Alternative Approaches to MDA Coverage Surveys in Uganda

Coverage surveys are an important tool for programs to evaluate their reporting systems and to determine whether effective MDA coverage has been achieved. However, for various reasons coverage surveys are seldom implemented. Some key challenges are: perceived technical difficulty, lack of resources, and lack of standardized guidance on how to conduct coverage surveys. This protocol seeks to address the 1st and 3rd points by comparing the feasibility of three different coverage survey methods (EPI approach, LQAS, and segmentation). This study was completed all 3 methods in the same district in Uganda. All 3 coverage surveys were integrated surveys, meaning that the questionnaire addressed coverage for ALB, IVM, PZQ, and ZITH. All methods found that the survey coverage was far below the WHO target thresholds. Furthermore, for all drugs assessed, the survey coverage was far below the reported coverage (the reported coverage suggested that coverage was above the target thresholds). Taken together this suggests that there are major issues with both the MDA and the reporting system in this district in Uganda. The country program has since taken important steps to improve coverage and the reporting system. The feasibility results found all 3 methods to be very similar with regards to time, cost and perceived difficulty. Because only the segmentation approach results in a probability sample, this method was recommended by the M Working Group and ultimately approved by the STAG. Since the approval, significant work has been underway to create guidelines for conducting coverage surveys for preventive chemotherapy. An Excel tool was created to improve the usability of the tool and online learning modules are currently in the works. This particular Dataverse entry focuses on the study data from Uganda.