Addressing barriers of community participation and access to mass drug administration for lymphatic filariasis elimination in Coastal Kenya using a participatory approach

Abstract

Since the prioritization of Lymphatic Filariasis (LF) elimination in 1997, progress has been made in reducing disease transmission and burden. Validation of elimination through Transmission Assessment Surveys (TAS) in implementation units (IUs) that have received at least 5 rounds of mass drug administration (MDA) and achieved minimum threshold of 65% treatment coverage is required. There are IUs that do not qualify for TAS due to achievement of low treatment coverage. This study sought to identify barriers of community participation and access to MDA, develop and test strategies to be recommended for improved uptake. Two wards in Kaloleni sub-county, Kilifi county with an average treatment coverage of 56% in 2015, 50.5% in 2016 were purposively sampled and a quasi-experimental study conducted. Through systematic random sampling, 350 (pre-intervention) and 338 (post-intervention) household heads were selected and interviewed for quantitative data. For qualitative data, 16 Focus Group Discussions (FGDs) with purposively selected community groups were conducted. Participatory meetings were held with county stakeholders to agree on strategies for improved community participation in MDA. The quantitative data were analyzed using STATA version 14.1, statistical significance assessed by chi square test and qualitative data by QSR NVIVO version 10. The identified strategies were tested in experimental sites during the 2018 MDA and the usual MDA strategies applied in control sites. The results showed an increase in community participation and access to MDA in both sites 80.6% (pre-intervention), 82.9% (post-intervention). The proportion of participants who considered the treatment as necessary significantly (p = 0.001) increased to 96.2% from 88.3% and significantly dropped for those with drug swallowing problems associated with: size (p<0.001), number (p<0.027) and taste (p = 0.001). The implemented strategies may have contributed to increased participation and access to MDA and should be applied for improved treatment uptake. Health education on disease aetiology and importance of drug uptake in all rounds is key to program’s success.

Towards elimination of Lymphatic Filariasis in Kenya: improving advocacy, communication and social mobilization activities for mass drug administration, a qualitative study

“…Stakeholders and partners in this study were willing to support the MDA for LF with resources such as gumboots, umbrellas, airtime, and fuel for officers’ moto bikes and fuel for vehicles used in the campaign. Resource mobilization from stakeholders and partners will be necessary as this will increase supervision, CDDs motivation, increase the households reached with messages on benefits of taking the drugs and their side effects which have been reported as barriers to improved MDA access [ 13 , 19 , 20 ]. Krentel et al, 2017 emphasize the importance of community engagement processes that promote participation being essential in achieving sustainable and successful implementation of MDA for LF [ 21 ].…”

Towards elimination of Lymphatic Filariasis in Kenya: Improving advocacy, communication and social mobilization activities for mass drug administration

“…Stakeholders and partners in this study were willing to support the MDA for LF with resources such as gumboots, umbrellas, airtime, fuel for o cers' moto bikes and fuel for vehicles used in the campaign. Resource mobilization from stakeholders and partners will be necessary as this will increase supervision and CDDs motivation which has been reported as barriers to improved MDA access (12)(13)(14). Implementers have therefore to pay attention to such opportunities and start conversations that will lead to improved access.…”

“…The study area has been previously described by Njomo et.,al (12,13) and Kusi C et.,al (14). Brie y, Kili County has a population of 1,109,735 and covers an area of 12,245.90 km 2 (15).…”

Towards elimination of Lymphatic Filariasis in Kenya: Improving advocacy, communication and social mobilization activities for mass drug administration, a qualitative study.

“…Stakeholders and partners in this study were willing to support the MDA for LF with resources such as gumboots, umbrellas, airtime, and fuel for o cers' moto bikes and fuel for vehicles used in the campaign. Resource mobilization from stakeholders and partners will be necessary as this will increase supervision and CDDs motivation which has been reported as barriers to improved MDA access (12)(13)(14). Implementers have therefore to pay attention to such opportunities and start conversations that will lead to improved access.…”

“…The study area has been previously described by Njomo et.,al (12,13) and Kusi C et.,al (14). Brie y, Kili County has a population of 1,109,735 and covers an area of 12,245.90 km 2 (15).…”