| Abstrakt: |
In Baringo County, Kenya, trachoma remains endemic despite repeated mass drug administration (MDA) efforts, with coverage in one of the wards consistently falling short of world health organization (WHO) targets. The disease is endemic in 12 out of the 47 counties in Kenya. Baringo county is a pastoral conflict, hard to reach area where eight rounds of mass drug administration (MDA) for trachoma have been implemented. In Loyamorok ward, treatment coverage has been below 68% against the WHO recommended threshold of 80%. Community engagements that promote participatory approaches are key to MDA success. In this study, we describe community-based participatory approaches qualitatively developed and implemented during the intervention phase of a study that involved a pre-intervention, intervention and post intervention phases and aimed to address barriers of community participation and access to trachoma MDA. Interviews and focus group discussions were used to identify barriers to community participation in MDA, that included power and gender dynamics, rampant insecurity, community myths and misconceptions, migration in search of water and pastures, vastness and terrain and ineffective teams which resulted to unsupervised swallowing of drugs during MDA campaigns. Stakeholders in trachoma were identified through meetings with national, county and sub-county health management teams. The stakeholders, community members and the research team used the identified barriers to formulate MDA strategies including effective stakeholder engagement, enhanced social mobilization, community awareness creation on trachoma, effective planning and execution of MDA and implementation monitoring of the MDA campaign, all aimed at increasing MDA coverage. Overall MDA coverage in the area increased from 67.6% in 2021 to 87% in 2023 thus meeting the WHO threshold of 80%. The use of community-based, participatory approaches in the development and implementation of data driven strategies has the potential to positively influence MDA coverage for trachoma, and other neglected tropical diseases. Author summary: Trachoma is a disease of the eye and a leading infectious cause of blindness in sub-Saharan Africa. It is caused by a bacterium called Chlamydia trachomatis. It is transmitted by directly or indirectly transferring of eye and nose discharges from people who already have the disease mostly by flies. The disease in controlled by among other things provision of drugs to communities where the disease is endemic through mass drug administration (MDA). For the MDA to be effective, more than 80% of the community members should be reached. In areas where communities record very low access to MDA, there is need to identify barriers and develop strategies to mitigate the same. In this study we describe community-based participatory approaches employed to develop and test implementation strategies aimed at increasing access to trachoma MDA in Loyamorok ward of Baringo county. The results showed an increase in community participation in the subsequent MDA, which could be attributed to the implemented strategies. [ABSTRACT FROM AUTHOR] |
