Compliance Of Mass Drug Administration Research Articles

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.

Evaluation of coverage and compliance to mass drug administration for lymphatic filariasis elimination in two endemic districts of Karnataka

Background: Lymphatic filariasis is a debilitating and disfiguring disease causing significant socioeconomic burden. India is endemic for filariasis which includes Kalaburagi and Yadgir districts in Karnataka. India has the target for filariasis elimination by 2020 and mass drug administration [MDA] is a strategy for elimination. The objective of the study was to evaluate the coverage and compliance of mass drug administration against lymphatic filariasis.Methods: The study was a cross sectional study conducted during the month of October 2018 in Kalaburagi and Yadgir districts. The study subjects included all the residents of cluster except subjects aged below 2 years and pregnant women. Multi stage sampling was used and three clusters from rural area and one cluster from urban area from each district. Data collection was done by household survey after informed consent using a standard questionnaire.Results: A total population of 1,963 subjects residing in 399 houses of two districts was included. Majority of the study subjects 1517 (77.27%) were in the age group of more than 15 years with predominantly males 984(50.12%). The coverage rate and compliance rate of MDA was 83.17% and 92.46% in Kalaburagi district and 86.71% and 86.98% in Yadgir district respectively. The effective coverage rate and coverage compliance gap was 76.89% and 7.53% in Kalaburagi district, 75.42% and 13.01% in Yadgir district. Incomplete dose of MDA was consumed by 17 subjects in Kalaburagi district and 21 subjects in Yadgir district.Conclusions: The effective MDA coverage in both the study districts is below 85% which is not satisfactory.

Evaluation of coverage, compliance of mass drug administration and assessment of awareness about lymphatic filariasis in Tikamgarh district of Madhya Pradesh: a cross sectional study

Background: Lymphatic filariasis is the second leading cause of disability worldwide accounting for more than 5 million disability adjusted life years annually. It has been a major public health problem in India which leads to irreversible chronic manifestations which are responsible for considerable economic loss and severe physical disability to the affected individuals. Mass drug administration (MDA) means administration of diethylcarbamazine and albendazole tablets to all people (excluding children &lt;2 years, pregnant women, seriously ill persons) in endemic areas once in a year. The objective of the study was to assess coverage, compliance of MDA and awareness about lymphatic filariasis in Tikamgarh district of Madhya Pradesh.Methods: Cross-sectional study was conducted and total 120 households were surveyed in four randomly selected clusters of Tikamgarh district of Madhya Pradesh.Results: Out of total 743 persons 678 (91.25%) persons were eligible for MDA. Coverage rate was 86.57% and compliance rate was 74.27%. The main reason for non-compliance was not having the concerned disease (55.78%) followed by fear of side effect (22.31%). Only 40.83% among the surveyed families were aware about MDA and only 45.83% respondents had heard about lymphatic filariasis.Conclusions: There is coverage and compliance gap and awareness about the lymphatic filariasis and MDA program is limited. Drug compliance need to be improved and awareness need to be raised. MDA program should not be confined to tablet distribution only and due importance should be given to compliance rate.

Mid-term assessment of mass drug administration for elimination of lymphatic filariasis: in Bundelkhand region of Madhya Pradesh

Background: Lymphatic filariasis is a vector borne parasitic disease caused by lymphatic dwelling nematode parasite. It is one of the world's leading causes of permanent and long-term disability with an estimated 5.1 million disability adjusted life years (DALYs) are lost due to this disease. The National Health Policy 2002 aims at Elimination of Lymphatic filariasis by 2015 through Annual Mass Drug Administration (MDA) of single dose of DEC. Objective was to assess coverage and compliance of MDA Program and awareness about lymphatic filariasis in Chhatarpur district of Madhya Pradesh.Methods: Cross-sectional Study was conducted. Total 120 households were surveyed in four selected clusters of Chhatarpur district of MP.Results: Out of total 835 persons only 94.37% persons were eligible and 47 (5.62%) were not eligible for MDA for MDA. Coverage rate was 90.22% and compliance rate was 75.24%. The main reason for non-compliance was not having the concerned disease 34.38 % followed by fear of side effect (24.90%). Only 37.5% among the surveyed families were aware about MDA. Majority of respondent 21 (46.66%) acquired knowledge from health workers.Conclusions: The compliance of MDA program was low and the awareness about the lymphatic filariasis in the study population was limited in Chhatarpur district. Poor compliance of MDA is attributed to inadequate consumption of drugs due to poor awareness among eligible population. For elimination of lymphatic filariasis active involvement of community is very essential. It can be made possible through behavior change communication and health education of people.

Coverage and compliance of mass drug administration for elimination of lymphatic filariasis in Khammam district

Background: Lymphatic filariasis (LF) is an important public health and socio-economic problem in the world and it was identified as one of the six diseases, which could be targeted for elimination /eradication. Annual mass drug administration of DEC with selective vector control could result in the effective elimination of infection by interruption of transmission. The present study aimed to find the coverage and compliance of mass drug administration (MDA) of diethyl-carbamazine (DEC) for elimination of lymphatic filariasis (LF) in Khammam district in November 2009.Methods: Cross-sectional, population-based, house-to-house survey was conducted after the round of MDA with DEC. Multi-stage systematic sampling method was used and four clusters were selected with 30 houses in each. A pretested questionnaire was used to interview the study participants. The data collected was analyzed and coverage rate, compliance rate and effective coverage rate were calculated.Results: The coverage rate was 65.54% with variation across different areas. The compliance with drug ingestion was 71.14%. The effective coverage (46.63%) was much below the target (85%) which has to be targeted by intensive information, education and communication (IEC). Side effects of DEC were minimum, transient and drug-specific.Conclusions: The coverage, compliance, and effective coverage rates were found to be lower than the target, which need to be intensified by extensive IEC.

Programmatic evaluation of mass drug administration for elimination of lymphatic filariasis and reasons for non-compliance in Gulbarga district, Karnataka in 2015

Background: Mass drug administration (MDA) to eliminate lymphatic filariasis (LF) is conducted once annually in the identified endemic districts of the country. MDA implementation is assessed by appointed independent teams within 2-3 weeks of the activity to suggest mid-term corrections and strengthen the on-going programme. This study was undertaken to assess the process of MDA implementation, drug coverage and compliance and to identify the reasons for non-compliance.Methods: A survey of four clusters comprising of three rural and one urban area was conducted in Gulbarga, during the third week following the MDA campaign in the district. Information pertaining to the MDA beneficiaries of the 124 evaluated households was collected over a period of three days using a structured proforma. The process of MDA implementation was evaluated at the district, taluk and primary health centre (PHC) levels.Results: From the information collected on 673 inmates of the households surveyed, the coverage and compliance rates of 87.5 and 60.9% respectively was found for diethylcarbamazine citrate and albendazole distribution and consumption. The important reasons for non–compliance to swallow the drugs identified were the beneficiaries being out of station during the campaign, was not aware of it, the drug distributer did not visit the beneficiaries house and fear of side effects of the drugs.Conclusions: Efforts to improve the compliance to consumption of the anti-filarial drugs at Gulbarga district is required for elimination of LF.

Perceived threat and benefit toward community compliance of filariasis' mass drug administration in Pekalongan district, Indonesia.

PurposeLymphatic filariasis (LF) is a chronic infection of Brugia malayi, Brugia timori, and Wuchereria bancrofti and is a mosquito-transmitted disease. Mass drug administration (MDA) needs to be done annually to control LF and requires adherence of endemic populations to take medication properly. Maintaining high coverage of MDA is a challenge because the activity needs to be done in several years. This study would like to know the compliance of the community in taking medication during MDA periods in Pekalongan district using the health belief model (HBM) approach.Patients and methodsStudy population was people living in endemic areas in Pekalongan district, Central Java Province. This was a cross-sectional study. HBM approach was used to analyze community perceived in regard to MDA. There were six of the 19 subdistrict selected as study location, and 100 subjects were selected from each sub-district. Therefore, a total of 600 subjects participated in this study. Data were collected using the structured questionnaire. Data were analyzed quantitatively using the Chi-squared test. Multivariate analysis was used for logistic regression.ResultsResults of this study showed that the mean age of subjects was 38.6 years and had been staying in their villages for more than 30 years. Gender, marital status, history of LF, history of LF in the family, and external cues to action did not relate to MDA compliance. Perceived susceptibility, perceived severity, perceived benefits, and perceived barriers were factors related to the compliance of MDA. After multivariate analysis, the perceived susceptibility did not have relationship with compliance.ConclusionThis study showed HBM variables, ie, perceived susceptibility, perceived severity, perceived benefit, and perceived barrier associated with the medication adherence of LF. The role of elimination officers was important to increase community knowledge about MDA program and the benefit to control LF disease.

Mass Drug Administration Coverage Evaluation Survey for Lymphatic Filariasis: An Experience from Paschim Bardhaman District, West Bengal

Purpose: The purpose of the present study was to assess the coverage and compliance of mass drug administration (MDA) to identify the factors for non-compliance, to find out the side effects experienced by the consumers and to ascertain the constraints/problems in implementing MDA by the functionaries in Paschim Bardhaman district of West Bengal after the last round of MDA (Dec 2017). Methods: In this cross-sectional coverage evaluation survey, one urban and three rural clusters were selected, using multistage cluster sampling. At least 30 households and 150 eligible subjects were included from each cluster (village/ward). Participants were interviewed using pre-designed and pretested schedule. A qualitative assessment was also done in the form of in-depth interview of different program implementers and participants. Results: Among the 660 eligible populations interviewed, distribution coverage for DEC and both the drugs were 76.4% and 74.8% respectively. For DEC, effective coverage was found to be 64.1%, which was 63.3% for both the drugs. Overall supervised consumption rate was very low (32% for DEC and 30.3% for both the drugs). Insufficient and delayed availability of drugs and IEC materials, budgetary constraints in undertaking IEC activities, poor community mobilization, and negligible supervised administration of drugs by the drug distributers were found to be the key qualitative issues. Conclusions: Supervised consumption of drugs in the presence of drug distributors was found to be grossly neglected in this district. Proper availability of medicines and logistics should be ensured and coordinated, and community awareness should be strengthened for successful implementation of this activity.

Evaluation of mass drug administration programme for elimination of lymphatic filariasis in Bidar district, Karnataka

Background: Lymphatic filariasis (LF) is endemic in 83 countries and territories, with more than a billion people at risk of infection. Filariasis has been a major public health problem in India next only to malaria. Study was done to assess coverage and compliance of mass drug administration (MDA) against lymphatic filariasis in Bidar district.Methods: This cross-sectional coverage evaluation survey was done in one urban and three rural clusters in district. The data was compiled, tabulated and analyzed using proportions.Results: A total of 739 subjects were interviewed, male subjects constituted about 57.5%. 96.58% persons have received the drugs. Out of the 678 persons who have received the drugs, 85.4% persons have consumed the drugs. Only 31.95% of study subjects consumed tablets in front of health workers. A total of 99 subjects not consumed tablets, 22.22% told drug distributor did not visit, 21.21% were out of station and 14.14% subjects were not aware. 24 persons suffered from nausea and vomiting.Conclusions: There is an urgent need for more effective drug delivery strategies and also proper IEC should be done to educate and to improve the coverage and compliance in the districts.

Community perspectives on persistent transmission of lymphatic filariasis in three hotspot districts in Ghana after 15 rounds of mass drug administration: a qualitative assessment

BackgroundThe Global Program for the Elimination of Lymphatic Filariasis (GPELF) started operation in 2000 and aimed at eliminating the disease by the year 2020, following 5–6 rounds of effective annual Mass Drug Administration (MDA). The MDA programme took off in Ghana in 2001 and has interrupted transmission in many areas while it has persisted in some areas after 10 or more rounds of MDA. This study was to appreciate community members’ perspectives on MDA after over 15 years of implementation. Findings will inform strategies to mobilise community members to participate fully in MDA to enhance the disease elimination process.MethodsThis was a qualitative study, employing key-informant in-depth-interviews. Respondents were selected based on their recognition by community members as opinion leaders and persons who were knowledgeable about the topic of interest in the community. A snowball sampling technique was used to select respondents.ResultsRespondents were well informed about the MDA with most of them saying, it has been implemented for over 12 years. They were aware that the MDA was for the treatment/control of LF (elephantiasis). It came to light that MDA compliance was affected by five related barriers. These are; Medication, Personal, Health system, Disease and Social structure related barriers. Adverse effects of the drugs and the fact that many people perceived that they were not susceptibility to the infection have grossly affected the ingestion of the drugs.ConclusionThere is a need for community mobilization and promotional activities to explain the expected adverse reactions associated with the drugs to the people. Also the importance of why every qualified person in the community must comply with MDA must be emphasized.

Coverage and compliance of mass drug administration against lymphatic filariasis in Kalaburgi district

Background: Lymphatic filariasis (LF) is endemic in 83 countries and territories, with more than a billion people at risk of infection. Filariasis has been a major public health problem in India next only to malaria. Study was done to assess coverage and compliance of mass drug administration (MDA) against lymphatic filariasis in Kalaburgi districts.Methods: This cross-sectional coverage evaluation survey was done in one urban and three rural clusters in district.The data was compiled, tabulated and analyzed using proportions.Results: A total of 791 subjects were interviewed, male subjects constituted about 47.7%. Majority of the subjects were in the age group of 16-60 years (69.9%), while only 3.2% were in &lt;2years. 82.9% persons have received the drugs. Out of the 530 persons who have received the drugs, 86.9% persons have consumed the drugs. Only 59.9% of study subjects consumed tablets in front of health workers. A total of 69 subjects have not consumed tablets, 20.3% said told fear of side reaction, and 20.3% subjects said they don’t have faith in tablet. Only 11 persons suffered from vomiting and nausea.Conclusions: There is an urgent need for more effective drug delivery strategies and also proper IEC should be done to educate and to improve the coverage and compliance in the districts.

Coverage and compliance of mass drug administration for elimination of lymphatic filariasis in endemic areas of bidar district, karnataka

Coverage and compliance of mass drug administration for elimination of lymphatic filariasis in endemic areas of bidar district, karnataka

The need of adequate information to achieve total compliance of mass drug administration in Pekalongan

World Health Organization (WHO) initiated The Global Program to Eliminate Lymphatic Filariasis (LF) through mass drug administration (MDA). Pekalongan started MDA in 2011. Yet the LF prevalence in 2015 remained exceed the threshold (1%). This study aimed to describe the inhibiting factors related to the compliance of MDA in community level. This was a rapid survey with cross sectional approach. A two-stages random sampling was used in this study. In the first stage, 25 clusters were randomly selected from 27 villages with proportionate to population size (PPS) methods (C-Survey). In the second stage, 10 subjects were randomly selected from each cluster. Subject consisted of 250 respondents from 25 selected clusters. Variables consisted of MDA coverage, practice of taking medication during MDA, enabling and inhibiting factors to MDA in community level. The results showed most respondents had poor knowledge on filariasis, which influence awareness of the disease. Health-illness perception, did not receive the drugs, lactation, side effect, and size of the drugs were dominant factors of non-compliance to MDA. MDA information and community empowerment were needed to improve MDA coverage. Further study to explore the appropriate model of socialization will support the success of MDA program

Comparison of coverage and compliance of mass drug administration 2017 in urban &amp; rural areas of Valsad district, Gujarat, India

Comparison of coverage and compliance of mass drug administration 2017 in urban &amp; rural areas of Valsad district, Gujarat, India

Directly observed therapy and repeat house-to-house visit: pincer movement for mass drug administration in West Bengal, India

Objective The aim of this study was to assess the effect of directly observed therapy (DOT) on coverage, the compliance of mass drug administration (MDA), and to find out correlates of noncompliance. Background MDA for the elimination of lymphatic filariasis (LF) by 2015 in West Bengal (WB) has been criticized for undercoverage and mere distribution of antifilarial medicines for unsupervised consumption. To overcome these shortcomings, the government of WB adopted DOT for MDA. Participants and methods A cross-sectional survey was conducted in three villages of three blocks and two wards of one municipality of Bankura district, WB, India, selected randomly. Information was collected by interviewing inhabitants of randomly selected households. Results Overall, appropriate medicine distribution and consumption were 71.31 and 53.21%, respectively. Multivariate analysis revealed that medicine consumption was higher among the following: participants who belonged to the Hindu religion; people of poor socioeconomic status; those who were distributed medicine by a routine health worker acting as drug administrators;; those whose consumption was supervised and those who had complied to MDA previously. Almost three-fourth consumptions were unsupervised. 58.73% respondents knew about LF and 42% knew about transmission; 50.79% had heard about MDA and 39.68% stated that MDA is to avoid LF. Noncompliance to the distributed medicines might be due to lack of awareness about LF and MDA. The reasons for noncompliance were as follows: 'fear of adverse reaction' (63.72%), 'didn't know why to consume' (23.89%), and 'healthy' (20.35%) were causes of noncompliance. Conclusion Despite DOT and repeat house visit coverage of MDA, we fell short of target. Mass mobilization with effective supervision is the need of hour for universal coverage of MDA with supervised consumption of tablets.

English

BACKGROUND: Lymphatic Filariasis (LF) is a serious Socio Economic and Public Health problem in the world. In India, it is estimated that 554.2 million populations are at risk of Lymphatic Filariasis infection, in 243 implementation units (Districts). National Health Policy, 2002 aims at elimination of transmission and prevention of disability due to Lymphatic Filariasis (LF) by the year 2015.mass drug administration (MDA) against filariasis with Diethylcarbamazine (DEC) combined with Albendazole (ABZ)to all people excluding children <2yrs, pregnant women and seriously ill persons in endemic areas once in a year. OBJECTIVE: To assess: (i) The filariasis knowledge in the community, (ii) To assess the coverage and compliance of MDA from the community perspective in the Guntur District. MATERIALS AND METHODS: Cross-sectional population based house to house visit. Setting: Both rural and urban areas of Guntur district outcome -Actual coverage, compliance and side effects. RESULTS: Twelve clusters, Total eligible population of 1820 were interviewed. The coverage rate was 94.6% with variation across different areas. CONCLUSION: The compliance of drug ingestion was 94.6% the side effects of DEC were minimum. The overall coverage was better in rural areas compared to urban areas.

Are we nearly there yet? Coverage and compliance of mass drug administration for lymphatic filariasis elimination.

Lymphatic filariasis has been targeted for elimination by 2020, and a threshold of 65% coverage of mass drug administration (MDA) has been adopted by the Global Programme to Eliminate Lymphatic Filariasis (GPELF). A recent review by Babu and Babu of 36 studies of MDA for lymphatic filariasis in India found that coverage, defined as receipt of tablets, ranged from 48.8 to 98.8%, while compliance, defined as actual ingestion of tablets, was 22% lower on average. Moreover, the denominator for these coverage figures is the eligible, rather than total, population. By contrast, the 65% threshold, in the original modelling study, refers to ingestion of tablets in the total population. This corresponds to GPELF's use of ‘epidemiological drug coverage’ as a trigger for the Transmission Assessment Surveys (TAS), which indicate whether to proceed to post-MDA surveillance. The existence of less strict definitions of ‘coverage’ should not lead to premature TAS that could impair MDA's sustainability.

Evaluation of mass drug administration for elimination of lymphatic filariasis in Goa, India

Background: The most practical and feasible method of controlling lymphatic filariasis is the rapid reduction of microfilarial load in the community by annual mass drug administration (MDA) of a single dose of diethyl Carbamazine Citrate. The objective of the study aimed at the trends in coverage and compliance of Mass Drug Administration with Diethyl Carbamazine Citrate (DEC) for elimination of lymphatic filariasis in Goa. Methods: Cross-sectional population surveys were conducted after every yearly round of MDA with DEC for the years 2006, 2007, 2008 and 2010 as part of independent assessment of MDA. Four clusters were selected from each district, each cluster having 30 households. A pretested questionnaire was used to interview the study participants and the responses were recorded in pre-designed formats. The data was analysed using SPSS package. Coverage rate, compliance rate, coverage-compliance gap and effective coverage rate were calculated. Results: The total coverage ranged from a high of 95.55% in the year 2007 and a low of 84.94% in 2006. The total compliance rate fluctuated between a low of 64.68% in 2010 and a high of 93.47% in 2006. Total coverage–compliance gap ranged from a high of 35.31% in the year 2010 and a low of 6.52%. Overall coverage and compliance rates were consistently higher in rural areas compared to urban areas for all the years under study. Conclusion: Coverage, compliance, coverage-compliance gap and effective coverage rate were found to be consistently lower in urban areas compared to rural areas. For the state to reach elimination targets, the MDA strategy implementation would require thorough review and revamping. Action on this front would ensure that gains made in filarial elimination are sustained eventually leading to elimination of lymphatic filariasis in the state of Goa.

Mass drug administration for lymphatic filariasis elimination in a coastal state of India: a study on barriers to coverage and compliance.

BackgroundLymphatic filariasis is targeted for elimination in India through mass drug administration (MDA) with diethylcarbamazine (DEC) combined with albendazole (ABZ). For the strategy to be effective, >65% of those living in endemic areas must be covered by and compliant to MDA. Post the MDA 2011 campaign in the endemic district of Odisha, we conducted a survey to assess: (i) the filariasis knowledge in the community, (ii) the coverage and compliance of MDA from the community perspective, and (iii) factors affecting compliance, as well as the operational issues involved in carrying out MDA activities from the drug distributor’s perspective.MethodsA sample of 691 participants – both male and female, aged two years or above – were selected through multistage stratified sampling and interviewed using a semi-structured questionnaire. Additionally, drug distributors and the medical officers in charge of the MDA were also interviewed to understand some of the operational issues encountered during MDA.ResultsNinety-nine percent of the study participants received DEC and ABZ tablets during MDA, of which only just above a quarter actually consumed the drugs. The cause of non-compliance was mostly due to fear of side effects, lack of awareness of the benefits of MDA, and non-attendance of health staff in the villages. Lack of adequate training of drug distributors and poor health communication activities before the MDA campaign commenced and the absence of follow-up by health workers following MDA were a few of the operational difficulties encountered during the MDA campaign.ConclusionCurrently MDA is restricted to the distribution of drugs only and the key issues of implementation in compliance, health education, managing side effects, and logistics are not given enough attention. It is therefore essential to address the issues linked to low compliance to make the program more efficient and achieve the goal of filariasis elimination.