Community acceptance of Ivermectin mass drug administration for malaria in Southern Thailand

Thailand's goal to eliminate malaria by 2030 faces significant challenges, in part due to inadequate vector control measures. Innovative strategies, such as mass drug administration (MDA) of ivermectin, have shown promise in improving vector control efforts. This study aims to assess the factors influencing the acceptance of ivermectin MDA among residents in southern Thailand. In 2022, a cross-sectional study was conducted in three districts of Surat Thani Province, southern Thailand, where an ivermectin MDA program was planned. Quantitative data were collected through structured surveys administered to randomly selected household heads using a standardized questionnaire. Descriptive statistics and multiple logistic regression models were employed to identify factors associated with the reported acceptance of ivermectin MDA. A total of 391 participants were surveyed, with the majority (96.4%) expressing acceptance of the planned ivermectin MDA. Forest-related workers (aOR: 4.2, 95% CI: 1.1-16.1) and those who believed malaria could be eliminated from their villages (aOR: 9.1, 95% CI: 2.8-29.9) were more likely to exhibit higher levels of acceptance. However, according to programmatic records, only 59.0% of the 3,137 eligible individuals completed all three rounds of ivermectin MDA. Key barriers to participation included absence from the village for unspecified reasons and reluctance to take the drug, particularly in later rounds. There was a noticeable gap between reported acceptance and actual participation in the ivermectin MDA. Targeted efforts to engage forest-related workers are crucial to maintain high participation rates. Strengthening community engagement by emphasizing the risks and benefits of ivermectin, outlining safety measures, and raising awareness about malaria prevention and control are crucial for improving MDA uptake.