Mass drug administration and the sustainable control of schistosomiasis: Community health workers are vital for global elimination efforts

Objectives: Schistosomiasis control is centred on preventive chemotherapy through mass drug administration (MDA). However, endemic countries continue to struggle to attain target coverage rates and patient compliance. In the Philippines, barangay health workers (BHWs) play a vital role in the coordination of MDA, acting as advocates, implementers, and educators. The aim of this study was to determine whether BHW knowledge and attitudes towards schistosomiasis and MDA is sufficient and correlated with resident knowledge and drug compliance. Methods: A cross-sectional survey was conducted in 2015 among 2186 residents and 224 BHWs in the province of Northern Samar, the Philippines using a structured survey questionnaire. Results: BHWs showed good familiarity on how schistosomiasis is acquired and diagnosed. Nevertheless, both BHWs and residents had poor awareness of the signs and symptoms of schistosomiasis, disease prevention, and treatment options. There was no correlation between the knowledge scores of the BHWs and the residents (r = 0.080, p = 0.722). Kruskal–Wallis analysis revealed significant differences in BHW knowledge scores between the low (3.29, 95% confidence interval 3.16–3.36), moderate (3.61, 95% confidence interval 3.49–3.69), and high (4.05, 95% confidence interval 3.77–4.13) compliance village groups (p = 0.002), with the high compliance areas having the highest mean knowledge scores. Conclusions: This study highlights the importance of community health workers in obtaining the World Health Organization drug coverage rate of 75% and improving compliance with MDA in the community. Investing in the education of community health workers with appropriate disease-specific training is crucial if disease elimination is ultimately to be achieved

Mass drug administration and the sustainable control of schistosomiasis: an evaluation of treatment compliance in the rural Philippines

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background Preventive chemotherapy is the current global control strategy for schistosomiasis. The WHO target coverage rate is at least 75% for school-aged children. In the Philippines, the reported national coverage rate (43.5%) is far below the WHO target. This study examined the factors associated with non-compliance to mass drug administration. Methods A cross-sectional survey was conducted in 2015 among 2189 adults in the province of Northern Samar, the Philippines using a structured face-to-face survey questionnaire. Results The overall rate of non-compliance to mass drug administration (MDA) in the last treatment round was 27%. Females (aOR = 1.67, P = 0.033) were more likely to be non-compliant. Respondents who believed that schistosomiasis was acquired by open defecation and poor sanitation (aOR = 1.41, P = 0.015), and by drinking unclean water (aOR = 2.09, P = 0.001) were more likely to refuse treatment. Uncertainties on whether schistosomiasis can be treated (aOR = 2.39, P = 0.033), their fear of adverse reactions to praziquantel (aOR = 1.94, P = 0.021), misconceptions about alternative forms of treatment (aOR = 1.45, P = 0.037), and that praziquantel is used for purposes other than deworming (aOR = 2.15, P = 0.021) were all associated with a higher odd of non-compliance. In contrary, being a farmer (aOR = 0.62, P =0.038), participation in past MDA (aOR = 0.30, P < 0.001), informed about impending MDA (aOR = 0.08, P < 0.001), and having heard of schistosomiasis (aOR = 0.22, P = 0.045) were all significantly associated with reduced non-compliance. Conclusions To improve drug compliance for schistosomiasis there is an urgent need for intensive health education campaigns before conducting MDA that would not only provide disease specific information, but also deal with prevailing misconceptions about transmission, prevention, treatment, and drug side-effects.This work was supported by Australian National Health and Medical Research Council

Human-centred design bolsters vaccine confidence in the Philippines: results of a randomised controlled trial

Background The public’s confidence in vaccinations has eroded, and anti-vaccination movements have gained traction around the world, including in the Philippines. ‘Salubong’, a Filipino term, refers to welcoming someone back into one’s life and elicits ideas about friendship and family relationships. We extended this concept to vaccines in efforts to design an intervention that would re-welcome vaccines into homes.Methods Using human-centred design, we developed and refined a story-based intervention that engages Filipino families, community leaders and community health workers. We conducted a randomised controlled trial among 719 caregivers of small children to test the developed intervention against a control video. We assessed the binary improvement (improvement vs no improvement) and the amount of improvement in vaccine attitudes and intentions after intervention exposure.Results Although the intervention group began with marginally higher baseline vaccine attitude scores, we found that 62% of the intervention group improved their vaccine attitude scores versus 37% of the control group (Fisher’s exact, p&lt;0.001). Among individuals whose scores improved after watching the assigned video, the intervention group saw higher mean attitude score improvements on the 5-point scale (Cohen’s d=0.32 with 95% CI 0.10 to 0.54, two-sided t-test, p&lt;0.01). We observed similar patterns among participants who stated that they had previously delayed or refused a vaccine for their child: 67% of 74 in the intervention group improved their vaccine attitude scores versus 42% of 54 in the control group (Fisher’s exact, p&lt;0.001). Among the subset of these individuals whose scores improved after watching the assigned video, the intervention group saw higher mean attitude score improvements on the 5-point scale that were marginally significant (Cohen’s d=0.35 with 95% CI −0.01 to 0.70, two-sided t-test, p=0.06).Conclusions Our results provide solid evidence for the potential of co-designed vaccine confidence campaigns and regulations

“Respect my opinion and I'll respect yours!”: Exploring the challenges, concerns, and informational needs of vaccine‐hesitant caregivers and pregnant women in the Philippines

Abstract Background Despite the instrumental role of vaccines, public confidence is declining, and anti‐vaccine movements have increased worldwide. With the goal of informing policy decisions and the development of interventions, we explore the concerns and challenges related to vaccine uptake (of childhood, maternal, and COVID‐19 vaccines) among parents or caregivers of under‐two children and pregnant women in urban and rural communities in the Philippines. Methods Between May and June 2022, we conducted combined in‐person and online interviews with purposively selected caregivers and pregnant women in the Calabarzon region (Naic, Cavite and Tanay, Rizal), and National Capital Region (Pasay and Muntinlupa Cities), Philippines. A total of 43 interviews were completed, audio‐recorded, transcribed, and analyzed according to the tenets of hermeneutic phenomenology. Results Our results, grounded on the social ecological model, underlined the interplays of contextual or logistical challenges on vaccine uptake, respondents’ overarching concerns about vaccines, and their informational needs that affected their vaccine decision‐making. Respondents described that the long‐established maternal and childhood vaccines no longer represent a high‐risk concern but highlighted their fears and hesitancy particularly to newer vaccines. Conclusion Our findings underscore the multilayered challenges in vaccine decision‐making among caregivers and pregnant women. The volatility of vaccine decision‐making necessitates rethinking the current immunization process, recalibrating the health workforce, and reinvigorating the health information delivery channels for more inclusive and responsive health care