title: Profiling Nonrecipients of Mass Drug Administration for Schistosomiasis and Hookworm Infections: A Comprehensive Analysis of Praziquantel and Albendazole Coverage in Community-Directed Treatment in Uganda.
abstract: BACKGROUND
  Repeated mass drug administration (MDA) with preventive chemotherapies is the mainstay of morbidity control for schistosomiasis and soil-transmitted helminths, yet the World Health Organization recently reported that less than one-third of individuals who required preventive chemotherapies received treatment.
  
  
  METHODS
  Coverage of community-directed treatment with praziquantel (PZQ) and albendazole (ALB) was analyzed in 17 villages of Mayuge District, Uganda. National drug registers, household questionnaires, and parasitological surveys were collected to track 935 individuals before and after MDA. Multilevel logistic regressions, including household and village effects, were specified with a comprehensive set of socioeconomic and parasitological variables. The factors predicting who did not receive PZQ and ALB from community medicine distributors were identified.
  
  
  RESULTS
  Drug receipt was correlated among members within a household, and nonrecipients of PZQ or ALB were profiled by household-level socioeconomic factors. Individuals were less likely to receive either PZQ or ALB if they had a Muslim household head or low home quality, belonged to the minority tribe, or had settled for more years in their village. Untreated individuals were also more likely to belong to households that did not purify drinking water, had no home latrine, and had no members who were part of the village government.
  
  
  CONCLUSIONS
  The findings demonstrate how to locate and target individuals who are not treated in MDA. Infection risk factors were not informative. In particular, age, gender, and occupation were unable to identify non-recipients, although World Health Organization guidelines rely on these factors. Individuals of low socioeconomic status, minority religions, and minority tribes can be targeted to expand MDA coverage.
authors.affiliation: Departments of Land Economy Pathology, University of Cambridge.
authors.forename: Goylette F
authors.initials: GF
authors.lastname: Chami
authors.affiliation: Departments of Land Economy.
authors.forename: Andreas A
authors.initials: AA
authors.lastname: Kontoleon
authors.affiliation: Departments of Land Economy Development Economics Group, Wageningen University, The Netherlands.
authors.forename: Erwin
authors.initials: E
authors.lastname: Bulte
authors.affiliation: Schistosomiasis Control Initiative, Imperial College London, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Fenwick
authors.affiliation: Schistosomiasis Control Initiative, Imperial College London, United Kingdom Bilharzia and Worm Control Programme, Vector Control Division, Uganda Ministry of Health, Kampala.
authors.forename: Narcis B
authors.initials: NB
authors.lastname: Kabatereine
authors.affiliation: Bilharzia and Worm Control Programme, Vector Control Division, Uganda Ministry of Health, Kampala.
authors.forename: Edridah M
authors.initials: EM
authors.lastname: Tukahebwa
authors.affiliation: Pathology, University of Cambridge.
authors.forename: David W
authors.initials: DW
authors.lastname: Dunne
mesh_terms: D000293:Adolescent; D000328:Adult; D015766:Albendazole / Q000008:administration & dosage*; D000818:Animals; D000871:Anthelmintics / Q000008:administration & dosage*; D018890:Chemoprevention / Q000379:methods*; D002648:Child; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D005260:Female; D006725:Hookworm Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D055118:Medication Adherence; D044382:Population Groups; D011223:Praziquantel / Q000008:administration & dosage*; D012424:Rural Population; D012552:Schistosomiasis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D014454:Uganda
chemical_list: D000871:Anthelmintics; D011223:Praziquantel; D015766:Albendazole
keywords: coverage; mass drug administration; schistosomiasis; soil-transmitted helminths; sub-Saharan Africa