What worked well/opportunities  • CHW familiarity with households led to warm reception  • Good knowledge of intervention area by CHWs  • High demand for drugs in the final year of treatment  • Effective community mobilization  • Opportunity to integrate MDA with other health interventions  • Presence of CHWs and their supervisory structure, and points of referral for serious side effects |
Challenges  • Fear of side effects, size of tablet and misconceptions regarding treatment  • Unrelated death and the associated negative publicity by the media  • Religious beliefs and mistrust of interventions  • Insufficient time and absence of community members during the MDA exercise  • Difficulty in directly observing treatment  • Unsanitary environmental conditions, insecurity and inaccessibility  • Demand for incentives by community members to take drugs |
Recommendations by CHWs  • Increase in duration for conducting MDA and number of CHWs  • Provision of incentives during the MDA exercise  • Community sensitization through media  • Incorporation of continuous Health education messaging in MDA exercises |