Community-directed mass drug administration is undermined by status seeking in friendship networks and inadequate trust in health advice networks
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Published version
Author(s)
Type
Journal Article
Abstract
Over 1.9 billion individuals require preventive chemotherapy through mass drug administration (MDA). Community-directed MDA relies on volunteer community medicine distributors (CMDs) and their achievement of high coverage and compliance. Yet, it is unknown if village social networks influence effective MDA implementation by CMDs. In Mayuge District, Uganda, census-style surveys were conducted for 16,357 individuals from 3,491 households in 17 villages. Praziquantel, albendazole, and ivermectin were administered for one month in community-directed MDA to treat Schistosoma mansoni, hookworm, and lymphatic filariasis. Self-reported treatment outcomes, socioeconomic characteristics, friendship networks, and health advice networks were collected. We investigated systematically missed coverage and noncompliance. Coverage was defined as an eligible person being offered at least one drug by CMDs; compliance included ingesting at least one of the offered drugs. These outcomes were analyzed as a two-stage process using a Heckman selection model. To further assess if MDA through CMDs was working as intended, we examined the probability of accurate drug administration of 1) praziquantel, 2) both albendazole and ivermectin, and 3) all drugs. This analysis was conducted using bivariate Probit regression. Four indicators from each social network were examined: degree, betweenness centrality, closeness centrality, and the presence of a direct connection to CMDs. All models accounted for nested household and village standard errors. CMDs were more likely to offer medicines, and to accurately administer the drugs as trained by the national control programme, to individuals with high friendship degree (many connections) and high friendship closeness centrality (households that were only a short number of steps away from all other households in the network). Though high (88.59%), additional compliance was associated with directly trusting CMDs for health advice. Effective treatment provision requires addressing CMD biases towards influential, well-embedded individuals in friendship networks and utilizing health advice networks to increase village trust in CMDs.
Date Issued
2017-04-08
Date Acceptance
2017-04-07
Citation
SOCIAL SCIENCE & MEDICINE, 2017, 183, pp.37-47
ISSN
0277-9536
Publisher
ELSEVIER
Start Page
37
End Page
47
Journal / Book Title
SOCIAL SCIENCE & MEDICINE
Volume
183
Copyright Statement
© 2017 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000402945000005&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Social Sciences
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
Social Sciences, Biomedical
Biomedical Social Sciences
Uganda
Social networks
Mass drug administration
Coverage
Compliance
NEGLECTED TROPICAL DISEASES
SOCIAL NETWORKS
UGANDA
SCHISTOSOMIASIS
BEHAVIOR
INNOVATIONS
INCENTIVES
CENTRALITY
1117 Public Health And Health Services
1601 Anthropology
1608 Sociology
Public Health
Publication Status
Published