Community perspective on feasibility of malaria mass drug administration: a qualitative evidence from the Eastern Region of Ghana

Background Malaria remains the leading cause of morbidity and mortality in Ghana, particularly in rural high-burden communities. Mass drug administration (MDA) has re-emerged as a complementary strategy to reduce transmission, yet community acceptability and implementation challenges remain underexplored. Methods We conducted a cross-sectional study in the Pokrom subdistrict following pilot mass drug administration (MDA) interventions. Data were collected through eleven focus group discussions (FGDs), nine with community members and two with healthcare providers, comprising 97 participants, as well as eight in-depth interviews (IDIs) with assemblymen, healthcare providers and personnel of malaria elimination programme. Thes were complemented by field notes. Participants were purposively selected from individuals who had participated in the MDA interventions and provided informed consent. This study explored community perceptions of malaria burden, perceived MDA effectiveness, reported adverse events, health-seeking behaviour, financial implications and acceptability. Transcripts were analysed thematically using a hybrid inductive–deductive approach informed by reflexive thematic analysis. Results Malaria was widely identified as the most pressing health concern in the subdistrict prior to the MDA intervention, with frequent hospitalisation and substantial household expenditure on treatment reported. Following the MDA interventions, notable reductions in malaria episodes were described, with some households transitioning from frequent infections to rare or no illness. These perceived improvements were accompanied by decreased healthcare-related costs, indicating important financial and economic benefits. Though adverse events, including dizziness, abdominal pain, and weakness, were reported, they were generally perceived as mild and transient. Initial challenges included inadequate community sensitization and negative messaging from some health workers, which temporarily affected uptake. Despite these concerns, willingness to participate in future MDA rounds remained high among community members, with recommendations emphasizing continued sensitization, strengthened drug delivery systems, and enhanced monitoring of side effects. Conclusions The MDA interventions were widely perceived as beneficial in reducing malaria burden and associated household healthcare costs in rural Ghana. Consistent with the Theoretical Framework of Acceptability, perceived effectiveness and economic benefits outweighed the burden of transient adverse events, contributing to perceived high community acceptability. Strengthening communication, pharmacovigilance, and community engagement could be critical for sustaining uptake and supporting the potential scale-up of MDA in high-burden malaria settings.