Analysis of Factors That Influence Compliance With Praziquantel for the Control of Intestinal Schistosomiasis in Communities of Mpigi District, Uganda.

Abstract

Background: Intestinal schistosomiasis has been a major public health problem in Uganda. Government of Uganda during 2006 initiated Mass Drug Administration (MDA) with annual single dose of praziquantel tablets to all the population living at the risk of the infection. Praziquantel (PZQ) is a drug of choice for treating schistosoma mamansoni but there are reports that indicate variations in compliance with the drug in endemic areas.

Objective: To assess the factors influencing compliance with praziquantel for the control of intestinal schistosomiasis in communities of Buwama and Nkozi sub-Counties, Mpigi district, Uganda.

Methods: Community based cross-sectional study was undertaken among four selected villages of Buwama and Nkozi Sub-counties in the month of August using results of May 2014 MDA compliance rates in the district. Information pertaining compliance with PZQ was gathered from 164 families and 491 respondents were recruited from 4 Villages 2 from Buwama and 2 from Nkozi by interview technique using structured questionnaire and key informant interviews. Data was analysed using SPSS version 16.0 at univariate, bivariate and multivariate levels.

Findings: There was no significant difference in the compliance rate with PZQ between Buwama and Nkozi Sub-counties (χ2=0.165, p= 0.685). Eleven factors associated with compliance were identified: awareness of bilharzia (hard about bilharzias (OR=5.222, C.I=2.078-13.122, P=0.000), Vector for bilharzias (OR=1.263, C.I=1.048-1.522, P=0.014), causes of bilharzia (OR=3.222, C.I=2.168-.090), P=.000 and how we get bilharzia (OR=1.2, C.I=1.013-1.423, P=0.035), same religious affiliation as their CMDs (OR=1.372, C.I=1.078- 1.751, P=0.011), fear for the smell of the tablets of praziquantel (OR=1.128, C.I=1/001-1.270, P=0.048), dose pole (OR=2.845, C.I=1.025-1.363, P=0.022), period of stay in village xi(OR=0.585, C.I =0.471-0.727, P=0.000).Other individual factors such as age, religion and employment of respondents were not associated with PZQ compliance in the area. Gender was the only Socio –behavior factor influencing compliance with praziquantel (OR=0.632, C.I=0.434-0.919, P=0.016). Males were more compliant than the females in both Sub-counties. Other social behaviour factors not influencing compliance were: family members, health seeking behavior, mobility of respondents and having the same religious affiliation as Community Medicine Distributors. Respondents who were sensitized on the disease and its treatment were (OR=2.112, C.I=1.077-4.140, P=0.030), inadequate CMDs training to counteract negative rumors and answer questions from community members, bilharzias seen as a number four disease in the area after malaria and HIV, CMDs do not get enough incentives and allowances during MDA, proportion receiving posters and other IEC materials was found to be small in Buwama and Nkozi respectively(χ2=6.856, p=0.009 and χ2=0.627, p=0.429), there is a variation in the annual treatment period between the two Sub counties (OR=3.202, C.I=1.618-6.336, P=0.001), door-to-door distribution strategy (OR=2.032, C.I=1.749-2.295, P=0.000) mostly used in the two Sub-counties and relatively good supervision during MDA(OR=4.434, C.I=2.345- 8.387, P=0.000) are positive predictors of compliance with praziquantel.

Conclusion: Results of the study identify individual, social-behaviour and program challenges to treatment adherence that are important in planning, implementing and evaluating national treatment programmes for intestinal schistosomiasis in the area. A large number of previous studies have identified community based mass-treatment interventions as an effective strategy to treat affected populations. However, limited evidence is available to discuss challenges to treatment adherence, access, delivery and monitoring at community level. The study contributes to the body of knowledge to the control of intestinal schistosomiasis in the area. It also revealed difficulties in CMDs trainings, distribution strategy, IEC distributions and community-based monitoring of MDA in both Sub-counties.

Recommendations: The research findings could contribute to schistosomiasis control in the two Sub-counties of Buwama and Nkozi. They could also have implications on the control of schistosomiasis in other endemic districts in Uganda and other similar settings elsewhere. The study has contributed to a body of knowledge on intestinal schistosomiasis control that could be useful to researchers and other scientists working on a related or similar topic.

Sensitisation of community members is important to increase awareness of the disease and its treatment, training of CMDs should be conducted for several days to empower them with necessary information necessary to counteract negative rumors and answer questions from community members. In addition the trainings should aim at strengthen community sensitization meetings in the effort to increase accessibility to the medicine in all endemic areas.

The program should increase incentives and allowances to CMDs for several days. Increase in the distribution of IEC materials, supervision and monitoring of program activities especially in Nkozi Sub-county is important to give extra support to CMDs and streamlining the distribution strategy.