Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA.
PLoS Negl Trop Dis. 2012;6(3):e1576. doi: 10.1371/journal.pntd.0001576. Epub 2012 Mar 20.
Persistent non-participation of children in mass drug administration (MDAs) for trachoma may reduce program impact. Risk factors that identify families where participation is a problem or program characteristics that foster non-participation are poorly understood. We examined risk factors for households with at least one child who did not participate in two MDAs compared to households where all children participated in both MDAs.
METHODS/PRINCIPAL FINDINGS: We conducted a case control study in 28 Tanzanian communities. Cases included all 152 households with at least one child who did not participate in the 2008 and 2009 MDAs with azithromycin. Controls consisted of a random sample of 460 households where all children participated in both MDAs. A questionnaire was asked of all families. Random-intercept logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), control for clustering, and adjust for community size. In total, 140 case households and 452 control households were included in the analyses. Compared to controls, guardians in case households had higher odds of reporting excellent health (OR 4.12 (CI 95% 1.57-10.86)), reporting a burden due to family health (OR 3.15 (95% CI 1.35-7.35)), reduced ability to rely on others for assistance (OR 1.66 (95% CI 1.01-2.75)), being in a two (versus five) days distribution program (OR 3.31 (95% CI 1.68-6.50)) and living in a community with < 2 community treatment assistants (CTAs)/1000 residents (OR 2.07 (95% CI 1.04-4.12). Furthermore, case households were more likely to have more children, younger guardians, unfamiliarity with CTAs, and CTAs with more travel time to their assigned households (p-values < 0.05).
CONCLUSIONS/SIGNIFICANCE: Compared to full participation households, households with persistent non-participation had a higher burden of familial responsibility and seemed less connected in the community. Additional distribution days and lessening CTAs' travel time to their furthest assigned households may prevent non-participation.
儿童持续不参与大规模药物治疗（MDA）可能会降低项目效果。导致部分家庭参与项目出现问题的风险因素或促进儿童不参与的项目特征尚不清楚。我们调查了与所有儿童均参与两次阿齐霉素 MDA 的家庭相比，至少有一个儿童未参与两次 MDA 的家庭的风险因素。
方法/主要发现：我们在坦桑尼亚的 28 个社区进行了病例对照研究。病例组包括所有在 2008 年和 2009 年的阿齐霉素 MDA 中，有一个或多个儿童未参与的 152 户家庭。对照组由所有儿童均参与两次 MDA 的 460 户家庭随机抽样组成。向所有家庭发放问卷。采用随机截距逻辑回归模型估计优势比（OR）和 95%置信区间（CI），对聚类进行控制，并调整社区规模。共有 140 个病例家庭和 452 个对照家庭参与分析。与对照组相比，病例组的监护人报告健康状况极佳的可能性更高（OR 4.12（95%CI 95% 1.57-10.86）），报告因家庭健康而负担过重的可能性更高（OR 3.15（95%CI 1.35-7.35）），依靠他人帮助的能力降低（OR 1.66（95%CI 1.01-2.75）），参加两天（而非五天）分配方案的可能性更高（OR 3.31（95%CI 1.68-6.50）），以及所在社区每 1000 名居民的社区治疗助理（CTA）数量不足 2 名（OR 2.07（95%CI 1.04-4.12））。此外，病例组家庭中儿童数量更多、监护人更年轻、对 CTA 不熟悉以及 CTA 到其指定家庭的旅行时间更长的可能性更高（p 值 < 0.05）。
结论/意义：与完全参与家庭相比，持续不参与家庭的家庭责任负担更重，社区联系也更少。增加分配日数并减少 CTA 到最远指定家庭的旅行时间可能会防止不参与。
