Feasibility of mainstreaming schistosomiasis and soil transmitted helminthiasis mass drug administration into primary healthcare: a baseline survey for a community case study in Western Kenya

Abstract

Background: Mass drug administration campaigns have enabled great progress in the prevention and control of schistosomiasis and soil transmitted helminthiasis. However, the persistence of these infections continues to challenge public health systems despite decades of control efforts. This study was commissioned to evaluate the feasibility of a transition from periodic mass drug administration campaigns to a sustainable, facility- and community-based delivery model in Western Kenya.

Methods: The study is part of a non-randomized, controlled before-and-after study using a mixed-methods approach. Data were collected from 1,229 households, 24 health facilities (12 control, 12 intervention), focus group discussions, and key informant interviews. The analysis focused on six domains of mainstreaming feasibility: perception of mainstreaming among key stakeholders, processes, infrastructure and system readiness, acceptability and trust for primary healthcare-led treatment, facilitators, and barriers. Finally, we calculated a composite readiness index to grade facility readiness.

Results: Generally, community perceptions to schistosomiasis and soil-transmitted helminthiasis treatment benefits were found to be high in both the control and intervention groups. Qualitative data showed enhanced trust in the integrated model by virtue of the credibility and professional nature of health facility staff. An overwhelming majority of community members received treatment through household visits (95.5%) implying reliance on periodic MDA at baseline. Community Health Promoters remain a critical source of information on treatment opportunities for low-literacy populations, while media and health facilities are increasingly important among more educated groups. We also found high infrastructural and systemic readiness for treatment mainstreaming with respect to stock availability and data reporting systems. However, stock outs were reported among the facilities. High variability in health worker training coverage suggests a critical challenge in workforce preparedness.

Conclusion: The findings point to a strong foundation for mainstreaming but underscore the need for a structured implementation package. Priority actions should include standardized operating procedures, supply chain and digital system strengthening, and expanded Community Health Promoter-led outreach activities to improve consistency, access, and sustainability of deworming services within primary healthcare platforms.