Beyond MDA: A Community Approach for Deworming

2021- present All Regions, Ethiopia

“To be honest, most people are unaware of intestinal parasites. Because of this, medication delivery is difficult.” – health volunteer 

In Ethiopia, an estimated 37.3 million people live in areas endemic for schistosomiasis and 79 million in areas endemic with soil-transmitted helminths. These intestinal parasites can lead to physical disability and cognitive impairment, slowing education achievement and economic development. To target these diseases, Ethiopia launched a national school-based deworming program in November 2015. However, despite several years of school-based mass drug administration (MDA) campaigns, the disease burden remains high in many areas.

In areas with high disease burden, transmission break cannot be achieved by targeting children alone as adults also act as a reservoir for the parasites. Moreover, preschool-age children and women of reproductive age have not been included in deworming campaigns before, though they are especially vulnerable to worms due to anemia and other complications. For these reasons, the Ethiopian Ministry of Health is scaling up its national deworming campaign to reach the whole community in highly endemic areas, starting with women of reproductive age. 

From December 2021, NALA has supported this endeavor. In the first phase of the project, NALA’s team undertook an intensive review and consultative process to examine and assess previous MDA campaigns in order to recommend optimal methods for expansion to women and others in the community. Based on this work, the team identified several barriers for community-wide distribution, including cultural and gender-based concerns, fears about side effects, and a lack of awareness/ concern. Following this, the team produced several recommendations for improved social mobilization and implementation strategies. The report can be viewed here (link to report).

In the second stage of the project, the team is developing and testing tools for expanded MDA. These include an improved process for identifying and training social mobilizers at the community level, as well as visual aids for the deworming team. These tools are currently being rolled out and tested across different regions to ensure relevance and suitability for different contexts. 

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