Determinants of uptake of Mass Drug Administration for Schistosomiasis Control in Butiaba, Uganda

Abstract

Introduction: Schistosomiasis is one of the Neglected Tropical Diseases (NTDs) targeted for elimination in Uganda through Mass drug administration(MDA) using praziquantel with a WHO target coverage and uptake of 75% to eliminate the disease as a public health problem by 2025. Treatment coverages reported have however often been suboptimal for programs to attain the goal of transmission interruption within reasonable time. This study aimed to assess the uptake of praziquantel during MDA and associated factors in Butiaba, Uganda. Methods: A cross sectional study was conducted in five randomly selected villages within Butiaba sub county in September 2021. Both quantitative and qualitative data was collected. Quantitative data was collected through researcher administered semi structured questionnaires. 450 adults (≥18years) were interviewed about swallowing praziquantel/praziquantel uptake during the 2020 MDA exercise, sociodemographic characteristics, knowledge and attitudinal factors for taking/not taking the drug. Qualitative data was collected through 2 Focus Group Discussions and 3 key informant interviews that were purposively selected with representation from the District health office, local leadership and MDA parish supervisors. Results: The overall self-reported uptake of praziquantel was 71.56% (322/450), 95% confidence interval (CI) 67.14%-75.68%. 5.78% of the participants reported having never swallowed praziquantel in their lifetime and 75%(96/128) of participants who didn’t swallow praziquantel in 2020 reported having at least swallowed the drug in the last 10years. Uptake of praziquantel was less likely if the respondent had no knowledge about schistosomiasis signs (adjusted odds ratio [AOR] 0.18, 95% CI 0.08–0.39) and more likely if the respondent was 30-39years (adjusted odds ratio [AOR] 2.31, 95% CI 1.35–3.95) or 40 years and above (adjusted odds ratio [AOR] 2.86, 95%CI 1.45–4.95). Operational challenges such as inadequate supply and financial constraint also influence uptake of praziquantel during MDA in Butiaba. Conclusion: Uptake of praziquantel during MDA in Butiaba was high but still below the target rate of 75% set by WHO. Limited knowledge on schistosomiasis symptoms, being in a young adult age group (18-29) and irregular inadequate drug supply are some of the factors associated with uptake being below target. Rigorous health education, adequate drug supply and a methodical approach to drug distribution targeting the young adults are likely to have considerable potential for increasing praziquantel uptake hence lead to successful schistosomiasis elimination in the sub county. Keywords: Schistosomiasis, mass drug administration, Sub-Saharan Africa, uptake,praziquantel.