Abstract
BackgroundUnderstanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa.MethodsA systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation.ResultsThe main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution.ConclusionMass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to improve implementation outcomes. Successfully achieving this requires undertaking formative research on the possible constraining and inhibiting factors, and incorporating the findings in the design and implementation of MDA for LF.
Highlights
Understanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions
We identified that innovative approaches to social mobilization through community led health education programmes and integration with existing health interventions were mostly documented in the West African region
Key areas of success that should be considered for every successful MDA for LF undertaking include those facilitating the implementation process such as; building of strategic partnerships for innovative resource mobilization, especially in resourcelimited settings, exploring possibilities of programme integration both at national and primary healthcare levels and extensive engagement of the community in programme implementation efforts
Summary
Understanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. According to the World Health Organization (WHO), LF accounts for at least 2.8 million disability adjusted years (DALYs) not including significant co-morbidity of mental illness commonly experienced by patients and their caregivers [1, 3]. This disease affects the poorest populations in society, those living in areas with poor water, sanitation and housing, causing permanent disfigurement, reduced productivity and social stigma [4]. The SSA region is estimated to have 409.7 million people from 35 endemic countries at risk of infection [7], which is about 32% of the LF global disease burden [2]. LF is associated with massive economic losses in SSA, impairing economic activity of up to 88% in infected people and causes almost US$1 billion in annual productivity losses, mostly resulting from the disability linked to hydrocele in men [8, 9]
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