Mass drug administration campaigns: Comparing two approaches for schistosomiasis and soil-transmitted helminths prevention and control in selected southern Malawi districts

Background: Mass drug administration (MDA) is one of the key interventions recommended by WHO to control neglected tropical diseases. In Malawi, health workers distribute anti-helminthic drugs annually with most support from donors. The mean community coverage of MDA from 2018 to 2020 were high at 87% for praziquantel and 82% for albendazole, however posing a sustainability challenge once donor support diminishes. Methods: : This was a cross-sectional study carried out in three districts, where four health centres and 16 villages were randomly selected and allocated to intervention and control arms. A mixed methods approach to data collection focusing on quantitative data for coverage and knowledge, attitudes and practices; and qualitative data for assessing perceptions of health providers and beneficiaries were used during baseline and follow-up assessments. Quantitative and qualitative data were analyzed using IBM SPSS software version 26 and NVivo 12 for Windows respectively. Results: : At follow-up, knowledge levels were high for what schistosomiasis is (65% - 88%) and what STH are (32% - 83%); and low for what causes schistosomiasis (32% - 58%), causes of STH (7% - 37%), intermediate organisms for schistosomiasis (13% - 33%) and types of schistosomiasis (2% - 26%) for both intervention and control arms. Increases in praziquantel coverage were registered in control (86% to 89%) and intervention communities (83% to 89%); decreases were recorded for control (86% to 53%) and intervention schools (79% to 59%). Costs for implementation of the study indicated that most resources were used at community (51%), health centre (29%) and district levels (19%). The intervention arm used more resources at health centre (27%) and community levels (44%) than the control arm. Health workers and community members perceived the use of the CDI approach as a good initiative and more favorable over the standard practice of delivering MDA. Conclusions: : The use of the CDI in delivery of MDA campaigns against schistosomiasis and STH is feasible, increases coverage and is acceptable in intervention communities. This could be a way forward addressing the sustainability concern when donor support wanes. Trial Registration: PACTR202102477794401