Abstract
Lymphatic filariasis is one of several neglected tropical diseases with severely disabling and stigmatizing manifestations that are referred to as 'neglected diseases of poverty'. It is a mosquito-borne disease found endemically and exclusively in low-income contexts where, concomitantly, general public health care is often deeply troubled and fails to meet the basic health needs of impoverished populations. This presents particular challenges for the implementation of mass drug administration (MDA), which currently is the principal means of control and eventual elimination. Several MDA programmes face the dilemma that they are unable to attain and maintain the required drug coverage across target groups. In recognition of this, a qualitative study was conducted in the Morogoro and Lindi regions of Tanzania to gain an understanding of community experiences with, and perceptions of, the MDA campaign implemented in 2011 by the National Lymphatic Filariasis Elimination Programme. The study revealed a wide variation of perceptions and experiences regarding the aim, rationale and justification of MDA. There were positive sentiments about the usefulness of the drugs, but many study participants were sceptical about the manner in which MDA is implemented. People were particularly disappointed with the limited attempts by implementers to share information and mobilize residents. In addition, negative sentiments towards MDA for lymphatic filariasis reflected a general feeling of desertion and marginalization by the health care system and political authorities. However, the results suggest that if the communities are brought on board with genuine respect for their integrity and informed self-determination, there is scope for major improvements in community support for MDA-based control activities.
Highlights
Lymphatic filariasis, a devastating disease caused by filarial nematode worms and spread by mosquitoes, is found in more than 80 countries (WHO, 2010; Simonsen et al, 2014)
A qualitative study was conducted in the Morogoro and Lindi regions of Tanzania to gain an understanding of community experiences with, and perceptions of, the mass drug administration (MDA) campaign implemented in 2011 by the National Lymphatic Filariasis Elimination Programme
Negative sentiments towards MDA for lymphatic filariasis reflected a general feeling of desertion and marginalization by the health care system and political authorities
Summary
A devastating disease caused by filarial nematode worms and spread by mosquitoes, is found in more than 80 countries (WHO, 2010; Simonsen et al, 2014). The World Health Organization, through its Global Programme to Eliminate Lymphatic Filariasis (GPELF), has targeted the disease for elimination as a public health problem by 2020 through a dual strategy of mass drug administration (MDA) to interrupt transmission of infection and morbidity control to alleviate disability of people affected by the acute and chronic manifestations (Gyapong et al, 2005; Ottesen, 2006; Kyelem et al, 2008; WHO, 2010, 2013). A high treatment coverage of 65% in the endemic population sustained for 5–6 years is required to effectively clear infected individuals and stop the transmission (Michael et al, 2004; WHO, 2011). A major challenge facing many MDA programmes for lymphatic filariasis control has been to attain and sustain the high treatment coverage required to interrupt transmission in endemic communities It is important to identify and understand these factors in order to strengthen the programme approach and increase treatment coverage
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