Implementation of school-based mass drug administration of praziquantel in Nigeria: barriers, facilitators and opportunities for improvement

Objective

The World Health Organization recommends annual preventive chemotherapy with a single dose of praziquantel at ≥ 75 % treatment coverage, but as of 2021, the national coverage rate in Nigeria among children falls below 10 %. This qualitative study sought to explore the barriers and facilitators to implementing large-scale praziquantel mass drug administration (MDA) programs for school-aged children in Nigeria to delineate tools and strategies that could improve the scaling-up and effectiveness of school-based praziquantel MDA programs.

Methods

An exploratory qualitative study was conducted with stakeholders with experience in MDAs involving praziquantel or related preventive chemotherapy drugs in Nigeria. Through snowball sampling, 30 stakeholders with experience in praziquantel school-based MDA in Nigeria were interviewed. An inductive approach was used to generate broad themes based on the barriers and facilitators identified by the key informants.

Results

A total of 45 barriers and 36 facilitators were identified and grouped inductively into eight themes: funding and resources, design and composition of praziquantel tablets, knowledge and awareness mobilization, government, nongovernmental organization, and school engagement, data management, logistics, training, and security.

Conclusion

This qualitative study reveals a wide range of barriers and facilitators in the MDA of praziquantel in Nigeria and uncovered critical points along the implementation pathway based on the locus of the barriers and facilitators identified. Collaboration with national, international, and non-profit organizations, and drug education through promotional materials, were the most frequently mentioned facilitators of the MDA program. In addition, insufficient program funding, and the complexity of the supply chain were the most cited barriers.