Community mass treatment with azithromycin for trachoma: Factors associated with change in participation of children from the first to the second round

BackgroundMass drug administration (MDA) with azithromycin is an important part of trachoma control programs. Maintaining high participation among children is challenging.AimWe 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.MethodsTwo-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.ResultsHouseholds 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).ConclusionsFactors related to program accessibility were associated with delayed participation and maintaining participation.