Azithromycin Mass Treatment for Trachoma Control: Risk Factors for Non-Participation of Children in Two Treatment Rounds

The World Health Organization advocates at least three mass drug administrations (MDAs) with antibiotics when the prevalence of follicular trachoma (TF) is greater than 10% in children under age ten. Full child participation is necessary for maximizing the impact of trachoma control programs. The present paper identifies guardian, household, and program risk factors for households with a child who never participated in two annual rounds of MDAs with azithromycin. In comparison to households with full child participation, guardians with at least one child who never participated had a higher burden of familial responsibility, as represented by reporting ill family members, more children, and were younger in age. In addition, guardians of persistent non-participants seemed less well connected in the community, in terms of reliance on others and not knowing who their assigned community treatment assistants (CTAs) were. These guardians were assigned to CTAs who had a wide geographic dispersion of their assigned households. By developing programs with local groups to find and encourage participation in at-risk households, program managers may have the greatest impact on preventing persistent child non-participation. Increasing the number of distribution days and reducing CTAs' travel time may further prevent non-participation

Mass Treatment with Azithromycin for Trachoma Control: Participation Clusters in Households

Trachoma, an infectious disease, continues to cause blindness. A great deal of the trachoma burden is concentrated in developing countries. The World Health Organization recommends mass treatment for entire communities in trachoma-endemic regions. In 32 Tanzanian and 48 Gambian communities with trachoma, mass treatment was directly observed following a census. Community coverage was mostly greater than 80%. Larger-than-expected proportions of households where all children were treated and where none of the children were treated were found in each country. Household clustering of treatment was higher in Tanzania compared to The Gambia. However, children who were not treated were not more likely to be infected compared to children who were treated. We found that treatment and non-treatment within communities does not occur at random but rather clusters within households. These findings impact the design of future coverage surveys and suggest that further research evaluate factors that are associated with familial non-compliance

Primary reason provided for non-participation in MDA by household participation status.^*

*<p>The chi-square comparison p-value is 0.00.</p

Model of risk factors for households with at least one persistent child non-participant.

<p>CI: Confidence interval.</p><p>CTA: Community treatment assistant.</p><p>OR: Odds ratio.</p>*<p>Odds ratios were adjusted for community size and clustering at community level using random-intercept logistic regression.</p

Multinomial logistic model comparing risk factors for case subgroups with control group.^*

<p>CI: Confidence interval.</p><p>CTA: Community treatment assistant.</p><p>RRR: Relative risk ratio represents the change in the odds of being in the case subgroup versus the control group associated with a one unit change in the independent variable.</p>*<p>Relative risk ratios were adjusted for community size and models used robust standard error estimates.</p