: Soil transmitted helminth (STH) infection, one of the 17 Worlds most Neglected Tropical Diseases (NTDs), is an epidemic public health problem in Bangladesh. Despite several rounds of mass drug administration (MDA), Bangladesh has faced challenges to achieve the target levels of coverage and compliance with its MDA program to eliminate STH infection. Objectives: The primary objectives of this study were to explore the barriers and gaps that hinder the utilization and coverage of MDA for STH by assessing the perception of community people towards the acceptability of the interventions. Materials & Methods: A mixed method study were conducted between January to July 2017 in Dhaka and Sylhet districts of Bangladesh. Qualitative data were collected through focus group discussions, in-depth interviews and key informant interviews and quantitative data were collected by means of a structured questionnaire. The study population included school age children with relevant parents, school teachers, health workers, community leaders and MDA program managers. Mixed sampling approaches were used to recruit study population. Descriptive statistical analysis was done to examine the quantitative data and thematic analysis was used for the qualitative data. In order to conclude whether results are statistically significant or not, the cut-off point for p-values was set at 0.05. Results: It was revealed that the participants have positive attitudes towards MDA but they pointed out the limitations in reaching all target population. The level of knowledge regarding STH and MDA were found to be significantly different among the study population. The evaluated coverage of MDA was also found lower than that reported. Some of the major barriers associated with coverage of MDA for STH found in this study were inadequate drug distribution policy, accessibility to schools, lack of community engagement, inadequate record keeping and follow up after each MDA cycle, and information dissemination gap. Lack of information about population dynamics, rumors about side effects and poor motivation among stakeholders adversely affected the acceptability and compliance of the intervention. Conclusion: This study has explored various factors that have become barriers inhibiting coverage and utilization of MDA for STH. It was found that MDA for STH failed to reach all target population which probably leads to the continued high prevalence rates of STH in Dhaka and Sylhet districts of Bangladesh. There is the need to re-strategize drug distributing methods and create effective policies to include all targeted population. Use of local channels for community sensitization, addition of local distribution points, regular monitoring and follow up and promotion of health education can possibly enhance both treatment coverage and program infrastructure.

Introduction: Soil-transmitted helminth (STH) infection, one of the 17 Worlds most Neglected Tropical Diseases (NTDs), is an epidemic public health problem in Bangladesh. Despite several rounds of mass drug administration (MDA), Bangladesh has faced challenges to achieve the target levels of coverage and compliance with its MDA program to eliminate STH infection. Objectives: The primary objectives of this study were to explore the barriers and gaps that hinder the utilization and coverage of MDA for STH by assessing the perception of community people towards the acceptability of the interventions. Materials & Methods: A mixed method study were conducted between January to July 2017 in Dhaka and Sylhet districts of Bangladesh. Qualitative data were collected through focus group discussions, in-depth interviews and key informant interviews and quantitative data were collected by means of a structured questionnaire. The study population included school age children with relevant parents, school teachers, health workers, community leaders and MDA program managers. Mixed sampling approaches were used to recruit study population. Descriptive statistical analysis was done to examine the quantitative data and thematic analysis was used for the qualitative data. In order to conclude whether results are statistically significant or not, the cut-off point for p-values was set at 0.05. Results: It was revealed that the participants have positive attitudes towards MDA but they pointed out the limitations in reaching all target population. The level of knowledge regarding STH and MDA were found to be significantly different among the study population. The evaluated coverage of MDA was also found lower than that reported. Some of the major barriers associated with coverage of MDA for STH found in this study were inadequate drug distribution policy, accessibility to schools, lack of community engagement, inadequate record keeping and follow-up after each MDA cycle, and information dissemination gap. Lack of information about population dynamics, rumors about side effects and poor motivation among stakeholders adversely affected the acceptability and compliance of the intervention. Conclusion: This study has explored various factors that have become barriers inhibiting coverage and utilization of MDA for STH. It was found that MDA for STH failed to reach all target population which probably leads to the continued high prevalence rates of STH in Dhaka and Sylhet districts of Bangladesh. There is the need to re-strategize drug distributing methods and create effective policies to include all targeted population. Use of local channels for community sensitization, addition of local distribution points, regular monitoring and follow-up and promotion of health education can possibly enhance both treatment coverage and program infrastructure.

Kata Kunci : Barriers, Utilization, Coverage, Mass Drug Administration, Soil-Transmitted Helminth.