A Mixed-Methods Evaluation of Mainstreaming Mass Drug Administration for Schistosomiasis and Soil-Transmitted Helminthiasis in Four Districts of Nigeria

Emily Griswold The Carter Center, Atlanta, Georgia;

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Abel Eigege The Carter Center, Jos, Nigeria;

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Emmanuel C. Emukah The Carter Center, Benin City, Nigeria;

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Jayden Pace Gallagher The Carter Center, Atlanta, Georgia;

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Jenna Coalson The Carter Center, Atlanta, Georgia;

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Lindsay Rakers The Carter Center, Atlanta, Georgia;

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Bulus Mancha The Carter Center, Jos, Nigeria;

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Okocha Ndudi The Carter Center, Benin City, Nigeria;

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Paul Ugbadamu The Carter Center, Benin City, Nigeria;

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Philomena Dikedi The Carter Center, Benin City, Nigeria;

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Happiness Poko Edo State Primary Health Care Development Agency, Nigeria;

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Jacob Danboyi Nasarawa State Ministry of Health, Nigeria;

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Philemon Dagwa Plateau State Ministry of Health, Nigeria;

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Vincent Anighoro Delta State Primary Health Care Development Agency, Nigeria;

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Christiana Davou Gwong NTD Unit, Bassa LGA, Plateau State, Nigeria;

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Esther Otabor NTD Unit, Egor LGA, Edo State, Nigeria;

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Goodluck James Amayat NTD Unit, Wamba LGA, Nasarawa State, Nigeria;

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Regina Ese Unukopia NTD Unit, Ughelli South LGA, Delta State, Nigeria

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Emmanuel S. Miri The Carter Center, Jos, Nigeria;

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Gregory S. Noland The Carter Center, Atlanta, Georgia;

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In Nigeria, mass drug administration (MDA) for schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) has often been coordinated with other programs that receive greater external funding. As these programs reach stop MDA milestones, SCH and STH programs will likely need to transition implementation, or “mainstream,” to domestic support. A mixed-methods study was conducted in four districts before (2021) and after (2022) mainstreaming to evaluate its impact on MDA coverage. Household surveys were done in 30 villages per district pre- and post-mainstreaming. All selected communities were eligible for STH treatment; around a third were eligible for SCH treatment. Mass drug administration was primarily conducted in schools. A total of 5,441 school-aged children were included in pre-mainstreaming and 5,789 were included in post-mainstreaming. Mass drug administration coverage was heterogeneous, but overall, mebendazole coverage declined nonsignificantly from 81% pre-mainstreaming to 76% post-mainstreaming (P = 0.09); praziquantel coverage declined significantly from 73% to 55% (P = 0.008). Coverage was significantly lower among unenrolled children or those reporting poor school attendance in nearly every survey. For the qualitative component, 173 interviews and 74 focus groups were conducted with diverse stakeholders. Respondents were deeply pessimistic about the future of MDA after mainstreaming and strongly supported a gradual transition to full government ownership. Participants formulated recommendations for effective mainstreaming: clear budget allocation by governments, robust and targeted training, trust building, and comprehensive advocacy. Although participants lacked confidence that SCH and STH programs could be sustained after reductions in external support, initial results indicate that MDA coverage can remain high 1 year into mainstreaming.

Author Notes

Financial support: This work received financial support from the Health Campaign Effectiveness Program, which is funded by the Bill & Melinda Gates Foundation at The Task Force for Global Health.

Disclosure: This study was approved under expedited review by the Emory Institutional Review Board (study No. 00002943). It was also reviewed by relevant local ministries of health and education in Nigeria. Ethical clearance was provided by each state ministry of health.

Authors’ addresses: Emily Griswold, Jayden Pace Gallagher, Jenna Coalson, Lindsay Rakers, and Gregory S. Noland, The Carter Center–USA, Atlanta, GA, E-mails: emily.griswold@cartercenter.org, jaypacegallagher@gmail.com, jenna.coalson@cartercenter.org, lindsay.rakers@cartercenter.org, and gregory.noland@cartercenter.org. Abel Eigege, Bulus Mancha, and Emmanuel S Miri, The Carter Center Nigeria, Jos, Nigeria, E-mails: Abel.eigege@cartercenter.org, Bulus.mancha@cartercenter.org, and Emmanuel.miri@cartercenter.org. Emmanuel C. Emukah, Ndudi Okocha, Paul Ugbadamu, and Philomena Dikedi, The Carter Center Nigeria, Benin City, Nigeria, emmanuel.emukah@cartercenter.org, okocha.ndudi@cartercenter.org, Paul.ugbadamu@cartercenter.org, and Philomena.dikedi@cartercenter.org. Happiness Poko, Edo State Primary Health Care Development Agency, State Secretariat, Ministry and Agency Compound, Benin City, Nigeria, E-mail: happypoko4real@gmail.com. Jacob Danboyi, Nasarawa State Ministry of Health, Ministry of Health, Lafia, Nigeria, E-mail: danboyijacob@gmail.com. Philemon Dagwa, Plateau State Ministry of Health, Joseph Gomwalk Secretariat Ministry of Health, Jos, Nigeria, E-mail: phildagw@gmail.com. Vincent Anighoro, Delta State Primary Health Care Development Agency, Delta State Primary Health Care Development Agency, Asaba, Nigeria, E-mail: anighorovincent@gmail.com. Christiana Davou Gwong, Bassa LGA, Plateau State, NTD Unit, Health Department, Bassa LGA, Nigeria, E-mail: davouchristy86@gmail.com. Esther Otabor, Egor LGA, Edo State, NTD Unit, Primary Health Care Department, Egor LGA, Nigeria, E-mail: Estheriredia52@gmail.com. Goodluck James Amayat, Wamba LGA, Nasarawa State, NTD Unit, Health Department, Wamba LGA, Nigeria, E-mail: goodluckamayat@gmail.com. Regina Ese Unukopia, Ughelli South LGA, Delta State, NTD Unit, Primary Health Care Department, Ughelli South LGA, Nigeria, E-mail: reginaunukopia2020@gmail.com.

 Address correspondence to Emily Griswold, 453 John Lewis Freedom Parkway, One Copenhill, Atlanta, GA 30307. E-mail: emily.griswold@cartercenter.org
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