Implementation challenges and opportunities for improved mass treatment uptake for lymphatic filariasis elimination: Perceptions and experiences of community drug distributors of coastal Kenya.

Doris W Njomo,Bridget W Kimani,Wyckliff P Omondi,Lydiah W Kibe,Hadley M Sultani,Collins Okoyo,Samuel Wanji

doi:10.1371/journal.pntd.0009012

Doris W Njomo, Bridget W Kimani + Show 5 more

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https://doi.org/10.1371/journal.pntd.0009012

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Abstract

Community drug distributors (CDDs) who are volunteers have the responsibility of awareness creation, household census, drug distribution and record-keeping and are thus key stakeholders in the campaign for Lymphatic Filariasis (LF) elimination. Taking into account their experiences and perceptions is important for a successful elimination campaign. We conducted a qualitative study in 2018 to identify implementation challenges and opportunities for improved mass drug administration (MDA) uptake based on the CDDs perceptions and experiences. Within a larger study that used mixed methods quasi-experimental design, we collected qualitative data from two wards in Kaloleni Sub-County of Kilifi County which was purposively selected owing to its low, 56% and 50.5% treatment coverage in 2015 and 2016 respectively. Focus group discussions (FGDs) (n = 8) and in-depth interviews (IDIs) (n = 8) with CDDs, IDIs (n = 22) with opinion leaders and IDIs (n = 8) with health workers were conducted and the data analyzed by QSR NVIVO version 10 according to thematic areas. The results showed that based on the perceptions and experiences of the CDDs, several challenges: communities’ refusal to take the drugs; absenteeism during MDA; non-adherence to CDDs selection criteria; inadequacy in number of CDDs engaged during the campaign and training provided; insufficiency of drugs issued to CDDs; lack of CDDs supervision and low motivation negatively impact on MDA uptake. Opportunities to address the challenges included: awareness creation on MDA, health education on LF and observation of hygiene during drug administration, increased duration of awareness creation and drug administration, adherence to CDDs selection criteria and putting into consideration the vastness of an area and population density while deploying CDDs. Other opportunities include: improved CDDs training and scheduling; issuing of enough drugs to CDDs to meet the communities’ demand and improved supervision and motivation of CDDs. Addressing the challenges highlighted is an important step of maximizing MDA uptake. The opportunities presented need to be considered by the NTD program personnel, the county health personnel and the community while planning the implementation of MDA campaigns.

Highlights

The Global Program to Eliminate Lymphatic Filariasis (GPELF) which was launched in the year 2000 has two principal goals: (i) to interrupt LF transmission and (ii) to manage morbidity and prevent disability in endemic countries [1]
World Health Organization conducted a rigorous review of data from safety and efficacy trials of the triple drug regimen and in November 2017 provided updated treatment guidelines that endorsed the use of IDA as an alternative mass drug administration (MDA) regimen for LF elimination programmes [5]
Eight in-depth interviews (IDIs) were conducted with Community Drug Distributors (CDDs) who distributed drugs during the November 2018 MDA

Summary

Introduction

The Global Program to Eliminate Lymphatic Filariasis (GPELF) which was launched in the year 2000 has two principal goals: (i) to interrupt LF transmission and (ii) to manage morbidity and prevent disability in endemic countries [1]. Recent scientific studies, led by the Death of Onchocerciasis and Lymphatic Filariasis (DOLF) project at Washington University in St. Louis, found that a three-drug regimen, using all three of the medicines typically delivered as a standard two-drug regimen to prevent LF (ivermectin + albendazole or diethylcarbamazine + albendazole (IDA)), is dramatically more effective for achieving sustained clearance of microfilariae from infected persons [4]. From 2000 to 2018, 7.7 billion treatments were delivered to more than 910 million people at least once in 68 countries, considerably reducing transmission and causing a decline of the population requiring MDA by 42% (597 million) where infection prevalence has been reduced below elimination thresholds [7]

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