Mass drug administration for soil-transmitted helminthiasis and schistosomiasis in selected districts of Rwanda: Coverage, implementation factors, and household water, sanitation, and hygiene conditions

Abstract

BACKGROUND: In Rwanda, about 1 in 3 people are affected by soil-transmitted helminthiases (38.7%) and 1 in 4 by schistosomiasis in high-risk areas (27.2% by point-of-care circulating cathodic antigen), both associated with poor water, sanitation, and hygiene (WASH). Mass drug administration (MDA) is the primary control strategy, but reported coverage may not reflect true reach. This study assessed MDA coverage of albendazole/mebendazole and praziquantel in selected districts, identified reasons for non-reach, examined factors associated with uptake, and described household WASH conditions. METHODS: A cross-sectional, community-based survey was conducted in five purposively selected districts using a stratified cluster design. Survey-weighted estimates summarized treatment reach (offered the drug), uptake (swallowed the drug), and household WASH conditions. Survey-weighted logistic regression was used to identify individual and implementation factors associated with uptake. RESULTS: Albendazole/mebendazole uptake was 91.9% (95% CI: 84.3-96.0), closely matching reported coverage of 96%. The main reasons for non-reach were drug stockouts (23.7%), absence during MDA (15.8%), and unwillingness to take the drug (15.2%). Praziquantel uptake was 88.0% (95% CI: 78.7-93.6), consistent with reported coverage of 80%. For praziquantel, unwillingness to take tablets (29.6%) and absence during MDA (14.4%) were the most common reasons for non-reach. Receiving sufficient information about MDA to make an informed decision was associated with higher odds of uptake for both ALB/MBZ (adjusted odds ratios [aOR]: 5.17, 95% CI: 2.01-13.27) and PZQ (aOR: 3.58, 95% CI: 1.33-9.64). For ALB/MBZ, finding MDA participation easy (aOR: 11.41, 95% CI: 2.59-50.16), feeling comfortable with the MDA distributor (aOR: 10.05, 95% CI: 2.43-41.47), and feeling comfortable with the MDA location (aOR: 3.23, 95% CI: 1.25-8.39) were each independently associated with higher uptake. For PZQ, males had significantly higher odds of uptake compared to females (aOR: 2.64, 95% CI: 1.15-6.07). Among households, 65.6% used improved drinking water sources, 91.4% obtained water from public places, 50.7% treated their water, 84.4% had improved toilets, 51.6% had visibly clean toilets, and 62% lacked a handwashing station. CONCLUSION: MDA coverage in Rwanda exceeded WHO targets and closely matched reported estimates, reflecting strong implementation. Addressing remaining gaps in drug supply, MDA communication, and WASH infrastructure will be important to sustain and strengthen control of soil-transmitted helminthiases and schistosomiasis.