Factors Influencing Drug Uptake during Mass Drug Administration for Control of Lymphatic Filariasis in Rural and Urban Tanzania

Abstract

BackgroundIn most countries of Sub-Saharan Africa, control of lymphatic filariasis (LF) is based on annual mass drug administration (MDA) with a combination of ivermectin and albendazole. Treatment coverages are however often suboptimal for programmes to reach the goal of transmission interruption within reasonable time. The present study aimed to identify predictors and barriers to individual drug uptake during MDA implementation by the National LF Elimination Programme in Tanzania.MethodsA questionnaire based cross sectional household survey was carried out in two rural and two urban districts in Lindi and Morogoro regions shortly after the 2011 MDA. 3279 adults (≥15 years) were interviewed about personal characteristics, socio-economic status, MDA drug uptake among themselves and their children, reasons for taking/not taking drugs, and participation in previous MDA activities for LF control.FindingsThe overall drug uptake rate was 55.1% (range of 44.5–75.6% between districts). There was no overall major difference between children (54.8%) and adults (55.2%) or between females (54.9%) and males (55.8%), but the role of these and other predictors varied to some extent between study sites. Major overall predictors of drug uptake among the interviewed adults were increasing age and history of previous drug uptake. Being absent from home during drug distribution was the main reason for not taking the drugs (50.2%) followed by clinical contraindications to treatment (10.8%), missing household visits of drug distributors (10.6%), and households not being informed about the distribution (9.0%).ConclusionDrug uptake relied more on easily modifiable provider-related factors than on individual perceptions and practices in the target population. Limited investments in appropriate timing, dissemination of accurate timing information to recipients and motivation of drug distributors to visit all households (repeatedly when residents are absent) are likely to have considerable potential for increasing drug uptake, in support of successful LF transmission elimination.

Lymphatic filariasis elimination efforts in Rufiji, southeastern Tanzania: decline in circulating filarial antigen prevalence in young school children after twelve rounds of mass drug administration and utilization of long-lasting insecticide-treated nets

“…In the current study, being absent during drug distribution was cited as the major reason for not taking the drugs. This was also noted in studies conducted previously in other parts of Tanzania (Kisoka et al, 2014, Simonsen et al, 2014). …”

“…The surveyed percentages of drug uptake in the current study were lower than the minimum of 65% required to attain the interruption of LF transmission, and this observation has been documented in other places implementing the programme (World Health Organization, 2011). Lower than optimal drug uptake is a challenge to the success of MDA campaigns in some areas of Tanzania (Kisoka et al, 2014, Simonsen et al, 2014). In the current study, being absent during drug distribution was cited as the major reason for not taking the drugs.…”

A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa

“…(Rural setting)Lofa County, Kolahun District.To assess community leaders’knowledge and attitudes regarding resumption of MDA for NTDs after the Ebola virus disease epidemic (EVD).Shift in national health systems priorities regarding funding, research and development due to EVD.Temporally halt to all MDA for LF activities in EVD affected areas.Fears in the community that EVD and MDA might be linked, hence affecting compliance/coverageProgramme sustainability, community participation and coverage3. Kisoka et al, 2014 [21]/Tanzania/May and August 2011Cross sectional household surveyData was collected from 3279 adults above 15 years of age.(Urban and Rural settings) Lindi and Morogoro regions.To assess, through household questionnaires, the associations between selected predictors and individual drug uptake shortly after the implementation of MDA in two rural and two urban Districts in TanzaniaDrug uptake relied more on easily modifiable provider-related factors than on individual perceptions and practices in the target population.Motivation of drug distributors to visit all households (repeatedly when residents are absent) are likely to have considerable potential for increasing drug uptake.Coverage4. Madon et al, 2014 [45]/Tanzania/not statedQualitative study15 key informantsinterviews with Voluntary health workers (VHWs), village leaders and health officials.…”

“…In Sierra Leone and Mali, high MDA for LF coverage was attained in urban settings after having previously recorded low coverage by hiring of paid CDDs [22, 23, 37]. These studies established that the volunteer system of CDDs was ineffective in urban settings, especially in over-populated, rapidly urbanizing and mixed ethnic communities. Management of adverse/side effects Side effects were some of the major reasons why community members did not participate in MDA for LF [21, 38, 40]. Successful MDA programmes had well-established plans for any adverse effects during implementation [34, 36, 37, 39–41].…”

Neglected Tropical Diseases in Biosocial Perspective

“…In many instances it has been shown that irrespective of the reported coverage levels, large numbers of people being targeted either refuse to swallow them or they are not offered them in the first place (e.g. Ranganath, 2010;Roy et al, 2013;Muhumuza et al, 2013Muhumuza et al, , 2015Kisoka et al, 2014Kisoka et al, , 2016Tuhebwe et al, 2015). These points relate to a fourth broad area of concern: the role of drug distributors in mass treatment programmes.…”