The acceptability of mass administrations of anti-malarial drugs as part of targeted malaria elimination in villages along the Thai-Myanmar border.
A targeted malaria elimination project, including mass drug administrations (MDA) of dihydroartemisinin/piperaquine plus a single low dose primaquine is underway in villages along the Thailand Myanmar border. The intervention has multiple components but the success of the project will depend on the participation of the entire communities. Quantitative surveys were conducted to study reasons for participation or non-participation in the campaign with the aim to identify factors associated with the acceptance and participation in the mass drug administrations.



The household heads in four study villages in which MDAs had taken place previously were interviewed between January 2014 and July 2015.



174/378 respondents (46 %) completed three rounds of three drug doses each, 313/378 (83 %) took at least three consecutive doses and 56/378 (15 %) did not participate at all in the MDA. The respondents from the two villages (KNH and TPN) were much more likely to participate in the MDA than respondents from the other two villages (HKT and TOT). The more compliant villages KNH and TPN had both an appearance of cohesive communities with similar demographic and ethnic backgrounds. By contrast the villages with low participation were unique. One village was fragmented following years of armed conflict and many respondents gave little inclination to cooperate with outsiders. The other village with low MDA coverage was characterised by a high percentage of short-term residents with little interest in community interventions. A universal reason for non-participation in the MDA applicable to all villages was an inadequate understanding of the intervention.



It is unlikely that community engagement can unite fragmented communities in participating in an intervention, which benefits the community. Understanding the purpose and the reasons underlying the intervention is an important pre-condition for participation. In the absence of direct benefits and a complete understanding of the indirect benefits trust in the investigators is critical for participation.
Shoklo Malaria Research Unit, Mae Sot, Thailand.
Ladda
L
Kajeechiwa
Shoklo Malaria Research Unit, Mae Sot, Thailand.
May Myo
MM
Thwin
Shoklo Malaria Research Unit, Mae Sot, Thailand.
Paw Wah
PW
Shee
Shoklo Malaria Research Unit, Mae Sot, Thailand.
Nan Lin
NL
Yee
Shoklo Malaria Research Unit, Mae Sot, Thailand.
Elvina
E
Elvina
Shoklo Malaria Research Unit, Mae Sot, Thailand.
Peapah
P
Peapah
Shoklo Malaria Research Unit, Mae Sot, Thailand.
Kyawt
K
Kyawt
Shoklo Malaria Research Unit, Mae Sot, Thailand.
Poe Thit
PT
Oo
Shoklo Malaria Research Unit, Mae Sot, Thailand.
William
W
PoWah
Shoklo Malaria Research Unit, Mae Sot, Thailand.
Jacqueline Roger
JR
Min
Shoklo Malaria Research Unit, Mae Sot, Thailand.
Jacher
J
Wiladphaingern
Mahidol Oxford Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. Lorenz@tropmedres.ac.
Lorenz
L
von Seidlein
Shoklo Malaria Research Unit, Mae Sot, Thailand.
Suphak
S
Nosten
Shoklo Malaria Research Unit, Mae Sot, Thailand.|Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
Francois
F
Nosten
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage*; D037621:Artemisinins / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D060740:Disease Eradication / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D002052:Myanmar; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011319:Primaquine / Q000008:administration & dosage; D011804:Quinolines / Q000008:administration & dosage; D011795:Surveys and Questionnaires; D013785:Thailand; D055815:Young Adult; D010879:Piperazines
D000962:Antimalarials; D037621:Artemisinins; D011319:Primaquine; D011804:Quinolines; C039060:artenimol; C034759:piperaquine; D010879:Piperazines
Acceptance; Behaviour; Community engagement; Knowledge; Malaria; Mass drug administration; Social mobilisation; Targeted malaria control
Soc Sci Med. 2003 Apr;56(7):1453-68
12614697
N Engl J Med. 2014 Jul 31;371(5):411-23
25075834
Soc Sci Med. 2005 Oct;61(7):1463-73
16005781
Cochrane Database Syst Rev. 2014 Jan 20;(1):CD010927
24443033
Am J Trop Med Hyg. 2015 Jul;93(1):125-34
26013371
Malar J. 2011 Aug 04;10 :225
21816085
Malar J. 2015 Jul 31;14:291
26228787
Malar J. 2014 Feb 04;13:47
24495715
Malar J. 2015 Sep 30;14:381
26424000
Acta Trop. 2010 Jun;114(3):177-83
20132788
Trop Med Int Health. 2001 Jun;6(6):442-8
11422958
J Clin Microbiol. 2014 Sep;52(9):3303-9
24989601
Lancet. 2000 Nov 4;356(9241):1560-4
11075770
Soc Sci Med. 2008 Sep;67(5):696-707
18455854
PLoS One. 2016 Feb 11;11(2):e0148627
26866685
PLoS One. 2014 Jan 14;9(1):e83413
24454703
Cochrane Database Syst Rev. 2013 Dec 09;(12):CD008846
24318836
Trop Med Int Health. 2006 Jul;11(7):975-82
16827698