02896nas a2200181   4500000000100000008004100001653003600042653003500078100001200113700001800125700001600143245015800159856009900317300001300416490000700429520226400436022001402700       2019                            d10aCommunity medicine distributors10amass drug administration (MDA)1 aChami G1 aKabatereine N1 aTukahebwa E00aThe division of labour between community medicine distributors influences the reach of mass drug administration: A cross-sectional study in rural Uganda.  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0007685&type=printable  ae00076850 v133 a<p><strong>BACKGROUND: </strong>Despite decades of community-based mass drug administration (MDA) for neglected tropical diseases, it remains an open question as to what constitutes the best combination of community medicine distributors (CMDs) for achieving high (&gt;65%/75%) treatment rates within a village.</p>

<p><strong>METHODS: </strong>Routine community-based MDA was evaluated in Mayuge District, Uganda. For one month, we tracked 6,148 individuals aged 1+ years in 1,118 households from 28 villages. Praziquantel, albendazole, and ivermectin were distributed to treat Schistosoma mansoni, lymphatic filariasis, and soil-transmitted helminths. The similarity/diversity between CMDs was observed and used to predict the division of labour and overall village treatment rates. The division of labour was calculated by dividing the lowest treatment rate by the highest treatment rate achieved by two CMDs within a village. CMD similarity was measured for 16 characteristics including friendship network overlap, demographic and socioeconomic factors, methods of CMD selection, and years as CMD. Relevant variables for MDA outcomes were selected through least absolute shrinkage and selection operators with leave-one-out cross validation. Final models were run with ordinary least squares regression and robust standard errors.</p>

<p><strong>RESULTS: </strong>The percentage of individuals treated with at least one drug varied across villages from 2.79-89.74%. The only significant predictor (p-value&lt;0.05) of village treatment rates was the division of labour. The estimated difference between a perfectly equal (a 50-50 split of individuals treated) and unequal (one CMD treating no one) division of labour was 39.69%. A direct tie (close friendship) between CMDs was associated with a nearly twofold more equitable distribution of labour when compared to CMDs without a direct tie.</p>

<p><strong>CONCLUSIONS: </strong>An equitable distribution of labour between CMDs may be essential for achieving treatment targets of 65%/75% within community-based MDA. To improve the effectiveness of CMDs, national programmes should explore interventions that seek to facilitate communication, friendship, and equal partnership between CMDs.</p>
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