Mass drug administration for lymphatic filariasis elimination in a coastal state of India: a study on barriers to coverage and compliance

Abstract

BackgroundLymphatic filariasis is targeted for elimination in India through mass drug administration (MDA) with diethylcarbamazine (DEC) combined with albendazole (ABZ). For the strategy to be effective, >65% of those living in endemic areas must be covered by and compliant to MDA. Post the MDA 2011 campaign in the endemic district of Odisha, we conducted a survey to assess: (i) the filariasis knowledge in the community, (ii) the coverage and compliance of MDA from the community perspective, and (iii) factors affecting compliance, as well as the operational issues involved in carrying out MDA activities from the drug distributor’s perspective.MethodsA sample of 691 participants – both male and female, aged two years or above – were selected through multistage stratified sampling and interviewed using a semi-structured questionnaire. Additionally, drug distributors and the medical officers in charge of the MDA were also interviewed to understand some of the operational issues encountered during MDA.ResultsNinety-nine percent of the study participants received DEC and ABZ tablets during MDA, of which only just above a quarter actually consumed the drugs. The cause of non-compliance was mostly due to fear of side effects, lack of awareness of the benefits of MDA, and non-attendance of health staff in the villages. Lack of adequate training of drug distributors and poor health communication activities before the MDA campaign commenced and the absence of follow-up by health workers following MDA were a few of the operational difficulties encountered during the MDA campaign.ConclusionCurrently MDA is restricted to the distribution of drugs only and the key issues of implementation in compliance, health education, managing side effects, and logistics are not given enough attention. It is therefore essential to address the issues linked to low compliance to make the program more efficient and achieve the goal of filariasis elimination.

Mass drug administration and the sustainable control of schistosomiasis: Community health workers are vital for global elimination efforts

“…At present, countries implementing MDA for schistosomiasis control are still struggling to attain the ideal level of coverage (75%). Increased awareness, understanding of disease, and treatment options have been linked to good coverage rates and compliance with MDA for other NTDs (Aswathy et al, 2009;Gunawardena et al, 2007;Hussain et al, 2014). The Philippines is one of the countries with below-target national coverage rates at 43.5% in 2015.…”

Knowledge, attitudes and perceptions regarding lymphatic filariasis: study on systematic noncompliance with mass drug administration

“…Approximately two-thirds of the infected population remain asymptomatic, and these individuals might not be aware of the benefits of treatment 40 . Albuquerque et al .…”

Directly observed treatment increases drug compliance in lymphatic filariasis mass drug administration

“…(13) Hussain et al (10) state that failure to attain drug compliance in the MDA program is due to absence of health personnel during distribution of antifilariasis drugs. Among 99% of subjects who are recipients of antifilariasis drugs in India, only around 25% take the drugs, which agrees with the MDA program in the Pabean area of Pekalongan.…”

“…(9) Another study showed that 99% of the study participants received DEC and albendazole tablets during MDA, of which only just above a quarter actually consumed the drugs. (10) The gap between MDA coverage rates and compliance rates, as reported in previous studies, needs to be subjected to further reasearch to find the causative factors. The purpose of the present study was to assess the impact of the MDA program and determine the factors associated with noncompliance in taking antifilariasis drugs.…”