BACKGROUND: In the Dominican Republic, a recent outbreak of malaria in the capital, Santo Domingo, threatens efforts to eliminate the disease . Mass drug administration (MDA) has been proposed as one strategy to reduce transmission . The success of MDA is contingent upon high levels of acceptance among the target population . To inform the design of future MDA campaigns, this rapid ethnographic assessment examined malaria-related knowledge and attitudes toward malaria MDA among residents of a transmission focus in Santo Domingo .

METHODS: In October 2019, a rapid ethnographic assessment was conducted in the Los Tres Brazos transmission focus, which had not previously received MDA . National malaria programme staff conducted 61 structured interviews with key informants, recorded observations, and held 72 informal conversations . Using a grounded theory approach, data were analysed during three workshop sessions with research team members .

RESULTS: Among those who had heard of malaria in the structured interviews (n = 39/61; 64 %), understanding of the disease was largely based on personal experience from past outbreaks or through word-of-mouth . Community health workers (promotores) were trusted for health information and malaria diagnosis more so than professional clinicians . No participant (0 %) was familiar with malaria MDA . After learning about MDA, almost all study participants (92 %) said that they would participate, seeing it as a way to care for their community . Reasons for not participating in future MDA included not trusting drug administrators, feeling reluctant to take unprescribed medicine, and fear of missing work . Additional identified challenges to MDA included reaching specific demographic groups, disseminating effective MDA campaign messages, and managing misinformation and political influence .

CONCLUSION: Residents appear accepting of MDA despite a lack of prior familiarity . Successful MDA will depend on several factors: fostering relationships among community-based health workers, clinicians, community leaders, and others; developing clear health messages that use local terms and spreading them through a variety of media and social networks; and contextualizing MDA as part of a broader effort to promote community health.