Research for Health Environment and Development (RHED), P.O. Box 345, Mangochi, Malawi.
Medical Aid Society of Malawi (MASM) Medi Clinics Limited, Area 12 Medi Clinic, P.O. Box 31659, Lilongwe, 3, Malawi.
BMC Health Serv Res. 2022 Apr 19;22(1):517. doi: 10.1186/s12913-022-07925-3.
Mass drug administration (MDA) is one of the key interventions recommended by WHO for prevention and control of neglected tropical diseases (NTD). In Malawi, MDA is widely carried out annually since 2009 for prevention and control of schistosomiasis and soil-transmitted helminths (STH). No study has been carried out to assess effectiveness of the MDA approach and to document perceptions of health providers and beneficiaries regarding use of MDA. This study was done to understand how well MDA is being implemented and to identify opportunities for improvement in MDA delivery in Malawi.
Designed as a cross-sectional and multi-methods research, the study was carried out in three southern Malawi districts of Chiradzulu, Mangochi and Zomba. In each district, four health centres and 16 villages were randomly selected to participate. A mixed-methods approach to data collection focusing on quantitative data for coverage and knowledge, attitudes and practices assessments; and qualitative data for assessing perceptions of health providers and beneficiaries regarding MDA was used. Quantitative data were processed and analyzed using IBM SPSS software version 26 while qualitative data were analysed using NVivo 12 for Windows.
Knowledge levels about schistosomiasis and STH in the districts varied according to disease aspects asked about. Majority are more knowledgeable about what schistosomiasis is (78%) and whether STH are treatable with drugs (97%); with least knowledgeable about the organism that transmits schistosomiasis (18%), types of schistosomiasis (11%) and what causes STH (20%). In 2018 and 2019 the districts registered high coverage rates for praziquantel and albendazole using community-based MDA (73-100%) and using school-based MDA (75-91%). Both the health authorities and community members perceived the MDA approach as good because it brings treatment closer to people.
With the high MDA coverage obtained in communities and schools, the effectiveness of MDA in the target districts is satisfactory. There are, however, several challenges including disproportionate knowledge levels, which are hampering progress towards attainment of the 2030 global NTD goals. There is a need for promotion of community participation and partnerships as well as implementation of other recommended interventions for sustainable prevention and control of schistosomiasis and STH.
大规模药物治疗（MDA）是世界卫生组织推荐的用于防治被忽视的热带病（NTD）的关键干预措施之一。在马拉维，自 2009 年以来，每年广泛开展 MDA 以预防和控制血吸虫病和土壤传播性蠕虫（STH）。尚未进行研究评估 MDA 方法的有效性，并记录卫生提供者和受益人对 MDA 使用的看法。本研究旨在了解 MDA 的实施情况，并确定改善马拉维 MDA 提供的机会。
本研究采用横断面和多方法设计，在马拉维南部的奇拉祖鲁、曼戈切和宗巴三个地区进行。在每个地区，随机选择四个卫生中心和 16 个村庄参与。采用混合方法收集数据，重点是定量数据，用于覆盖范围和知识、态度和实践评估；以及定性数据，用于评估卫生提供者和受益人对 MDA 的看法。定量数据使用 IBM SPSS 软件版本 26 进行处理和分析，定性数据使用 NVivo 12 for Windows 进行分析。
根据所询问的疾病方面，地区的血吸虫病和 STH 知识水平有所不同。大多数人更了解血吸虫病是什么（78%）以及 STH 是否可以用药物治疗（97%）；对传播血吸虫病的生物（18%）、血吸虫病的类型（11%）和导致 STH 的原因（20%）了解最少。2018 年和 2019 年，该地区使用基于社区的 MDA（73-100%）和基于学校的 MDA（75-91%），记录了吡喹酮和阿苯达唑的高覆盖率。卫生当局和社区成员都认为 MDA 方法很好，因为它使治疗更接近人们。
在社区和学校获得高 MDA 覆盖率的情况下，目标地区 MDA 的有效性令人满意。然而，存在一些挑战，包括不成比例的知识水平，这阻碍了实现 2030 年全球 NTD 目标的进展。需要促进社区参与和伙伴关系，以及实施其他推荐的干预措施，以实现血吸虫病和 STH 的可持续预防和控制。
