Acceptability of Azithromycin Mass Treatment for Trachoma Elimination in Injibara Town and Adjacent Banja Woreda of Awi Zone, Amhara Region
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Date
2014-06
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Addis Ababa University
Abstract
Trachoma is the leading cause of infectious blindness worldwide. Globally 1.2 billion people live
in endemic areas. In Ethiopia, approximately 67 million people are at risk for trachoma. The
Amhara National Regional State of Ethiopia is the most trachoma-endemic among all nine
regional states and two city administrations, with Trachomatous inflammation Follicular
prevalence of 62.6%. Mass azithromycin treatment is the one arm of the SAFE strategy. The
trachoma elimination program would be successful if and only if the coverage is as high as
possible with full community participation. If not all the community members attend the mass
treatment, the trachoma infection will return to the baseline prevalence after the treatment
stopped due to high transmission rate. The objective of this study was to assess the acceptability
of the azithromycin mass treatment and its determinants in Injibara town and the adjacent Banja
woreda of Awi zone, Amhara National Regional State. A community based cross sectional
survey with both quantitative and qualitative methods was conducted from July 7-25, 2013.
Households’ survey with structured questionnaire, FGDs and key informant interviews were
used for data collection. A total of 5826 eligible household members from 1267 households were
enrolled in the survey. The 2012 annual azithromycin mass treatment coverage obtained from the
present study was 92.9%. From the total 6 rounds of azithromycin mass treatment in the study
area, only half (50.6%) of the community took for more than three times. On average, each
illegible person in the community had taken the drug for 3.6 times. The percentage of rural
household members who had taken azithromycin more than three times was higher than the
corresponding urban members. The rural residents were at better performance in taking the 2012
treatment as compared to the urban residents (AOR=2.35; 95%CI [1.80-3.06]). Household heads
interference with the drug uptake of their family members’ has negative association with
azithromycin uptake (AOR=0.153; CI=95% (0.086-0.272). All the study participants who were
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greater than 30 years more likely took azithromycin more than 3 times as compared with
children less than 15 years (COR=2.81, AOR=2.74, 95% CI [1.95-3.02]). Azithromycin uptake
status of female household heads was less than the corresponding male household heads
(AOR=0.41; 95% CI [0.24-0.720]). Household heads awareness about trachoma (AOR=2.55;
95% CI [1.19-5.44]) and azithromycin mass treatment (AOR=7.19; 95% CI [3.27-15.82]) had
positive association with acceptability. The 2012 azithromycin mass treatment coverage in
Injibara town and Banja woreda was higher than the WHO minimum target. But, concerning to
the overall coverage, the data taken from the present study contradicts the coverage data taken
from the woreda. The communities’ Azithromycin mass treatment acceptability had increased in
the recent campaigns as compared to the previous campaigns. There is low coverage and
acceptability of the treatment in the urban community as compared to the rural residents.
Supplementary benefits of azithromycin, health education about trachoma and the drug,
willingness and being old are some of the factors positively related with acceptability whereas
educational status, marital status and experience with side effects were not associated with the
drug uptake status. Strengthen the program in the urban and consideration of additional
campaigns for both areas as well as providing additional health education with skilled health
professionals is mandatory.
Key words: Azithromycin mass treatment, Mass drug administration, Acceptability, Trachoma,
Trachoma elimination
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Keywords
Azithromycin mass treatment; Mass drug administration; Acceptability; Trachoma; Trachoma elimination