Adherence of community health volunteers to mass drug administration guidelines for schistosomiasis control in Western Kenya

Abstract

Background Mass drug administration (MDA) of Praziquantel to at-risk populations is the main control strategy in endemic regions against Schistosomiasis. Community health volunteers (CHVs) are the primary implementers of MDA programmes for various neglected tropical diseases in sub- Saharan Africa and are key to achieving programmes goals. CHVs involvement in MDA activities is critical when assessing intervention implementation because of their connection with the health systems, programme managers, and the communities they work in. The objectives of this study were to measure adherence of CHVs to MDA guidelines and to determine the relationship between measured adherence and its determinants. Methodology A cross-sectional survey was conducted in Kisumu, Siaya and Homa Bay counties. The study population was comprised of 72 CHVs who were previously involved in MDA activities in western Kenya. Data was collected using validated interviewer-administered questionnaires and analysed using Stata v.14. The questionnaire was developed based on Carroll’s conceptual framework for implementation fidelity and the current MDA guidelines for schistosomiasis. The outcome variable was adherence. Adherence scores were computed as an overall composite score derived by aggregating and averaging scores from two components of adherence, coverage and content. Logistic regression analyses were then applied to establish the determinants associated with adherence. Results More female CHVs (54/72, 75%) participated in the MDA activities compared to the male CHVs. The CHVs ages ranged from 27 to 67 years. Content and coverage were both delivered with high adherence to the guidelines by the CHVs, content was however shown to be an important component with regard to adherence as a higher number of CHVs recorded the highest possible score in this component of adherence. In the three counties, 81% of the CHVs scored high adherence to the MDA guidelines. Quality of delivery was associated with high adherence. The odds of adherence were significantly higher for the CHVs who waited for side effects in the community members compared to those who did not wait (OR 4.05, 95% CI:1.05- 15.59) and was statistically significant (p = 0.04). Conclusions and Recommendations It is important that programme managers monitor the process of implementation where CHVs are involved to ensure that programmes are implemented as intended. During the MDA activities, CHVs should be encouraged to wait after administration of treatment not only to manage the side effects but to also ensure that all community members are taking the medication and thus achieve the 75% treatment goal. The current conceptual framework by Carroll provides a guide in the evaluation of CHV performance during intervention activities. Further research on adherence with regard to evaluating CHV performance would prove useful in ensuring programme goals are met.