Compliance Of Mass Drug Administration Research Articles

Heterogeneity in elimination efforts could increase the risk of resurgence of lymphatic filariasis in Madagascar

BackgroundProgress in lymphatic filariasis (LF) elimination is spatially heterogeneous in many endemic countries, which may lead to resurgence in areas that have achieved elimination. Understanding the drivers and consequences of such heterogeneity could help inform strategies to reach global LF elimination goals by 2030. This study assesses whether differences in age-specific compliance with mass drug administration (MDA) could explain LF prevalence patterns in southeastern Madagascar and explores how spatial heterogeneity in prevalence and age-specific MDA compliance may affect the risk of LF resurgence after transmission interruption. MethodologyWe used LYMFASIM model with parameters in line with the context of southeastern Madagascar and explored a wide range of scenarios with different MDA compliance for adults and children (40–100%) to estimate the proportion of elimination, non-elimination and resurgence events associated with each scenario. Finally, we evaluated the risk of resurgence associated with different levels of migration (2–6%) from surrounding districts combined with varying levels of LF microfilaria (mf) prevalence (0–24%) during that same study period. ResultsDifferences in MDA compliance between adults and children better explained the observed heterogeneity in LF prevalence for these age groups than differences in exposure alone. The risk of resurgence associated with differences in MDA compliance scenarios ranged from 0 to 19% and was highest when compliance was high for children (e.g. 90%) and low for adults (e.g. 50%). The risk of resurgence associated with migration was generally higher, exceeding 60% risk for all the migration levels explored (2–6% per year) when mf prevalence in the source districts was between 9% and 20%. ConclusionGaps in the implementation of LF elimination programme can increase the risk of resurgence and undermine elimination efforts. In Madagascar, districts that have not attained elimination pose a significant risk for those that have achieved it. More research is needed to help guide LF elimination programme on the optimal strategies for surveillance and control that maximize the chances to sustain elimination and avoid resurgence.

Erratum: Coverage and compliance of mass drug administration (MDA) programme for elimination of lymphatic filariasis in an endemic district of eastern Uttar Pradesh, India

Erratum: Coverage and compliance of mass drug administration (MDA) programme for elimination of lymphatic filariasis in an endemic district of eastern Uttar Pradesh, India

Household Survey to Evaluate the Coverage of Mass Drug Administration for the Lymphatic Filariasis in District Umaria, Madhya Pradesh, India in Year 2023

Background: In 2023, the Umaria district in Madhya Pradesh, India, was identified as an endemic district for Lymphatic Filariasis (LF). The National Programme for Elimination of Lymphatic Filariasis conducted annual mass drug administration (MDA) campaigns in February to eliminate LF by 2027. Objective: This study aimed to estimate the coverage and compliance rate of MDA in the Umaria district of Madhya Pradesh, India, in 2023. Methodology: A cluster sampling method was used for evaluation. The district was divided into three implementation units, corresponding to its three administrative blocks. Four clusters were selected within each unit, consisting of one urban and three rural clusters. Thirty households were randomly selected as respondents from each cluster. Data was collected in May 2023 using a standardized coverage evaluation form designed by the World Health Organization. Result: Among the 360 households surveyed, information on 1606 beneficiaries was obtained. MDA was offered to 94% of the total population, with a coverage and compliance rate of 98.5% among the eligible population. The most common reasons for not consuming the drugs were "not present at house during the campaign" and "fear of drugs." Less than one percent of beneficiaries reported any side effects following the consumption of MDA. Conclusion & Implication: The coverage and compliance of MDA in the district appear to be optimal. The National Programme for Elimination of Lymphatic Filariasis should now consider conducting Transmission Assessment Surveys to determine the endemicity of districts that have reached the critical threshold of LF infection. Additionally, establishing adequate sentinel sites, organizing night blood examination camps in endemic areas, and improving Information Education Communication activities may aid in achieving LF elimination by 2027.

Assessment of coverage and compliance of mass drug administration for lymphatic filariasis in Medak District-2021

Abstract In India Mass Drug Administration (MDA) drive is undertaken every year. In mass drug administration DEC and Albendazole combination is used. For the strategy to be effective, more than 85% of those living in endemic areas must be covered by MDA. Methods: This is a cross-sectional study in which family clusters were selected from rural and urban areas. Information about coverage, compliance with MDA and knowledge of filariasis was obtained using a questionnaire. Data were analysed using percentages and proportions. Results: In this study, about 92.51% of the study participants received DEC and ABZ tablets during MDA, of which 95.14 % of participants consumed the drugs. The most common cause of noncompliance was fear of side effects. Conclusion: Coverage of the population with DEC and albendazole combination was good but compliance needs to be improved. IEC activities should be intensified. Local leaders should be involved in the programme to increase compliance.

Coverage of mass drug administration (MDA) and operational issues in elimination of lymphatic filariasis in selected districts of Jharkhand, India.

Despite annual rounds of mass drug administration (MDA) being carried out every year since 2004 to break the transmission of lymphatic filariasis, India has not achieved elimination status in many areas of country. This study was conducted to determine the operational issues in the implementation of MDA for elimination of lymphatic filariasis in selected districts of Jharkhand. Two districts of Jharkhand state were selected for present cross-sectional study. Multi-staged cluster sampling was adopted to select study participants. Data were collected with use of prescribed questionnaire of National Vector Borne Disease Control Programme (NVBDCP) from the study participants. Data related to socio-demographic details, coverage and compliance of MDA and operational issues were collected. Findings of independent assessment show that percentage of MDA coverage and compliance for Hazaribag district was 96.02% and 88.90%, respectively. On the other hand, percentage of MDA coverage and compliance was found to be only 67.06% and 48.44% in Chatra district. Overall drug consumption was significantly associated with age group (p-value = 0.045), educational status (p-value = <0.0001) and socio-economic status (p-value <0.0001) of eligible population. Most common reason for not swallowing the drugs was found to be absence of family members at the time of MDA rounds followed by no visit of house by drug distributors. Coverage and compliance of MDA was better in Hazaribag district as compared to Chatra district. In order to increase compliance, socio-demographic factors must also be addressed apart from other operational issues.

Coverage and compliance of mass drug administration (MDA) programme for elimination of lymphatic filariasis in an endemic district of eastern Uttar Pradesh, India.

Lymphatic filariasis is targeted for elimination in India through mass drug administration (MDA) with diethylcarbamazine (DEC) combined with albendazole (ABZ). To assess the coverage, compliance and causes for non-compliance towards MDA in an endemic district of Uttar Pradesh (U.P.), north India. A cross-sectional coverage evaluation survey was conducted in 24 rural and 6 urban clusters of Ghazipur district in eastern U.P. using multi-stage random sampling technique with probability proportional to estimated size (PPES). Data was collected in a semi-structured Performa from all the individuals in the selected households by interview technique. Bivariate analysis was performed to identify the factors associated with non-consumption of MDA drugs. A total of 1422 individuals were surveyed from 30 randomly selected subunits of which 1401 (98.5%) were eligible for MDA at the time of the round. Majority of the participants were in the age-group of 15-59 years (67.0%) and were males (53.3%). The overall coverage of MDA (both drugs) among the eligible population in Ghazipur district was 58.5%. Compliance among those who had received both the drugs was 61.6% with effective coverage of 36.0%. The coverage was significantly higher in rural areas compared to the urban clusters (p<0.0001). The most common reason quoted for not consuming drugs was fear of side effects (34.9%). However, the incidence of adverse events among those who consumed the drugs was only 2.5%. None of the socio-demographic variables showed a significant association with the compliance to the drugs. Coverage and compliance of MDA in Ghazipur district of U.P., India was found to be below satisfactory levels. Targeted Information Education and Communication (IEC) campaigns focusing on the safety of drugs and the necessity of MDA, and mass mobilization with effective monitoring and supervision is the need of the hour for effective coverage of MDA Programme.

The Impact of Mass Drug Administration on Lymphatic Filariasis

Mass drug administration (MDA) has made a significant impact on the control of lymphatic filariasis (LF) since the establishment of the Global Programme to Eliminate Lymphatic Filariasis. However, its implementation is associated with several challenges, hampering interruption of parasite transmission and LF elimination in endemic areas. This study assessed the impact of MDA by comparing baseline microfilaria and antigen prevalence with those after three years (mid-term) and ≥5 years of MDA implementation and their respective prevalence reductions and identified specific challenges that may hinder its effective implementation. Three years of MDA implementation were observed to have microfilaria prevalence reductions (88.54% to 98.66%) comparable to those of studies that implemented MDA for five to 10 years (≥5 years, 79.23% to 98.26%). Inadequate community understanding of and participation in the LF MDA programme are major drawbacks to its effective implementation. The implementation of MDA that incorporates community participation, incentivisation, education, and training strategies has the potential of increasing MDA coverage and compliance, thereby interrupting parasite transmission and reducing microfilarial prevalence to levels that warrant LF elimination.

Urogenital schistosomiasis prevalence, knowledge, practices and compliance to MDA among school-age children in an endemic district, southern East Tanzania

BackgroundTanzania has a high prevalence of urogenital schistosomiasis. Praziquantel is administered to school-age children on an annual basis as part of efforts to reduce transmission and morbidity associated with heavy infections. We investigated the prevalence, knowledge, and practices of urogenital schistosomiasis transmission, as well as compliance with mass drug administration (MDA) among schoolchildren in Masasi District. Materials and methodsA cross-sectional survey was conducted in five primary schools. A pre-tested questionnaire was used to assess knowledge and practice related to the transmission of urogenital schistosomiasis, as well as compliance with MDA. Collected urine samples were examined macroscopically for macrohematuria. They were then tested for microhematuria and Schistosoma haematobium (S. haematobium) eggs with urine dipsticks and filtration technique, respectively. FindingsThe study included 389 primary school children in total. Overall, 27 (6.9%) of children had S. haematobium infection, and 37 (9.5%) had microhematuria. The mean (SD) intensity was 123.4 (247.4) eggs per 10 ml of urine. A total of 10 (2.6%) had heavy intensity of infection. The majority (94.9%) reported having complied to the previous round of MDA six months prior to this study, and 308 (79.2%) were aware that water contact is associated with an increased risk of urogenital schistosomiasis infection. Nevertheless, 182 (46.8%) of the participants engaged in swimming activities, with 92 (50.9%) of the participants being female. The prevalence of urogenital schistosomiasis was higher (10.9%) among children who participated in swimming activities versus those who did not (3.4%) (P = 0.003). ConclusionDespite high MDA compliance, urogenital schistosomiasis is still prevalent among primary school children in Masasi District. Children who swim in freshwater bodies such as rivers and ponds are more likely to contract urogenital schistosomiasis.

Coverage evaluation of Mass Drug Administration (MDA) for lymphatic filariasis in a district of Bundelkhand Region of Uttar Pradesh

Introduction: Lymphatic filariasis results in severe disability that leading to severe social and economic burden at each level from individual to family, and community. This study was carried out to assess the coverage and compliance of MDA. Methods: From 300 households (1837 individuals) in both rural &amp; urban area were covered in coverage evaluation survey by systematic selection of subunits using probability proportionate to size (PPS). Each household was visited by WHO designated team and data were collected using predesigned questionnaire. Data was compiled on MS-excel spreadsheet, frequency and percentage were calculated. Results: The overall effective coverage for all drugs was low (19.1%). The coverage was low, compliance was higher in urban as compared to rural area. Females had better coverage and compliance than males. The primary reasons for drug not offered was nobody came to offer drug, drug not swallowed was not sick, drug swallowed was useful information from drug administrator (DA). Only one female reported adverse effect. Conclusion: Increase in coverage along with decrease in coverage-compliance gap is needed to achieve filariasis elimination that warrants intense IEC activities using different platforms, development of better drug delivery strategies and strengthening monitoring system.

Mass drug administration for lymphatic filariasis elimination amidst COVID-19 pandemic in Odisha, India: A step towards achieving SDG-3.

Sustainable Development Goal-3 (SDG) aims to eliminate lymphatic filariasis by 2030 through >65% coverage and compliance of mass drug administration (MDA), the preventive chemotherapy strategy of delivering anthelminthic drugs. However, the ongoing COVID-19 pandemic has disrupted such programmes, yet MDA was administered during February 2021 in Odisha, India. We aimed to assess the coverage and compliance of the present round of MDA amidst the pandemic and explore factors for non-compliance in Cuttack district of Odisha, a filariasis endemic area. Community-based participants enrolled through multistage stratified sampling were administered a semi-structured questionnaire following COVID-19 protocols. The coverage of MDA was 93.2% whereas consumption was 73.7%. Participants reported that healthcare workers were motivated and satisfactorily explained the benefits of MDA but still fear of side-effects was the major cause of non-compliance. Nonetheless, this recent round of MDA was effective, despite challenges posed by the ongoing pandemic.

Coverage and compliance of mass drug administration in lymphatic filariasis amidst the COVID-19 pandemic: A community based epidemiological study.

Despite the target of elimination of lymphatic filariasis by 2015, a few districts of West Bengal including Bankura district failed to achieve it. Under-coverage and unsupervised consumption of medicines during mass drug administration (MDA) campaign were implicated for the failure. Thereby, directly observed therapy (DOT) and mop up by repeated home visits for MDA were adopted. The objective of this study is to assess the coverage of anti-filarial medicines distribution and rate of consumption as well as to find out the causes of nonconsumption. A cross-sectional survey was conducted in three sub-centers each of three blocks and three wards of Bankura municipality of Bankura district, WB, India, selected through the stratified random sampling method. Information was collected interviewing inhabitants of the house hold selected through the systematic random sampling technique. Overall, appropriate medicine distribution was 82.9% with 95.3% of correct consumption of both medicines under supervision. 91.87% of the respondents were aware about Lymphatic filariasis (LF) of which 89.95% reported swelling of leg/foot/hand, 9.57% as pain, 6.22% fever, and 1.44% reported swelling of testis as symptoms of LF. Altogether 10.6% individual, who consumed any medicine (527), reported AEs, out of that 66.1%, 19.6%, and 14.3% complained of dizziness/headache, nausea/vomiting, and drowsiness, respectively, and 28.6% of them sought consultation with health workers. Substantial supervised consumption in the form DOT in this round too leads to the fact that the effective coverage of MDA has reached the target. It seemed that some segment of the beneficiary is remaining as persistent noncomplaints. Mass mobilization for motivating this persistent defaulter section is the need of the hour.

Facilitators and barriers in implementation of mass drug administration for lymphatic filariasis elimination in India: A protocol for systematic review and qualitative meta-synthesis.

Lymphatic filariasis (LF) is a debilitating and disabling parasitic disease of immense public health concern in India with more than 650 million people at risk. Mass drug administration (MDA) is the recommended preventive chemotherapy strategy to eliminate LF. But, its coverage and compliance has been a mixed success. There is an urgent need of evidence to strengthen the program further, which can be done by exploring and understanding implementer as well as beneficiary perspectives. To systematically review the facilitators and barriers experienced during the coverage and compliance of MDA for LF elimination in India from both beneficiary and provider's (health system) perspective. We will search at Medline database through PubMed and Embase, along with ProQuest and Google Scholar to retrieve literature. Original qualitative observational studies exploring challenges and enablers in MDA program will be screened by two independent reviewers systematically based on title and abstract followed by full text. The risk of bias will be assessed through critical appraisal skills program checklist for each included article. Data will be extracted in a pre-designed proforma with study characteristics, demographic features, and texts and quotes of qualitative data. Data will be analyzed through thematic analysis and motivation-opportunity-ability-behavior framework using MAXQDA software. This is a literature-based review with minimal privacy concerns. The findings of this study will be published in a peer-reviewed journal and disseminated through policy brief to program implementers.

A strong effect of individual compliance with mass drug administration for lymphatic filariasis on sustained clearance of soil-transmitted helminth infections

BackgroundThe impact of semiannual mass drug administration (MDA) with albendazole (ALB; 400 mg) alone on lymphatic filariasis (LF) and soil-transmitted helminth (STH) infections was assessed during two trials conducted from 2012 to 2018 in the Republic of Congo and the Democratic Republic of Congo. The collected data were analyzed to evaluate the effect of compliance with ALB treatment on STH infections.MethodsSTH infections were diagnosed with duplicate Kato-Katz thick smears and the results are reported as eggs per gram of stool. All subjects with at least two STH infection assessments were included in the analyses. We used parametric survival models to assess the influence of compliance with ALB treatment on the probability of (i) achieving sustained clearance of an STH infection, and (ii) acquiring an STH infection during the follow-up.ResultsOut of 2658 subjects included in the trials, data on 202 participants (701 person-years; PY) with hookworm infection, 211 (651 PY) with Ascaris lumbricoides infection and 270 (1013 PY) with Trichuris trichiura infection were available to calculate the probability of achieving sustained clearance of infection. The effect of ALB was dose related for all three STH. For hookworm, the time required for sustained clearance was longer (4.3 years, P < 0.001) for participants who took zero doses per year and shorter (3.4 years, P = 0.112) for participants who took two doses per year compared to those who took one dose per year (3.7 years). For Ascaris, the time required to obtain sustained clearance followed the same pattern: 6.1 years (P < 0.001) and 3.2 years (P = 0.004) vs 3.6 years for, zero, two and one dose per year, respectively. For Trichuris, less time was required for sustained clearance (4.2 years, P < 0.001) for fully compliant participants, i.e. those who took two doses per year, than for those who only took one dose per year (5.0 years). ALB was more effective in achieving sustained clearance of STH infection in subjects with light baseline infection intensities compared to those with higher egg counts.ConclusionOur results illustrate the importance of MDA compliance at the level of the individual with respect to the STH benefit provided by semiannual ALB MDA, which is used for the elimination of LF in Central Africa.Graphical

A study on coverage and compliance of mass drug administration for lymphatic filariasis in Prayagraj District, Uttar Pradesh, India

Background: Lymphatic filariasis is one of the six infectious diseases identified by the International Task Force for Disease Eradication as “eradicable” or “potentially eradicable. It is estimated that, to interrupt transmission of lymphatic filariasis, MDA compliance must exceed 65–75%. This study was conducted to assess coverage and compliance of mass drug administration for lymphatic filariasis in Prayagraj District.Methods: This was a pre-tested, questionnaire based cross-sectional study. The study subjects (508) were selected randomly from rural (clusters of three villages) and urban (cluster of one ward) area of Prayagraj, Uttar Pradesh. Data was analyzed by using software SPSS version 23.0 and Chi-square test was used to test the association between the different variables. p-value less than 0.05 was considered as significant.Results: The overall coverage rate, compliance rate, coverage-compliance gap and effective coverage rate of study population (eligible for MDA) in Prayagraj District were 69.94%, 84.19%, 15.81% and 58.88% respectively. The coverage rate and effective coverage rate were 78.71% and 64.85% respectively among urban area as well as 66.99% and 56.88% respectively among rural area.Conclusions: The coverage rate and effective coverage rate were higher among population in urban area as compared to rural area while compliance rate was lower and hence coverage-compliance gap was higher among population in urban area as compared to rural area. The most common reason for not consuming drugs was ‘drugs not delivered by drug distributors’ (73.11%).

Mass Drug Administration for Lymphatic Filariasis Elimination in Two Districts of North Karnataka: Coverage and Compliance Assessment

Introduction: Lymphatic filariasis or elephantiasis is the most debilitating and disfiguring scourge among all diseases which imposes severe social and economic burden. Currently an estimated 63crores people are at a risk of filariasis in 256 endemic districts across 16 states and 5 union territories in India. National filarial control programme is operational since 1955 in India and the current goal is achieving elimination of filariasis by 2020through Mass Drug Administration (MDA). Objective: To assess the coverage, compliance and causes for noncompliance of MDA in the study districts. Method: A cross sectional descriptive study was conducted in October 2019 and January 2020 in Koppal and Bidar districts respectively. Randomly four clusters were selected, three from rural area and one from urban area. All the residents of a cluster were included except subjects aged below 2 years and pregnant women. Data collection was done by household survey using a standard questionnaire. Results: Total populations of 2043 subjects residing in 480 houses were included. The coverage rate was95.44 &amp;94.73% with compliance rate of 91.61% &amp;93.12% in Koppal &amp; Bidar districts, respectively. The effective coverage rate was 87.44 %&amp; 88.2% in Koppal &amp; Bidar districts respectively. Drug consumption by DOT was 95.1% in Koppal&amp;85.8% in Bidar district. Conclusions: The coverage&amp; compliance of MDA was found to be satisfactoryas it was &gt;65%.Consumption of MDA by DOT to be more emphasized to reduce coverage compliance gap and increase the effective coverage rate.

Integration of health education to improve the compliance to MDA for soil-transmitted helminths infection in Bangladesh: An implementation research

Background: In Bangladesh, the prevention and control strategy of soil-transmitted helminthiasis (STH) is based on mass drug administration (MDA) program. Despite bi-annual MDA since 2008, the reported compliance is still below the target, and the STH prevalence is high in several areas. This study was done to assess the feasibility and barriers of integrating health education (HE) intervention to achieve the target MDA compliance in the local context of Bangladesh. Methods and materials: A mixed-method study, utilizing PRISM (Practical Robust Implementation Sustainability Model) framework, was conducted between October 2017 to March 2018 in Dhaka and Sylhet districts of Bangladesh. A total of 640 school-aged children selected from four different schools was divided into intervention and control groups. Eight focus group discussions (FGDs) and eight in-depth interviews (IDIs) were also conducted among 56 adults, including parents of school-aged children, school teachers, and health officers. Results: Quantitative findings revealed that HE Intervention had a significant role (p < 0.05) to improve the mean knowledge score in the intervention group (3.35) compared to the control group (0.29). STH preventive behaviors and MDA participating attitude were also significantly increased in the intervention group (p < 0.05) compared to the control group (p > 0.05). Some of the significant barriers associated with HE integration identified in the qualitative study were budget deficiencies, inadequate training of program implementers and information gaps. In contrast, school environment and positive community attitudes were observed as supportive factors for the integration of HE. Conclusion: Increased knowledge score and behaviour changes due to HE intervention demonstrated in this study hint that integration of HE with MDA is feasible and can be promising to promote MDA compliance and to reduce STH prevalence in this setting. However, local political context, as well as collaboration between research and control, should need to be adequately addressed for the sustainability of integration.

A community survey of coverage and adverse events following country-wide triple-drug mass drug administration for lymphatic filariasis elimination, Samoa 2018.

The Global Programme to Eliminate Lymphatic Filariasis has made considerable progress but is experiencing challenges in meeting targets in some countries. Recent World Health Organization guidelines have recommended two rounds of triple-drug therapy with ivermectin, diethylcarbamazine (DEC), and albendazole (IDA), in areas where mass drug administration (MDA) results with two drugs (DEC and albendazole) have been suboptimal, as is the case in Samoa. In August 2018, Samoa was the first country in the world to implement countrywide triple-drug MDA. This paper aims to describe Samoa’s experience with program coverage and adverse events (AEs) in the first round of triple-drug MDA. We conducted a large cross-sectional community survey to assess MDA awareness, reach, compliance, coverage and AEs in September/October 2018, 7–11 weeks after the first round of triple-drug MDA. In our sample of 4420 people aged ≥2 years (2.2% of the population), age-adjusted estimates indicated that 89.0% of the eligible population were offered MDA, 83.9% of the eligible population took MDA (program coverage), and 80.2% of the total population took MDA (epidemiological coverage). Overall, 83.8% (2986/3563) reported that they did not feel unwell at all after taking MDA. Mild AEs (feeling unwell but able to do normal everyday things) were reported by 13.3% (476/3563) and moderate or severe AEs (feeling unwell and being unable to do normal everyday activities such as going to work or school) by 2.9% (103/3563) of participants. This study following the 2018 triple-drug MDA in Samoa demonstrated a high reported program awareness and reach of 90.8% and 89.0%, respectively. Age-adjusted program coverage of 83.9% of the total population showed that MDA was well accepted and well tolerated by the community.

Assessing Coverage and Compliance of Mass Drug Administration under Elimination of Lymphatic Filariasis Program in Malda District, West Bengal

Background: Lymphatic filariasis, commonly known as elephantiasis, is a neglected tropical disease. Evaluation of mass drug administration (MDA) is done internally by the health authorities and externally by independent agencies. This paper reports the findings of evaluation of MDA conducted in Malda district of West Bengal state in May-June 2015. Objectives: To assess the Coverage &amp; Compliance rates of MDA against lymphatic filariasis and to study the factors influencing non-coverage and non-compliance in Malda district. Materials &amp; Methods: A Community based cross-sectional study was conducted in three selected rural blocks and one municipality. Family was the unit of sampling in the current MDA coverage survey. 30 families in each of four clusters were taken as samples. Cluster sampling technique was adopted. The data was collected in a pre-designed semi-structured proforma from 120 households. Results: 564 eligible population 120 families were studied and 50.53% of them were males. Predominant respondents were male (92%) with average age 40.7 years. The Diethylcarbamazine citrate plus Albendazole coverage rate was 95% and the compliance rate was 71.6%. The major reason for non–compliance was due to fear of side effects amounting to 58%. Only 4 persons reported adverse effects after drug consumption. Conclusion: Though distribution was high, many people were not consuming drugs. Consumption was not properly supervised and there was misconception prevailed among workers about time of consumption. A high level of motivation and commitment from the drug distributors with adequate training is required for ensuring a high coverage and compliance rates. Supervision should be strengthened to improve consumption and misconception should be eliminated through training.

Impact of annual and semi-annual mass drug administration for Lymphatic Filariasis and Onchocerciasis on Hookworm Infection in Côte d'Ivoire.

Mass Drug Administration (MDA) programs to eliminate Lymphatic Filariasis (LF) in western Africa use the anthelminthics ivermectin plus albendazole. These drugs have the potential to impact also Soil-Transmitted Helminth (STH) infections, since the drugs have a broad range of anthelminthic activity. Integration of preventive chemotherapy efforts for LF, onchocerciasis and STH is recommended by the World Health Organization (WHO) in order to avoid duplication of MDA and to reduce costs. The objective of the current study was to determine whether five semi-annual rounds of community-wide MDA to eliminate LF and onchocerciasis have a greater impact on STH than three annual rounds of MDA with similar compliance. The effects of MDA using ivermectin (IVM, 0.2 mg/kg) combined with albendazole (ALB, 400 mg) on the prevalence and intensity of hookworm infection were evaluated in the Abengourou (annual MDA) and Akoupé (semi-annual MDA) health Districts in eastern Côte d’Ivoire from 2014 to 2017. A cross-sectional approach was used together with mixed logistic regression, and mixed linear models. Subjects were tested for STH using the Kato-Katz technique before the first round of MDA and 12, 24, and 36 months after the first round of MDA. The mean self-reported MDA compliance assessed during the survey was 65%, and no difference was observed between treatment areas. These results were confirmed by an independent coverage survey as recommended by WHO. Hookworm was the most prevalent STH species in both areas (23.9% vs 12.4%) and the prevalence of other STH species was less than 1%. The crude prevalence of hookworm dropped significantly, from 23.9% to 5.5% (p <0.001, 77% reduction) in the annual MDA treatment area and from 12.4% to 1.9% (p <0.001, 85% reduction) in the semi-annual treatment area. The average intensity of hookworm infection decreased in the annual MDA area (406.2 epg to 118.3 epg), but not in the semi-annual MDA area (804.9 epg to 875.0 epg). Moderate and heavy infections (1% and 1.3% at baseline) were reduced to 0% and 0.4% in the annual and semi-annual treatment areas, respectively. Using a mixed logistic regression model, and after adjusting for baseline prevalence, only the year 2 re-examination showed a difference in prevalence between treatments (OR: 2.26 [95% CI: 1.03, 4.98], p = 0.043). Analysis of intensity of hookworm infection indicated also that treatment differences varied by follow-up visit. In conclusion twelve months after the last treatment cycle, three annual and five semi-annual rounds of community-wide MDA with the combination of IVM and ALB showed strong, but similar impact on hookworm prevalence and intensity in eastern Côte d’Ivoire. Therefore, an annual MDA regimen seems to be an efficient strategy to control hookworm infection in endemic areas with low and moderate infection prevalence.Trial registration: The study was registered at ClinicalTrial.gov under the number NTC02032043.

Integration of health education intervention to improve the compliance to mass drug administration for soil-transmitted helminths infection in Bangladesh: An implementation research

IntroductionIn Bangladesh, the prevention and control strategy of soil-transmitted helminthiasis (STHs) is based on the mass drug administration (MDA) program. Despite bi-annual MDA since 2008, the reported compliance is still below the target, and the STH prevalence is high in several areas. This study was done to assess the feasibility and barriers of integrating health education (HE) intervention to achieve the target MDA compliance in the local context of Bangladesh. Materials and methodsA mixed-method study, utilizing PRISM (Practical Robust Implementation Sustainability Model) framework, was conducted between July 2017 to March 2018 in Dhaka and Sylhet divisions of Bangladesh. A total of 640 school-aged children selected from four different schools were divided into intervention and control groups. Eight focus group discussions (FGDs) and eight in-depth interviews (IDIs) were also conducted among 56 adults, including parents of school-aged children, school teachers, and health officers. ResultsQuantitative findings revealed that HE intervention had a significant role (P < .05) to improve the mean knowledge score in the intervention group (3.35) compared to the control group (0.29). STH preventive behaviours and MDA participating attitudes were also significantly increased in the intervention group (P < .05) compared to the control group. Some of the major barriers associated with HE integration identified in the qualitative study were budget deficiencies, inadequate training of program implementers, and information gaps. In contrast, the school environment and positive community attitudes were observed as supportive factors for the integration of HE. ConclusionIncreased knowledge score and behaviour changes due to HE intervention demonstrated in this study hint that integration of HE with MDA is feasible and can be promising to promote MDA compliance and to reduce STH prevalence in this setting. However, the allocation of adequate budget, as well as coordination and collaboration with local political context, should be addressed for the sustainability of integration.