| Summary: | <p>The emergence of artemisinin-resistant malaria in Southeast Asia has prompted malaria control programs to expedite efforts to eliminate malaria. One suggested approach is the mass administration of antimalarials (MDA) to entire target population regardless of malaria infection. MDA is one of the central components of Targeted Malaria Elimination (TME), an approach recently piloted in Laos. For MDA to be successful (leading to interruption of local malaria transmission), a high population coverage is critical. Among myriad factors, community engagement has been recognized as critical to promoting high coverage. The main aim of this study was to design, execute and assess a locally suitable community engagement strategy that can promote the uptake of and adherence to MDA. This study utilized a longitudinal mixed method approach. In addition to the local social and cultural factors, five main elements of community engagement that contributed to high population coverage were identified: 1. Stakeholder and authority engagement: a stepwise approach from central to the local level; 2. Local human resources: recruitment and training of local community members to execute TME; 3. Formative research: an exploration of the local social and cultural context to guide the community engagement; 4. Responsiveness: flexible and adaptable approach based on the demands and needs of the community and 5. Sharing control/leadership with the community: joint decision making with the community members. Various factors contributed to the high population coverage recorded in the Lao TME study (above 85%): community engagement to promote the concept of asymptomatic malaria and the rationale for MDA, baseline understanding of malaria as a health concern, perceptions that TME was worthwhile, provision of free primary health care, partnering of the research with local volunteers and authorities, building social relationship with community members and the cohesive nature of the communities that boosted the trust and participation in MDA.</p>
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