Cromwell E.A., King J.D., McPherson S., Jip F.N., Patterson A.E., Mosher A.W., Evans D.S., Emerson P.M.
Monitoring of Mass Distribution Interventions for Trachoma in Plateau State, Nigeria
PLoS Neglected Tropical Diseases
The Carter Center, Atlanta, GA, United States; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; The Carter Center Nigeria, Jos, Nigeria
Cromwell, E.A., The Carter Center, Atlanta, GA, United States; King, J.D., The Carter Center, Atlanta, GA, United States; McPherson, S., Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Jip, F.N., The Carter Center Nigeria, Jos, Nigeria; Patterson, A.E., The Carter Center, Atlanta, GA, United States; Mosher, A.W., The Carter Center, Atlanta, GA, United States; Evans, D.S., The Carter Center, Atlanta, GA, United States; Emerson, P.M., The Carter Center, Atlanta, GA, United States
Mass drug administration (MDA) with antibiotics is a key component of the SAFE strategy for trachoma control. Guidelines recommend that where MDA is warranted the whole population be targeted with 80% considered the minimum acceptable coverage. In other countries, MDA is usually conducted by salaried Ministry of Health personnel (MOH). In Plateau State, Nigeria, the existing network of volunteer Community Directed Distributors (CDD) was used for the first trachoma MDA. We conducted a population-based cluster random survey (CRS) of MDA participation to determine the true coverage and compared this to coverage reported from CDD registers. We surveyed 1,791 people from 352 randomly selected households in 24 clusters in three districts in Plateau State in January 2011, following the implementation of MDA. Households were enumerated and all individuals present were asked about MDA participation. Household heads were questioned about household-level characteristics and predictors of participation. Individual responses were compared with the CDD registers. MDA coverage was estimated as 60.3% (95% CI 47.9-73.8%) by the survey compared with 75.8% from administrative program reports. CDD registration books for comparison with responses were available in 19 of the 24 clusters; there was a match for 658/682 (96%) of verifiable responses. CDD registers did not list 481 (41.3%) of the individuals surveyed. Gender and age were not associated with individual participation. Overall MDA coverage was lower than the minimum 80% target. The observed discrepancy between the administrative coverage estimate from program reports and the CRS was largely due to identification of communities missed by the MDA and not reported in the registers. CRS for evaluation of MDA provides a useful additional monitoring tool to CDD registers. These data support modification of distributor training and MDA delivery to increase coverage in subsequent rounds of MDA. © 2013 Cromwell et al.
azithromycin; tetracycline; adolescent; adult; aged; article; child; female; health education; health program; health survey; household; human; interview; major clinical study; male; mass drug administration; monitoring; Nigeria; patient participation; preschool child; prevalence; register; sample size; school child; trachoma; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Child; Child, Preschool; Drug Monitoring; Drug Therapy; Drug Utilization; Female; Health Services Research; Humans; Infant; Interviews as Topic; Male; Middle Aged; Nigeria; Patient Acceptance of Health Care; Trachoma; Treatment Outcome; Young Adult