03347nas a2200349   4500000000100000008004100001260001200042653002300054653004600077653001800123653002200141100001400163700001400177700001600191700001300207700001200220700001100232700001200243700001600255700001100271700001300282700001400295700001500309700001300324700001400337245018600351856005900537300000900596490000600605520237200611022001402983       2024                            d  c10/202410aControl Strategies10aInfections, diseases, disorders, injuries10aPublic health10aSystematic review1 aSangare M1 aDiabate A1 aCoulibaly Y1 aTanapo D1 aThera S1 aDolo H1 aDicko I1 aCoulibaly O1 aSall B1 aTraore F1 aDoumbia S1 aKulkarni M1 aNutman T1 aKrentel A00aUnderstanding the barriers and facilitators related to never treatment during mass drug administration among mobile and migrant populations in Mali: a qualitative exploratory study.  uhttps://gh.bmj.com/content/bmjgh/9/10/e015671.full.pdf  a1-150 v93 a<p><strong>Introduction: </strong>Five of the neglected tropical diseases use a strategy of preventative chemotherapy distributed via mass drug administration (MDA) for all eligible people living in endemic areas. To be successful, high coverage must be sustained over multiple rounds. Therefore, it will be difficult to reach elimination as a public health problem using MDA if there remain clusters of people who have never been treated. The study aims to explore the reasons why people with high mobility report being never treated during MDA and to provide evidence to support the development of standardised questions for data collection using qualitative research tools.</p>

<p><strong>Methods: </strong>We conducted an exploratory study using qualitative methods among displaced people, nomads/transhumants and economic migrants who self-reported that they had never been treated during MDA in the health districts of Tominian and Kalabancoro in Mali. Data were collected through in-depth individual interviews and focus group discussions. Nvivo V.14 software was used for data management and analysis.</p>

<p><strong>Results: </strong>The main reasons reported for never treatment included: geographical mobility, lack of awareness/information, negative rumours, fear of side effects, conflict and insecurity and logistical difficulties faced in reaching these populations. Proposed solutions included involving communities in the MDA, increasing awareness and information campaigns, effectively managing side effects, and designing and implementing flexible and effective interventions.</p>

<p><strong>Conclusion: </strong>This study highlights that there are people with high mobility who may never have been treated during any round of MDA. The reasons for never treatment highlight the challenges faced when reaching particular groups during MDA activities/interventions. Suggested remedies will require programmes to implement more flexible and tailored interventions. Customised approaches based on the context are essential to guarantee fair access to preventive chemotherapy. Effective interventions must consider the supply and demand side in crafting interventions. This research adds to the evidence base to understand never treatment, particularly among highly mobile population groups and in schistosomiasis elimination programmes.</p>
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