Factors Influencing the Compliance with Mass Drug Administration for Soil-Transmitted Helminthiasis in Adolescent Girls and Women of Reproductive Age in Bukavu, Democratic Republic of Congo: An Implementation Research Study

Abstract

Soil-transmitted helminthiasis (STH) remains a major public health concern in the Democratic Republic of Congo (DRC) despite years of mass drug administration (MDA). Women of reproductive age (WRA) are particularly vulnerable, yet their compliance with MDA is often suboptimal.  This study explored barriers and facilitators of compliance among adolescent girls and WRA in Bukavu, DRC. This mixed-methods cross-sectional study conducted in the Kadutu Health Zone from September 2024 to March 2025. Quantitative data were collected from 487 WRA using structured questionnaires and analyzed with R presenting descriptive and multivariate logistic regression. Qualitative data from 13 key informant interviews and 2 focus group discussions were thematically analyzed using NVivo (version 14). Overall compliance was 64.9%, but varied significantly by age, education, and economic status. Adolescents (15–19 years) had the lowest adherence (57.7%) and highest refusal (16%), while university-educated women achieved 81% compliance. Women with low economic status were disproportionately represented among those never treated (36.4%). Prior MDA experience (AOR = 39.8; 95% CI: 13.0–151), being informed about the campaign (AOR = 4.73; 95% CI: 2.01–11.1), and university education (AOR = 6.16; 95% CI: 1.15–33.1) were the strongest predictors of compliance. Qualitative findings highlighted barriers such as fear of side effects, misconceptions (e.g., albendazole as aborticide), limited autonomy among adolescents, and poor instructions, while facilitators included prior positive experience, trust in health programs, and effective communication through radio. Compliance among WRA remains below optimal levels despite high reported coverage. Addressing misconceptions, improving health education, engaging community leaders, and strengthening program logistics are critical to enhancing adherence and achieving STH control goals.