Integration of deworming into primary healthcare in Western Kenya: a quasi-experimental evaluation

The WHO 2030 NTD roadmap calls for integrating mass drug administration (MDA) into primary healthcare (PHC) systems. A coverage evaluation survey conducted in Western Kenya exposed the persistent limitations of mass drug administration campaigns, showing that nearly 25% of surveyed individuals never received treatment. The effect of stock-outs and ineffective mobilizations were also noted. To consolidate the gains from previous mass drug administrations (MDAs), integration of MDA into Primary Health Care (PHC) services was piloted through the Deworming Innovation Fund by leveraging community health structures and digital health platforms for improved delivery.

A quasi-experimental controlled before-and-after (CBA) study was conducted across 24 wards that were selected based on high helminth prevalence, comparable population size, facility availability, and accessibility for monitoring (12 intervention, 12 control) in Bungoma, Kakamega, Vihiga, and Trans-Nzoia counties. The start date of intervention was in April 2025, n = 1,229) and the end date of endline data collection was in June 2025, n = 1,130). The intervention took 3 months. Household surveys measured preventive chemotherapy (PC) coverage, epidemiological coverage, awareness sources, and treatment uptake. Mixed methods included key informant interviews and focus group discussions. The primary outcome was PC coverage (target ≥75% per WHO).

The integrated PHC model in the intervention group helped to increase deworming coverage from 58.4% to 75%; representing an adjusted odd ratio of 2.14 (95% CI: 1.48-3.09). This is in comparison to other control areas where coverage changed only marginally from 57.1% to 60.3%. However, the possible unmeasured programme and confounding implementation limits the quasi-experimental design. As a result, results are mostly relevant to county healthcare managers, NGOs and policymakers. These are people seeking scalable child healthcare interventions in endemic environments. Health facilities became a prominent awareness source only in intervention sites (30% at endline vs. 15% at baseline). In contrast, our study found lower non-treatment rates at 5% (compared to about a quarter reported in the 2024 MDA Coverage Evaluation Survey (CES), potentially reflecting the impact of the integrated approach or differences in recall period and sampling. The 5% of households reporting never receiving treatment were associated with various reasons, including; ineligibility (56%) or absence (17%), not lack of awareness (1%). Control wards showed sharp declines in awareness post-campaign, while intervention wards maintained or improved awareness through routine facility contacts.

PHC-integrated deworming achieved effective coverage comparable to traditional campaigns, with superior sustainability of awareness.