Assessing implementation fidelity of community based integrated mass drug administration for neglected tropical disease control in Kano State, Nigeria

A research report submitted to faculty of health sciences in partial fulfillment of the requirement for the degree of Master of Science in Epidemiology in the field of implementation science University of the Witwatersrand, Johannesburg. November, 2017.Background There is a dearth of information about how well this intervention is conducted in communities (implementation fidelity) as fidelity data are not included in routine program data. Therefore, this study measured the implementation fidelity of mass drug administration for onchocerciasis, lymphatic filariasis, and soil transmitted helminthiasis control, described factors affecting it, and determined the relationship between identified factors and implementation fidelity. Methodology A cross sectional survey was conducted in Nassarawa and Gezawa local government areas of Kano State, Nigeria, where a total 348 community directed distributors were interviewed. Scores were calculated by linearly combining responses obtained using Likert scales. Mean and median of implementation fidelity score were computed. Also, the mean of key determinants were calculated. Adjusted and unadjusted general linear regression models were then fitted to determine the relationship between implementation fidelity and identified determinants. Results The mean(SD) implementation fidelity score was 55.39(8.10) and median(IQR) was 56(60 - 49). Minimum implementation fidelity score obtained was 36 and maximum score was 72. The mean(SD) quality of delivery score, intervention complexity score, facilitation strategy score and participant responsiveness score were 16.77(2.74), 11.03(3.04), 8.83(0.99) and 4.62(0.52) respectively. Evidence of association between some factors and implementation fidelity score were found at p < 0.05. They include: intervention complexity (Adj Coef: -0.62(-0.93 to -0.30), iv facilitation strategies (Adj Coef:-1.68(-3.05 to -0.32), participants responsiveness (Adj Coef: 2.99(1.58 to 4.39), knowledge of NTD (Adj Coef: 0.75(0.36 to 1.13), CDD selection by local government staff (Adj Coef: 7.48(2.85 to 12.11), CDD who volunteered (Adj Coef: 8.38(4.59 to 12.16) CDD with formal training in a health-related field (Adj Coef: 7.34(2.61 to 12.07), and CDD participation in other public health activities (Adj Coef: -6.16(-9.49 to -2.83). Conclusion This study demonstrated the feasibility of measuring implementation fidelity of mass drug administration. In addition, key determinants such as intervention complexity and participant responsiveness were found to be important factors affecting implementation fidelity and could be the target of future implementation strategies.LG201