Factors Associated with Non-Participation and Non-Adherence in Directly Observed Mass Drug Administration for Malaria in The Gambia.
Factors Associated with Non-Participation and Non-Adherence in Directly Observed Mass Drug Administration for Malaria in The Gambia.
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DOI：
10.1371/journal.pone.0148627
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Grietens KP
中科院分区：
文献类型：
--
作者：
Dierickx S;Gryseels C;Mwesigwa J;O'Neill S;Bannister-Tyrell M;Ronse M;Jaiteh F;Gerrets R;D'Alessandro U;Grietens KP
据报告疟疾传播有所下降的几个疟疾流行国家正在考虑大规模药物管理对消除疟疾的潜在好处。为了使这一战略发挥作用，重要的是要有很大比例的目标人群参与，这需要深入了解可能影响MDA计划参与和遵守的因素。这项社会科学研究是2014年6月至8月在冈比亚农村12个村庄进行的一轮直接观察的双氢青蒿素-哌喹MDA运动的辅助。社会科学研究采用了一种混合方法，结合定性方法（参与观察和深入访谈）和定量方法（非参与和非坚持社区成员之间的结构化后续访谈）。在研究村庄登记的3942人中，67.9%坚持连续三天的剂量。其余村民中，12.6%没有参加筛查，3.5%不符合条件，16%没有遵守治疗计划。不参与和依从性的主要障碍是个人和特定亚组的长期和短期流动性、感知的药物不良反应和谣言、与MDA物流相关的不便（例如等待时间）以及感知的MDA信息缺乏。虽然目标社区没有根本性的抵制，但坚持率为67.9%。这表明有必要了解当地的看法和障碍，以提高其效力。此外，某些制约因素在社会空间上是聚集的，这可能会造成问题，因为疟疾残余传播的重点地区可能仍然存在，使疟疾传播到传播暂时中断的邻近地区。
The potential benefits of Mass Drug Administration (MDA) for malaria elimination are being considered in several malaria endemic countries where a decline in malaria transmission has been reported. For this strategy to work, it is important that a large proportion of the target population participates, requiring an in-depth understanding of factors that may affect participation and adherence to MDA programs. This social science study was ancillary to a one-round directly observed MDA campaign with dihydroartemisinin-piperaquine, carried out in 12 villages in rural Gambia between June and August 2014. The social science study employed a mixed-methods approach combining qualitative methods (participant observation and in-depth interviewing) and quantitative methods (structured follow-up interviews among non-participating and non-adhering community members). Of 3942 people registered in the study villages, 67.9% adhered to the three consecutive daily doses. For the remaining villagers, 12.6% did not attend the screening, 3.5% was not eligible and 16% did not adhere to the treatment schedule. The main barriers for non-participation and adherence were long and short-term mobility of individuals and specific subgroups, perceived adverse drug reactions and rumors, inconveniences related to the logistics of MDA (e.g. waiting times) and the perceived lack of information about MDA. While, there was no fundamental resistance from the target communities, adherence was 67.9%. This shows the necessity of understanding local perceptions and barriers to increase its effectiveness. Moreover, certain of the constraining factors were socio-spatially clustered which might prove problematic since focal areas of residual malaria transmission may remain allowing malaria to spread to adjacent areas where transmission had been temporarily interrupted.