Assessing factors influencing communities’ acceptability of mass drug administration for the elimination of lymphatic filariasis in Guyana

Abstract

Background Guyana is one of four countries in the Latin American Region where lymphatic filariasis (LF) remains endemic. In preparation for the introduction of a new triple drug therapy regimen (ivermectin, diethylcarbamazine, and albendazole (IDA)) in 2019, an acceptability study was embedded within sentinel site mapping in four regions to assess mass drug administration (MDA) coverage and compliance, acceptability, and perceptions about treatment and disease. The results from this survey would inform the rollout of IDA in Guyana in 2019. Methods Data collection for the study occurred in August 2019, using a validated questionnaire administered by trained enumerators. Across all regions, a total of 1,248 participants were sampled by the Filarial Mapping team. Four-hundred and fifty-one participants aged over 18 years were randomly selected for participation in an expanded acceptability questionnaire. All data were captured in Secure Data Kit (SDK). Results Acceptability was measured using a mean acceptability score. Unadjusted mean scores ranged from 24.6 to 29.3, with 22.5 as the threshold of acceptability. Regional variation occurred across many indicators of interest: self-rated understanding about LF, mechanisms of LF transmission, LF drug safety and history of treatment during MDA. Region IV (Georgetown) recorded higher knowledge about LF, but lower compliance and acceptability. Number of pills was not perceived as a concern. Conclusion Acceptability of MDA was good across all four regions under study. Results from this study set a baseline level for key indicators and acceptability, from which the acceptability of IDA can be measured. Regional variations across indicators suggest that localized approaches should be considered for social mobilization and MDA delivery to capture these contextual differences.

Factors Associated with the Acceptability of Mass Drug Administration for Filariasis: A Systematic Review

“…Cross-sectional 2004 [9,22,25,28] Longitudinal study Rosanti, Mardihusodo, Artama 2016 [20] Case-control Nujum et al 2012 [24] Qualitative study [20] shows the highest drug compliance rate of 86.8%, followed by Bhatia et al [23] with 77.7% and Putri et al [22] with uptake of 75%. Meanwhile, the lowest compliance rate is illustrated by a study conducted by Nujum et al [24] with 39.52%.…”

“…Of eleven studies, three used DEC as a single drug [19,22,23], four used DEC and Albendazole [20,21,24,25], one used a triple-drug [9], one used Albendazole with either DEC or ivermectin and only one study mentioned MDA as a general and not the specific regime [19].…”

“…Knowledge and awareness of the disease itself were positively associated with acceptance and MDA participation compliance [9,24,25]. MDA acceptance was more likely to occur if villagers were familiar with the risks and benefits of MDA and its rationale for MDA [23].…”

“…Since 2000, annual MDA coverage has increased from 3 million people in 12 countries to 6.7 billion people in 66 of the 72 countries where LF is known to be endemic [5]. However, while the program has achieved effective coverage in several regions, it has had variable success in others [9]. High compliance of MDA is difficult to achieve and sustain.…”

Adverse drug effects among students following mass de-worming exercise involving administration of Praziquantel and Albendazole in KEEA Municipality, Ghana

“…Fear for ADEs associated with MDA is considered a major factor that contribute to low MDA participation [ 6 , 18 , 19 ]. These drawbacks impact negatively on MDA effectiveness with respect to compliance with anthelminthic drug ingestion especially when school children or their guardians does the administration [ 20 ]. Advanced countries and some emerging economies that subscribe to MDA to manage helminthic infections do have post-MDA surveillance programs to monitor ADEs associated with MDA in order to effectively manage them to ensure patient safety [ 21 ].…”