A Qualitative Study Identifying Factors and Solutions to Increase Gender Equity in Soil-Transmitted Helminth Treatment for Children in India, Benin, and Malawi

Abstract

Background: Approximately 24% of the world’s population is infected with a soil-transmitted helminth (STH), a neglected tropical disease (NTD) where a parasitic worm lives in human intestine (1). STH infection disproportionally affects marginalized populations in low-and-middle income countries (LMIC) (2). Children are the most vulnerable population to STH infection and experience a disproportionate amount of STH morbidities causing cognitive delay, stunting, malnutrition, and increased school-absenteeism (3). Few studies have identified factors contributing to gender inequity in deworming treatment of children. We aim to identify factors and solutions to gender equitable deworming treatment of children in Benin, India, and Malawi. Methods: The Health Equity Implementation Framework (HEIF) was utilized to inform this study and develop our codebook. We conducted a secondary analysis of 40 focus group discussions from the DeWorm3 Project. A thematic analysis based on the HEIF and valence scoring of the HEIF domains were used to analyze the data. Results: Seven themes were developed according to the HEIF in regard to factors and solutions that contribute to gender equitable deworming treatment of children. The themes are as follows: cMDA reaches out of school children, who are disproportionately female , parental engagement during cMDA contributes to gender equitable treatment in children, household gender norms can perpetuate both equities and inequities in children, CDD’s influence equitable treatment uptake, community fear can lead to treatment refusal and sensitization is imperative to overcome this barrier, migration outside of the community inhibits deworming treatment through cMDA, and providing children food during MDA can increase treatment uptake for all genders (4,5). Through scoring the HEIF domains, we found the Clinical Encounter domain of the HEIF had the strongest, positive influence on gender equitable treatment . Conclusion: To achieve global benchmarks of reducing STH-associated morbidities in children, it is necessary to implement strategies to reach all children. To engage gender equitable treatment of children in deworming campaigns, we recommend implementing these three strategies: cMDA as the standard of care for deworming, tailoring sensitization of deworming to children to overcome their specific fears and providing food to children during deworming to promote gender equitable treatment of children.