Integrating Community-directed Interventions to Eliminate Neglected Tropical Diseases Caused by Soil-transmitted Helminth Infections and Rabies in Tanzania

The study was carried out in the Ngorongoro District, Tanzania inhabited by semi-nomadic Maasai people. The remote area was chosen because MDRV and MDA are carried out annually in the region as separate programs. The MDA program delivers twice yearly deworming treatment to every primary school and is coordinated by the District Medical Office (DMO). The MDRV program vaccinates dogs annually and is coordinated by the District Veterinary Office. The MDA and MDRV carried out in this study constituted one cycle of the established MDA and MDRV in the target villages. The study took place between February and October 2016, however activities were suspended during the rainy season to avoid inclement weather from affecting participation.

The study focused on 24 villages. The target villages were located within the eight wards immediately surrounding the district's administrative centre and were selected through convenience. Each of the 24 villages were randomly assigned to one of three arms: i) Arm A (n = 8) received both MDA and MDRV; ii) Arm B (n = 8) received MDA only; iii) Arm C (n = 8) received MDRV only. All villages were equally likely to be assigned to each arm. As per the established MDA and MDRV programs, a nurse from the DMO and two village-based community health workers carried out the MDA whilst a rabies field team (a veterinarian, two field staff and a ward-based person) delivered the MRDV. STH and / or rabies awareness information was provided to respondents in the form of verbal disease avoidance advice.

Villages in this region cover a large area, and all are divided into sub-village units. Each intervention ('event') was delivered at the level of the sub-village using a 'central-point' strategy, which required villagers to travel from their homes to the central-point event to receive treatment. Village leaders estimated that hosting each sub-village event for one day would provide sufficient time for villagers to attend. Consequently each event was scheduled to last for one day, and the number of days the team(s) spent in each village equalled the number of sub-villages.

Arm A events comprised an MDA and a MDRV clinic hosted concurrently, while Arm B and Arm C events comprised only one clinic (MDA or MDRV, respectively). For Arm A villages, the MDA and MDRV delivery teams travelled together in one vehicle and set up the clinics close to each other. For Arm B and C villages, the MDA and MDRV teams travelled separately.

In order to allow comparison of the MDA with school-based delivery (second objective) the events were all hosted during the school term. In sub-villages with a primary school, the clinics were positioned outside the school grounds, whilst in sub-villages that did not have a primary school the clinics were located in a central location.