Mass vaccination and drug administration for malaria elimination in Bangladesh: design and implementation of a community engagement strategy

BACKGROUND: Community engagement is increasingly recognised as an essential element of health research in underserved settings, yet limited evidence describes how engagement strategies are designed, adapted, and implemented during large-scale intervention trials. This implementation case study describes the development, implementation, and iterative adaptation of a stakeholder and community engagement strategy embedded within a field trial of mass vaccination and drug administration (MVDA) for malaria elimination in Bangladesh. METHODS: The cluster-randomised, open-label trial was conducted across 100 villages (~12,000 people) in the Chittagong Hill Tracts, Bangladesh. The paper draws on implementation records, field observations, meeting reports, and structured team reflections generated during programme delivery to describe the engagement process, key adaptations, implementation challenges, and lessons learned. RESULTS: Early stakeholder engagement informed a context-specific engagement strategy that emphasised collaboration with village leaders, culturally tailored communication, responsiveness to community concerns, and integration of basic healthcare support. Throughout implementation, engagement activities were iteratively adapted in response to community feedback, rumours, seasonal livelihood demands, and local cultural and religious beliefs. These iterative approaches were followed by continued engagement across remote and culturally diverse communities, although persistent challenges included geographical isolation, social and political factors, complex trial messaging, competing livelihood priorities, and concerns regarding vaccination, including fears about fertility. CONCLUSIONS: Community engagement functioned as an adaptive and responsive process rather than a fixed intervention. These experiences provide transferable lessons for designing stakeholder and community involvement strategies for complex health research conducted in underserved and culturally diverse settings.