title: Factors Associated with Non-Participation and Non-Adherence in Directly Observed Mass Drug Administration for Malaria in The Gambia.
abstract: BACKGROUND
  The potential benefits of Mass Drug Administration (MDA) for malaria elimination are being considered in several malaria endemic countries where a decline in malaria transmission has been reported. For this strategy to work, it is important that a large proportion of the target population participates, requiring an in-depth understanding of factors that may affect participation and adherence to MDA programs.
  
  
  METHODS
  This social science study was ancillary to a one-round directly observed MDA campaign with dihydroartemisinin-piperaquine, carried out in 12 villages in rural Gambia between June and August 2014. The social science study employed a mixed-methods approach combining qualitative methods (participant observation and in-depth interviewing) and quantitative methods (structured follow-up interviews among non-participating and non-adhering community members).
  
  
  RESULTS
  Of 3942 people registered in the study villages, 67.9% adhered to the three consecutive daily doses. For the remaining villagers, 12.6% did not attend the screening, 3.5% was not eligible and 16% did not adhere to the treatment schedule. The main barriers for non-participation and adherence were long and short-term mobility of individuals and specific subgroups, perceived adverse drug reactions and rumors, inconveniences related to the logistics of MDA (e.g. waiting times) and the perceived lack of information about MDA.
  
  
  CONCLUSIONS
  While, there was no fundamental resistance from the target communities, adherence was 67.9%. This shows the necessity of understanding local perceptions and barriers to increase its effectiveness. Moreover, certain of the constraining factors were socio-spatially clustered which might prove problematic since focal areas of residual malaria transmission may remain allowing malaria to spread to adjacent areas where transmission had been temporarily interrupted.
authors: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.|Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands.|Rhea, Centre of Expertise Gender, Diversity and Intersectionality, Vrije Universiteit Brussel, Brussels, Belgium.
authors: Susan
authors: S
authors: Dierickx
authors: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.|Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands.
authors: Charlotte
authors: C
authors: Gryseels
authors: Medical Research Council Unit, Fajara, The Gambia.
authors: Julia
authors: J
authors: Mwesigwa
authors: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors: Sarah
authors: S
authors: O'Neill
authors: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors: Melanie
authors: M
authors: Bannister-Tyrell
authors: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
authors: Maya
authors: M
authors: Ronse
authors: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.|Medical Research Council Unit, Fajara, The Gambia.
authors: Fatou
authors: F
authors: Jaiteh
authors: Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands.
authors: René
authors: R
authors: Gerrets
authors: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.|Medical Research Council Unit, Fajara, The Gambia.|London School of Tropical Medicine and Hygiene, London, Unoted Kingdom.
authors: Umberto
authors: U
authors: D'Alessandro
authors: Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.|Partners for Applied Social Sciences (PASS) International, Tessenderlo, Belgium.|School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
authors: Koen Peeters
authors: KP
authors: Grietens
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000883:Anthropology; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000008:administration & dosage*; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005714:Gambia; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000188:drug therapy* / Q000635:transmission; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D011804:Quinolines / Q000008:administration & dosage*; D019035:Rural Health Services; D012424:Rural Population; D055815:Young Adult; D010879:Piperazines
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D011804:Quinolines; C039060:artenimol; C034759:piperaquine; D010879:Piperazines