title: Community mass treatment with azithromycin for trachoma: Factors associated with change in participation of children from the first to the second round.
abstract: BACKGROUND
  Mass drug administration (MDA) with azithromycin is an important part of trachoma control programs. Maintaining high participation among children is challenging.
  
  
  OBJECTIVE
  We assessed factors identifying households with a child who changed participation from the first MDA to the second MDA compared to households where all children participated at both MDAs.
  
  
  METHODS
  Two case-control comparisons were conducted in 11 Tanzanian communities, which underwent MDA in 2008 and 2009. The first case group (n=165) was a random sample of households with a child who changed from a 2008 non-participant to a 2009 participant (delayed participant). The second case group (n=165) was a random sample of households with a child who went from a 2008 participant to a 2009 non-participant (change to non-participant). Controls (n=330) were a random sample of households where all children participated in both rounds. Risk factors were assessed using questionnaires asked of children's guardians. Logistic models with a random-intercept were used to estimate odds ratios and 95% confidence intervals.
  
  
  RESULTS
  Households with delayed participation were more likely to be in communities with fewer treatment days (OR=2.98, 95% CI=1.80-4.92) and assigned to Community Treatment Assistants (CTA) with a wide area to cover (OR=1.88, 95% CI=1.09-3.23). Households with change to non-participation were more likely to live further from the distribution site (OR=3.17, 95% CI=1.19-8.46), have the guardian born outside the village with short-term residency (OR=2.64, 95% CI=1.32-5.31), and be assigned to a male CTA (OR=1.75, 95% CI=1.08-2.83).
  
  
  CONCLUSIONS
  Factors related to program accessibility were associated with delayed participation and maintaining participation.
authors.affiliation: Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Elizabeth N
authors.initials: EN
authors.lastname: Ssemanda
authors.affiliation: Kongwa Trachoma Project, Kongwa, Tanzania.
authors.forename: Harran
authors.initials: H
authors.lastname: Mkocha
authors.affiliation: Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Levens
authors.affiliation: Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Munoz
authors.affiliation: Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Sheila K
authors.initials: SK
authors.lastname: West
keywords: Trachoma; azithromycin; mass drug administration