Abstract
BackgroundThe main strategy adopted for Lymphatic Filariasis (LF) elimination globally is annual mass drug administration (MDA) for 4 to 6 rounds. At least 65% of the population at risk should be treated in each round for LF elimination to occur. In Kenya, MDA using diethylcarbamazine citrate (DEC) and albendazole data shows declining compliance (proportion of eligible populations who receive and swallow the drugs) levels (85%–62.8%). The present study's aim was to determine the role of personal opinions and experiences in compliance with MDA.Methods/FindingsThis was a retrospective cross-sectional study conducted between January and September 2009 in two districts based on December 2008 MDA round. In each district, one location with high and one with low compliance was selected. Through systematic sampling, nine villages were selected and interviewer-based questionnaires administered to 965 household heads or adult representatives also systematically sampled. The qualitative data were generated from opinion leaders, LF patients with clinical signs and community drug distributors (CDDs) all purposively selected and interviewed. Sixteen focus group discussions (FGDs) were also conducted with single-sex adult and youth male and female groups. Chi square test was used to assess the statistical significance of differences in compliance with treatment based on the records reviewed.The house-to-house method of drug distribution influenced compliance. Over one-quarter (27%) in low compared to 15% in high compliance villages disliked this method. Problems related to size, number and taste of the drugs were more common in low (16.4%) than in high (14.4%) compliance villages. Reasons for failure to take the drugs were associated with compliance (p<0.001). The reasons given included: feeling that the drugs were not necessary, CDD not visiting to issue the drugs, being absent and thinking that the drugs were meant for only the patients with LF clinical signs. A dislike for modern medicine prevailed more in low (6.7%) than in high (1.2%) compliance villages. Experience of side effects influenced compliance (P<0.001). The common side effects experienced included giddiness, fever, headache and vomiting. Social support, alcohol and substance use were not associated with compliance in both types of villages (p>0.05).Conclusions/SignificanceCommunity sensitization on treatment, drugs used, their regimen and distribution method involving all leaders should be strengthened by the Programme Implementers. The communities need to be made aware of the potential side effects of the drugs and that health personnel are on standby for the management of side effects in order to build confidence and increase the compliance levels.
Highlights
Lymphatic filariasis (LF) caused by filarial worms and transmitted by mosquitoes is ranked as the second largest cause of disability in the world [1]
A higher proportion (27%) in low compared to 14.9% in high compliance villages disliked this method of drug distribution, P,0.001
Other reasons included having to wait for the community drug distributors (CDDs) for a long time and poor CDD interaction (Table 2).in 4 focus group discussions (FGDs) from high and 4 from low compliance villages, a large majority of the participants reported that the interaction with the CDDs was poor as they did not give adequate information about the drugs, left drugs behind for absentees, did not have good communication skills, ‘overdosed’ the people and were strangers to the community members
Summary
Lymphatic filariasis (LF) caused by filarial worms and transmitted by mosquitoes is ranked as the second largest cause of disability in the world [1]. Lymphatic filariasis was identified as a potentially eradicable disease by the International Task Force for Disease Eradication in 1993[4].For elimination to occur, at least 65% treatment coverage of endemic communities and sustaining such coverage for 6–10 years is recommended [5]. The main strategy adopted for Lymphatic Filariasis (LF) elimination globally is annual mass drug administration (MDA) for 4 to 6 rounds. In Kenya, MDA using diethylcarbamazine citrate (DEC) and albendazole data shows declining compliance (proportion of eligible populations who receive and swallow the drugs) levels (85%–62.8%). = 55 Education (n = 965) Never attended school Incomplete primary Completed primary Completed secondary Tertiary education Main Occupation (n = 965) Peasant farmer Housewife Casual laborer Small/big business Fisherman Salaried doi:10.1371/journal.pone.0048395.t001 Frequency (%)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
