Okoyo Collins, Kopi Omar, Gichuki Paul M, Kimani Bridget W, Kanyui Tabitha, Waititu Titus, Omondi Wyckliff P, Njomo Doris W
Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya.
Department of Epidemiology, Statistics and Informatics, Kenya Medical Research Institute, Nairobi, Kenya.
PLoS Negl Trop Dis. 2025 Aug 11;19(8):e0013408. doi: 10.1371/journal.pntd.0013408. eCollection 2025 Aug.
Trachoma remains a significant public health issue in many regions, including Baringo County, Kenya. Despite the ongoing mass drug administration (MDA) campaigns in Baringo, the achievement of optimal treatment coverage has been hindered by factors such as conflicts and the nomadic lifestyle dominating this region. To address these challenges, innovative strategies are needed to improve community engagement and enhance MDA uptake. This study evaluated the effectiveness of community participation approaches in improving MDA access among residents of Baringo County.
The study used a pre- and post-intervention design, utilizing a systematic random sampling of households. The study area was Loyamorok Ward, Tiaty East Sub-County in Baringo County. The county was purposively selected due to its historical challenges in achieving optimal treatment coverage for trachoma, including its nomadic lifestyle, intercounty border movements, and persistent conflicts. A sample of 350 respondents was randomly selected for the pre- and post-intervention surveys. Data were collected using a structured questionnaire, which captured information on socio-demographic and socio-economic characteristics, knowledge about trachoma and MDA, drug use, and perceptions of the treatment. Generalized linear models were employed to estimate the likelihood of MDA access before and after the intervention and the impact of the intervention, which incorporated time difference as an interaction term in the models.
The results indicated a significant increase in community participation and MDA access, with the proportion of participants who took drugs during the last MDA significantly rising from 72.4% pre-intervention to 92.9% post-intervention (Diff = -0.205, z = -5.68, p < 0.001). Type of occupation was found to significantly impact access to MDA for trachoma, participants doing pastoral activities (aOR = 11.45, 95% CI: 1.15-114.14, p = 0.038), and those who were not engaged in work outside the home (housewife) (aOR = 12.87, 95% CI: 1.09-151.52, p = 0.042) showed significant increased access to MDA compared to salaried workers. The study showed that knowledge about trachoma and MDA significantly improved after the implementation of the interventions. Awareness about MDA increased from 45.7% during pre-intervention to 53.3% post-intervention.
These findings suggest that the implemented community participation strategies positively influenced MDA uptake. The implemented interventions should be considered for wider application to enhance treatment coverage and accelerate trachoma elimination efforts in Kenya.
沙眼在包括肯尼亚巴林戈县在内的许多地区仍然是一个重大的公共卫生问题。尽管巴林戈正在开展大规模药物管理（MDA）运动，但该地区的冲突和游牧生活方式等因素阻碍了最佳治疗覆盖率的实现。为应对这些挑战，需要创新策略来提高社区参与度并增强MDA的接受度。本研究评估了社区参与方法在改善巴林戈县居民获得MDA方面的有效性。
该研究采用干预前后设计，对家庭进行系统随机抽样。研究区域是巴林戈县提亚蒂东部次县的洛亚莫罗克选区。由于该地区在实现沙眼最佳治疗覆盖率方面存在历史挑战，包括游牧生活方式、县际边境流动和持续冲突，因此有目的地选择了该地区。在干预前后的调查中随机抽取了350名受访者作为样本。使用结构化问卷收集数据，该问卷收集了社会人口和社会经济特征、沙眼和MDA知识、药物使用以及对治疗的看法等信息。采用广义线性模型估计干预前后获得MDA的可能性以及干预的影响，该模型将时间差异作为交互项纳入其中。
结果表明社区参与度和获得MDA的机会显著增加，在最后一次MDA期间服药的参与者比例从干预前的72.4%显著上升至干预后的92.9%（差异=-0.205，z=-5.68，p<0.001）。发现职业类型对获得沙眼MDA有显著影响，从事畜牧活动的参与者（调整后的比值比[aOR]=11.45，95%置信区间[CI]：1.15-114.14，p=0.038）以及不从事家庭以外工作的人（家庭主妇）（aOR=12.87，95%CI：1.09-151.52，p=0.042）与受薪工人相比，获得MDA的机会显著增加。研究表明，实施干预措施后，对沙眼和MDA的了解有了显著改善。对MDA的知晓率从干预前的45.7%提高到干预后的53.3%。
这些发现表明实施的社区参与策略对MDA的接受度产生了积极影响。应考虑更广泛地应用所实施的干预措施，以提高治疗覆盖率并加速肯尼亚的沙眼消除工作。
