03530nas a2200325 4500000000100000008004100001260001600042653002100058653003500079100001300114700001200127700001600139700001300155700001300168700002000181700001600201700001200217700001900229700001400248700001400262700001800276700001600294700001300310245019700323856016700520300001600687490000600703520248100709022001403190 2020 d bElsevier BV 10 aGeneral Medicine 10 amass drug administration (MDA) 1 aOswald W 1 aKepha S 1 aHalliday KE 1 aMcharo C 1 aSafari T 1 aWitek-McManus S 1 aHardwick RJ 1 aAllen E 1 aMatendechero S 1 aBrooker S 1 aNjenga SM 1 aMwandawiro CS 1 aAnderson RM 1 aPullan R 00 aPatterns of individual non-treatment during multiple rounds of mass drug administration for control of soil-transmitted helminths in the TUMIKIA trial, Kenya: a secondary longitudinal analysis uhttps://reader.elsevier.com/reader/sd/pii/S2214109X20303442?token=01F8FA0E943F94EC60530524EEDEB61AFEBE21C8D25D9BB85AEC6F0FD3A463230EE3EE304374C9210FE052D6B1514C7F ae1418-e1426 0 v8 3 aBackground
Few studies have been done of patterns of treatment during mass drug administration (MDA) to control neglected tropical diseases. We used routinely collected individual-level treatment records that had been collated for the Tuangamize Minyoo Kenya Imarisha Afya (Swahili for Eradicate Worms in Kenya for Better Health [TUMIKIA]) trial, done in coastal Kenya from 2015 to 2017. In this analysis we estimate the extent of and factors associated with the same individuals not being treated over multiple rounds of MDA, which we term systematic non-treatment.
Methods
We linked the baseline population of the TUMIKIA trial randomly assigned to receive biannual community-wide MDA for soil-transmitted helminthiasis to longitudinal records on receipt of treatment in any of the four treatment rounds of the study. We fitted logistic regression models to estimate the association of non-treatment in a given round with non-treatment in the previous round, controlling for identified predictors of non-treatment. We also used multinomial logistic regression to identify factors associated with part or no treatment versus complete treatment.
Findings
36 327 participants were included in our analysis: 16 236 children aged 2–14 years and 20 091 adults aged 15 years or older. The odds of having no treatment recorded was higher if a participant was not treated during the previous round of MDA (adjusted odds ratio [OR] 3·60, 95% CI 3·08–4·20 for children and 5·58, 5·01–6·21 for adults). For children, school attendance and rural residence reduced the odds of receiving part or no treatment, whereas odds were increased by least poor socioeconomic status and living in an urban or periurban household. Women had higher odds than men of receiving part or no treatment. However, when those with pregnancy or childbirth in the previous 2 weeks were excluded, women became more likely to receive complete treatment. Adults aged 20–25 years were the age group with the highest odds of receiving part (OR 1·41, 95% CI 1·22–1·63) or no treatment (OR 1·81, 95% CI 1·53–2·14).
Interpretation
Non-treatment was associated with specific sociodemographic groups and characteristics and did not occcur at random. This finding has important implications for MDA programme effectiveness, the relevance of which will intensify as disease prevalence decreases and infections become increasingly clustered. a2214-109X