A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa

Abstract

BackgroundUnderstanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa.MethodsA systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation.ResultsThe main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution.ConclusionMass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to improve implementation outcomes. Successfully achieving this requires undertaking formative research on the possible constraining and inhibiting factors, and incorporating the findings in the design and implementation of MDA for LF.

Qualitative Study: Leverage and Barrier Factors of Mass Drug Administration for Lymphatic Filariasis Elimination Program in Tangerang and Subang Regency

“…The systematic review results highlight a better understanding of factors that influence compliance in the implementation of MDA-LF lymphatic filariasis that may be used to improve results for current and future MDA program campaigns [9]. The factors include building strategic partnerships in order to mobilize resources and the possibility of program integration, both at the central and regional levels [10]. In addition, the involvement of the wider community is also stated as one of the factors contributing to the success of MDA-LF.…”

“…In addition to training for health volunteers, giving incentives can be one solution to overcome the limited human resources. Thus, they can empower more health volunteers who can be given additional assignments related to the reports of side effects [10,21,22].…”

Towards elimination of lymphatic filariasis in southeastern Madagascar: Successes and challenges for interrupting transmission

“…For all other children and adults, MDA is facilitated through community health workers who distribute treatments on a door-to-door basis. However, uptake during community administration by health workers can be considerably more challenging, since household members may be absent, adults can decide not to take the drugs, or health workers may not be able to cover their assigned area [ 27 ]. Indeed, many studies have found very low uptake among adult populations (around 50%) due to a variety of context-specific factors [ 27 – 29 ].…”

“…However, uptake during community administration by health workers can be considerably more challenging, since household members may be absent, adults can decide not to take the drugs, or health workers may not be able to cover their assigned area [ 27 ]. Indeed, many studies have found very low uptake among adult populations (around 50%) due to a variety of context-specific factors [ 27 – 29 ]. Although results from KAP surveys of sentinel and spot-check sites did not support this hypothesis, the low level of knowledge about LF found in these children (less than one in ten) could have biased their responses.…”

Program Eliminasi Lymphatic Filariasis di Indonesia

“…Hal tersebut disebabkan karena kurangnya informasi dari petugas tentang pentingnya pengobatan massal ini sehingga tidak menjadi perhatian penting bagi masyarakat. 32 Lemahnya surveilans filariasis dalam mengendalikan lingkungan perkembangbiakan nyamuk serta rendahnya kualitas sanitasi masyarakat 33 yang mendukung meningkatnya tempat perkembangbiakan akan berdampak pada meningkatnya transmisi filariasis di wilayah tersebut. Surveilans yang responsif dan cepat merupakan kunci keberhasilan program dalam pengendalian penyakit tropis termasuk filariasis.…”