Willingness of adults to accept malaria mass drug administration using the theoretical framework of acceptability: a cross-sectional study in an urban municipality, Ghana.

BACKGROUND: Malaria continues to pose a major public health threat in sub-Saharan Africa, with Ghana accounting for 2.5% of all malaria cases in the region. Mass drug administration (MDA) has emerged as a viable intervention for malaria elimination, yet its success largely depends on community acceptance and adherence, particularly when asymptomatic individuals are required to take antimalarial drugs. The study assessed the willingness of adults in the La Dade-Kotopon Municipality (LaDMA) of Ghana to accept Malaria MDA programs using the Theoretical Framework of Acceptability (TFA) constructs and explore factors influencing its acceptability in urban Accra.

METHODS: This study employed a cross-sectional study design involving 421 adults from two communities in LaDMA, namely La and Burma Camp communities which served as the strata for this study. A step-by-step stratified procedure was used to select the study participants at random by sampling at the community and household levels. A structured questionnaire was administered to participants. Acceptability of MDA was assessed using Sekhon et al. seven Theoretical Framework of Acceptability (TFA) constructs. Both descriptive and inferential analyses were conducted at an alpha level of 0.05.

RESULTS: The median age of the participants was 33 years and 57.5% were females. Majority (58.7; 95% CI 54.0-63.0) of the participants in LaDMA found the malaria MDA program acceptable and will be willing to participate in it. Individuals aged 50-59 years had 66% lower odds of MDA acceptability compared to those aged 18-29 years (aOR = 0.34, 95% CI: 0.11-0.95, p = 0.040). Those with tertiary education had 72% lower odds of MDA acceptability compared to those with primary education (aOR = 0.28, 95% CI: 0.09-0.86, p = 0.027). Ewes had 68% lower odds of MDA acceptability compared to Gas (aOR = 0.32, 95% CI: 0.12-0.82, p = 0.019).

CONCLUSION: Willingness to accept malaria MDA is moderate, with over 40% of participants finding the intervention unacceptable. Residents who endorsed community wellbeing as a reason to participate were substantially more likely to accept MDA. Programmatic strategies should prioritize targeted engagement to address barriers among non-accepting groups, while emphasizing community-wide benefits to sustain participation among those already willing.