Co-Delivery of Preventive Chemotherapies Against Onchocerciasis and Soil-Transmitted Helminths Along With Complementary Social and Behavioral Change Communication Interventions in Ethiopia
Background: Increased global attention is focused on learning health campaign integration effectiveness, acceptability, and feasibility. This study assessed the effectiveness and acceptability of codelivered mass drug administrations (MDAs) for onchocerciasis chemotherapy and deworming of children and women of reproductive age, complemented by social and behavioral change communication (SBCC) interventions to promote appropriate knowledge and practices related to water, sanitation, and hygiene, COVID-19, onchocerciasis and soil-transmitted helminths, and on identification and referral of unvaccinated and under-vaccinated children under one year of age.
Methods: A mixed-method implementation study with a pre-posttest design was conducted in 10 villages of Jimma zone, Oromia, Ethiopia, between June 2021 and September 2022. A formative qualitative assessment was conducted to explore communities’ perceptions, enablers, and barriers for the co-delivery. Then, a household survey involving 732 households was conducted to assess communities’ knowledge, attitudes, and practices (KAP). Informed by the formative results, a detailed co-delivery strategy was co-developed through a participatory process. Health extension workers (HEWs) supported by community volunteers co-administered the MDAs in villages in May 2022. A KAP-integrated post-campaign coverage validation survey was conducted on 776 sampled households and qualitatively through focus group discussions with beneficiaries and key informant interviews and expert group discussion at different levels. The data were analyzed for themes using SPSS version 22.0 and ATLAS.ti version 7.5.
Results: The co-delivery strategy achieved treatment coverage of 89.5%, 84.1%, and 83.2% for onchocerciasis, soil-transmitted helminths (STH), and combination therapy, respectively, with reported adverse events close to zero. Communities’ overall satisfaction with the co-administration of medicines (91.6%) and intention to receive co-administration in the future (96.3%) were quite high. Compared to the baseline, communities’ knowledge of onchocerciasis STH and their prevention methods improved substantially. For example, the knowledge that a blackfly causes onchocerciasis increased by 20%; contact with soil/feces transmits STH (by 13%); and appropriate hand-washing practices before handling/eating food (by 32.8%), and after toilet (by 31.7%). Communities and stakeholders perceived that the co-delivery strategy is effective, acceptable, and feasible. Reasons for acceptability include direct engagement of HEWs in the co-administration, which is believed to have resulted in fairness, access, and transparency in the distribution and provision of adequate information. Similarly, stakeholders believed the co-delivery had advantages over the single-campaign approach as a result of improved access and equity (effectiveness); higher efficiency (reduced misuse/abuse of drugs); and improved quality (proper dosage and management of activities).
Conclusions: The co-delivery led by the HEWs and supported by community volunteers produced good treatment coverage. Moreover, the approach was found to be appropriate, acceptable, and feasible. Thus, it is worthy of adoption, continuation, and scaling up with further evaluation in other contexts and settings of Ethiopia. Reorientation of community volunteers’ role from drug distributors to “community mobilizers” is recommended for their effective engagement in the co-delivery. The study findings can inform policy and practice toward the goals of eliminating onchocerciasis, STH, and neglected tropical diseases