Community perceptions of a mass administration of an antimalarial drug combination in The Gambia

To test the hypothesis that widespread treatment with artemisinin derivativ es can reduce malaria transmission, a mass drug administration (MDA) campai gn was undertaken in an area of The Gambia in 1999. Coverage of 85% of the target population was achieved, but the intervention did not reduce overall malaria transmission. We studied the perceptions, knowledge and attitudes of the community to the MDA campaign, A validated questionnaire was adminis tered to randomly selected MDA participants (n = 90) and MDA refusers (n = 71). Individuals who believed in the importance of the MDA (adjusted OR 58. 3%; 95% CI 17.4-195.8) and those who were aware that a high level of partic ipation was needed for the MDA to be successful (adjusted OR 28.1; 95% CI 1 0.3-75.9) were more likely to participate. Understanding that the purpose o f the MDA was to reduce malaria (adjusted OR 13.9; 95% CI 5.5-35.1) and kno wledge of the fact that malaria is transmitted by mosquitoes and of the cli nical signs of malaria (adjusted OR 3.4; 95% CI 3.1-9.0) were associated wi th participation. Individuals who discussed the MDA with other villagers (a djusted OR 5.5; 95% CI 2.2-13.5) and those who attended the sensitization m eeting (adjusted OR 2.6; 95% CI 1.1-6.0) were also more likely to participa te. Women were significantly more likely to participate in the MDA than men (adjusted OR 3.1; 95% CI 1.5-6.2). Individuals who refused to participate were unlikely to plan participation in future MDAs. One of the most difficu lt challenges in the implementation of a mala;ia control strategy such as a n MDA is to convince villagers to participate and to make them aware that a high level of participation by the community is needed for success. We fou nd that our sensitization meetings could be improved by giving more informa tion on how the MDA works and finding means to generate small group discuss ions after the meeting.