Special Program of Implementation Research on Tropical Diseases, Faculty of Medicine, Universitas Gadjah Mada, Indonesia; Department of Parasitology, Sylhet Agricultural University, Bangladesh.
Faculty of Medicine, Universitas Gadjah Mada, Indonesia.
J Infect Public Health. 2019 Mar-Apr;12(2):205-212. doi: 10.1016/j.jiph.2018.10.002. Epub 2018 Oct 29.
Bangladesh has implemented school-based mass drug administration (MDA) bi-annually since 2008 aimed to control soil-transmitted helminth (STH) infection. Despite several rounds of MDA, the government is still facing challenges to achieve the target coverage and utilization of the intervention. This study was done to explore and explain the barriers and gaps that hinder the utilization and coverage of MDA for STH.
This research was a mixed method study, was conducted in two selected districts of Bangladesh. A total of 160 questionnaire surveys, 12 in-depth interviews, 8 focus group discussion, and 2 key-informant interviews were done among 238 study participants which included school-age children with relevant parents, school teachers, health workers, community leaders and MDA program managers. Descriptive statistical analysis was used to analyze the quantitative data while thematic analysis was applied for the qualitative data.
It was revealed that the participants have positive attitudes towards MDA but they pointed out the limitations in reaching all target population especially non-school going children. The level of knowledge regarding STH and MDA were found different among the study population. The evaluated coverage of MDA was also found lower than that reported. Some major barriers associated with MDA coverage found in this study were drug distribution policy, accessibility to schools, poor record keeping, follow-up, and information dissemination. Inadequate information about population dynamics and rumors about side effects of MDA drugs adversely affected the compliance of the intervention. Insufficient training of drug distributors and poor motivation among stakeholders also added to the barriers.
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, adding local distribution points, regular monitoring and follow-up and promotion of health education can possibly enhance both treatment coverage and program infrastructure.
自 2008 年以来，孟加拉国每两年实施一次学校群体药物驱虫（MDA），旨在控制土壤传播性蠕虫（STH）感染。尽管已经进行了几轮 MDA，但政府仍面临着难以实现目标覆盖率和干预措施利用的挑战。本研究旨在探讨和解释阻碍 STH MDA 利用和覆盖的障碍和差距。
这是一项混合方法研究，在孟加拉国的两个选定地区进行。共有 238 名研究参与者参与了 160 份问卷调查、12 次深入访谈、8 次焦点小组讨论和 2 次关键知情人访谈，其中包括学龄儿童及其相关家长、学校教师、卫生工作者、社区领导和 MDA 项目管理人员。描述性统计分析用于分析定量数据，而主题分析则用于分析定性数据。
研究结果表明，参与者对 MDA 持积极态度，但他们指出，特别是对于非在校儿童，很难覆盖到所有目标人群。研究人群对 STH 和 MDA 的了解程度存在差异。评估的 MDA 覆盖率也低于报告的覆盖率。本研究发现与 MDA 覆盖率相关的一些主要障碍包括药物分发政策、学校可达性、记录保存不善、随访和信息传播。关于人口动态的信息不足以及关于 MDA 药物副作用的谣言，对干预措施的依从性产生了不利影响。药物分发人员的培训不足以及利益相关者的积极性不高也增加了障碍。
有必要重新制定药物分发方法并制定有效的政策，以覆盖所有目标人群。利用当地渠道进行社区宣传、增加当地分发点、定期监测和随访以及推广健康教育，可能会提高治疗覆盖率和计划基础设施。
