Determinants of drug uptake during mass drug administration for trachoma in Turkana West Sub- County, Turkana County, Kenya.

Abstract

Background: Trachoma is one of the neglected tropical diseases that cause blindness if left untreated. The disease is endemic in 53 countries, where an estimated 325 million people at risk of exposure, with Africa contributing 86% of the burden. In Kenya, trachoma is endemic in 12 out of 47 counties. The World Health Organization (WHO) recommends annual mass drug administration (MDA) using azithromycin for at least 80% of the target population with active transmission. A previous survey indicated there was still 17.5% transmission despite seven rounds of annual MDA done between 2011 and 2021 in Turkana West sub-County. Given the complexity and the distinct population in the sub-County, it is essential to understand the determinants of drug uptake to reduce trachoma transmission in the population. Objectives: To assess the treatment coverage of MDA and identify sociodemographic, community, and program determinants of drug uptake during MDA for Trachoma in Turkana West sub-County. Methodology: A cross-sectional study involving a cluster survey using a calculated sample size of 541 households was used to estimate MDA coverage. Household heads were interviewed using a structured questionnaire. To determine the factors associated with uptake, a sample of 87 was randomly selected from those who did not receive treatment and compared with 87 randomly selected from those who received treatment. Frequencies, proportions, and measures for central tendency were calculated for categorical and continuous variables, respectively. Odds ratio (OR) was used as the measure of association and chi-square for statistical significance; associations with a p-value <0.05 were considered statistically significant. Four key informants; the eye coordinator, health promotion officer, community strategy focal person, and pharmacist based at the sub-County trachoma program were interviewed. Qualitative data were analyzed thematically. Results: A total of 512 respondents were interviewed (94.5% response); the treatment coverage for trachoma was 78% (n=512) from the survey, and the administrative reported coverage was 82% (n=180,885). The mean age of the sampled population (n=174) was 34 years (±13), with 123 (71%) of them being female and 110 (63%) being married. About 99 (57%) of the participants had no formal education, 135 (78%) had no occupation, and 121 (70%) resided in a settled village. Community factors associated with the increase in drug uptake were awareness of trachoma disease (OR=9.1, p-value<0.001), receiving information on planned MDA (OR=2.66, p-value=0.002), health education sessions (OR=2.22, p-value=0.013). The program factor associated with increased drug uptake during MDA was house-to-house drug distribution strategy (OR=3.36, p-value=0.001). Key informants identified seasonal timings; community sensitization and mobilization; supplies; capacity building and community compliance as influencers of MDA uptake. Conclusion: The treatment coverage did not meet the WHO recommended target of 80%, and the administrative reported coverage was higher than that of the survey. Being aware of trachoma, having information about planned MDA, attending a health education session and house-to-house strategy increased azithromycin uptake during MDA. Recommendation: The trachoma program should run effective sensitization campaigns to address the sub-optimal MDA coverage. The program should also employ independent end- process monitoring during MDAs to determine uptake.