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.
Highlights
Lymphatic Filariasis (LF) is a mosquito transmitted parasitic disease which in Africa is caused by the filarial nematode Wuchereria bancrofti
mass drug administration (MDA) is based on annual distribution of a single dose of albendazole in combination with either diethylcarbamazine or ivermectin to all eligible individuals, with the main purpose to kill circulating microfilarae produced by the adult worms, and thereby reduce the level of transmission in the endemic communities
To achieve the goal of elimination of lymphatic filariasis (LF) as a public health problem, it is crucial that a major proportion in the target community adhere to treatment and take the offered tablets once a year for a period of 5 to 6 years [4,9], which is believed to correspond to the reproductive lifespan of the adult parasitic worms
Summary
Lymphatic Filariasis (LF) is a mosquito transmitted parasitic disease which in Africa is caused by the filarial nematode Wuchereria bancrofti. The World Health Organization subsequently launched the Global Programme to Eliminate Lymphatic Filariasis (GPELF) with the major goal to eliminate LF as a public health problem by the year 2020 [7]. The programme has a twofold aim of interrupting transmission by annual mass drug administration (MDA) and alleviating suffering and disability by applying measures for morbidity control. MDA is based on annual distribution of a single dose of albendazole in combination with either diethylcarbamazine or ivermectin to all eligible individuals, with the main purpose to kill circulating microfilarae produced by the adult worms, and thereby reduce the level of transmission in the endemic communities. In 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.
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