Mass drug administration coverage and determinants of drug uptake for elimination of Onchocerciasis in Ulanga District

Abstract

AbstractBackgroundOnchocerciasis remain to be an important public health problem targeted for elimination in Tanzania. Ulanga District was known for its high endemicity since 1960s and has been implementing MDA through Community Directed Treatment with Ivermectin (CDTI) strategy since 1998. However, current reports indicate high prevalence of Onchocerciasis in both human and vector species probably because of poor treatment coverage indicating limited evidence for transmission. This study was conducted to assess treatment coverage and explore determinants of drug uptake during MDA program.MethodsA cross-sectional community-based study using multistage cluster sampling was carried out in Ulanga District, Morogoro Tanzania from April-June 2019. Study participants were randomly selected from households and interviewed using a structured questionnaire. Modified Poisson regression was performed to determine independent factors associated with MDA uptake.ResultsA total of 502 participants were recruited during the study period with a response rate of 96%. The majority (67%) were females, and the mean age of the study participants was 37.8 ±15 years with an age range of 25–34 (25.5 %). MDA coverage for the studied villages was as follows; Mawasiliano (68%) Uponera (83%), Isongo (84%) and Togo (79%). The drug uptake for all villages was below the optimal coverage recommended by WHO (85%) for successful transmission interruption. Having an age of ≤ 24 years [Adjusted Prevalence Ration (APR) = 3.9(95% CI:1.9-8.3), p < 0.05)], Living in the village for at least a year [APR = 3.4 (95% CI:2.4-4.8), p <0.05)] and believing IVM prevent Onchocerciasis [APR = 13.4(95% CI:2.9-60.9)], p<0.05) were associated with increased chances of Ivermectin uptake during MDA. In addition, decreased drug uptake [APR = 12(95% CI: 2.4-60.9), p<0.05)] was attributable to fear of restriction to drinking alcohol after taking drugs.ConclusionLow coverage below the WHO optimal recommended coverage has been demonstrated in the studied villages. This implies low drug uptake, delayed interruption of transmission and Onchocerciasis elimination. These findings, therefore, emphasize the need to intensify the MDA awareness campaigns targeting less compliant groups in the community to reinforce the benefits of ivermectin in Onchocerciasis control and address the community misconceptions about MDA.