Table 3.
Recommendation category | Benin | India | Malawi |
MDA distribution mode | Door-to-door distribution | Door-to-door distribution preferable; potential for 3–4 central distribution sites in some communities | Door-to-door distribution |
Intervention cost/financial incentives for participation | Free, but need to address rumours about nefarious intentions behind free MDA distribution | Free treatment preferable to most participants; need to address fears of perceived poor-quality medications provided by government programmes. Financial incentives should not be given for MDA participation, but incentives such as combs and soap were suggested | Free, but communities with past exposure to research studies might expect financial incentives for MDA participation |
Community drug distributor preferences | Health workers (health facility workers or CDDs) who are familiar to community members | Trained health workers (nurses, doctors, ASHAs) who are familiar. Individuals without training should not be distributors | Health workers (including HSAs) who are familiar to community members. Volunteers are less respected and should not be distributors |
Duration and time of distribution | Distribution over multiple days to accommodate different household schedules and reach the greatest number of people. Rainy season and market days should be avoided. Must consider work schedules and implement flexible distribution times | Distribution over multiple days. Evening or early morning preferred distribution time to accommodate work schedules | Distribution over multiple days to accommodate different household schedules and reach the greatest no of people |
Key leaders to engage prior to cMDA | Village chiefs, religious leaders, and health workers | President and ward councillor of community (Panchayat), other health workers (Anganwadi workers), and teachers | Village chiefs, local leaders, religious leaders, local NGOs, HSAs, and teachers |
Community education topics to engage MDA participants | Educate community about purpose and potential side effects of treatment | Educate community about purpose, advantages, and potential side effects of treatment, and proper dosage for different people (eg, children, elders) | Educate community about purpose and potential side effects of treatment; sensitisation must be done more than 1 day in advance to allow decision-making time |
Mechanisms for engaging community members | Utilise radio, phones, community meetings and word of mouth to share information. Ring gongs at distribution time | Utilise radio, loudspeaker announcements, flyers, health documentaries, TV news, community meetings (women's groups), and community dramas to share information. Beat drums at distribution time | Utilise radio, phones, loudspeaker announcements, dramas, community meetings, door-to-door outreach, to share information |
ASHA, Accredited Social Health Activists; CDDs, community drug distributors; c-MDA, community-wide mass drug administration; NGOs, non-governmental organisation; TV, television.