Coverage of azithromycin mass treatment for trachoma elimination in Northwestern Ethiopia: a community based cross-sectional study

BACKGROUND: Mass drug administration with antibiotics predominantly with azithromycin is one of the four arms of the SAFE strategy. The elimination of ocular chlamydial infection is only achieved as long as the azithromycin mass treatments (AMT) are given frequently enough and at a high enough coverage. This study was conducted to assess the coverage of azithromycin mass treatment and its determinants in Awi Zone, Northwestern Ethiopia. METHODS: House to house survey using a structured questionnaire was done between July 7 to July 25, 2013. Coverage is defined as the proportion of individuals in the eligible population who actually ingested the Azithromycin during the Campaign. RESULTS: A total of 1267 households were enrolled in the survey in which 5826 eligible members were living in these households. Almost half (54.6%) of the community members who were eligible for all six campaigns had participated in more than three campaigns of azithromycin mass treatment. The overall average self-reported coverage of the azithromycin mass treatment (AMT) in all six campaigns was 62.8% (64% in rural vs. 61.6% urban). On average, each eligible person had taken the drug 3.77 times. The rural residents were significantly more likely to have received treatment during the last round of AMT in 2012 {AOR = 2.35; 95% CI [1.80–3.06]}. Azithromycin uptake status of female household heads was less than the corresponding male household heads {AOR = 0.41; 95% CI [0.24–0.72]}. Household heads’ awareness about trachoma (AOR = 2.55; 95% CI [1.19–5.44]) and AMT {AOR = 7.19; 95% CI [3.27–15.82]} had positive association with acceptability. CONCLUSION: The overall average AMT coverage was found to be low. There was low coverage of the treatment in the urban community as compared to the rural residents. Misconceptions of household heads about trachoma and azithromycin have negatively affected the coverage. Further work on why female household heads are associated with higher risk of non-participation in AMT is warranted. Strengthening awareness creation and consideration of additional campaigns is essential. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12886-018-0868-1) contains supplementary material, which is available to authorized users.