Community views on mass drug administration for filariasis: a qualitative evidence synthesis

Abstract

Background The World Health Organization (WHO) recommends mass drug administration (MDA), giving a drug at regular intervals to a whole population, as part of the strategy for several disease control programmes in low‐ and middle‐income countries. MDA is currently WHO policy for areas endemic with lymphatic filariasis, which is a parasitic disease that can result in swollen limbs and disability. The success depends on communities adhering to the drugs given, and this will be influenced by the perception of the drug, the programme, and those delivering it. Objectives To synthesize qualitative research evidence about community experience with, and understanding and perception of, MDA programmes for lymphatic filariasis. To explore whether programme design and delivery influence the community experience identified in the analysis. Search methods We searched CENTRAL, MEDLINE, Embase, and seven other databases up to 8 April 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies. Selection criteria This review synthesized qualitative research and mixed‐methods studies when it was possible to extract qualitative data. Eligible studies explored community experiences, perceptions, or attitudes towards MDA programmes for lymphatic filariasis in any country, conducted between 2000 and 2019. Data collection and analysis We extracted data on study design including: authors, aims, participants, methods, and qualitative data collection methods. We also described programme delivery factors including: country, urban or rural setting, endemicity, drug regimen, rounds of MDA received at the time of the study, who delivered the drugs, how the drugs were delivered, use of health education, and sensitization and adherence monitoring. We conducted a thematic analysis and developed codes inductively using ATLAS.ti software. We examined codes for underlying ideas, connections, and interpretations and, from this, generated analytical themes. We assessed the confidence in the findings using the GRADE‐CERQual approach, and produced a conceptual model to display our findings. Main results From 902 results identified in the search, 29 studies met our inclusion criteria. The studies covered a broad range of countries in Africa, South‐East Asia, and South America, and explored the views and experiences of community members and community drug distributors in low‐income countries endemic for lymphatic filariasis. Four themes emerged. People weigh up benefits and harms before participating . People understand the potential benefits in terms of relief of suffering, stigma, and avoiding costs (high confidence); however, these theoretical benefits do not always mesh with their experiences (high confidence). In particular, adverse effects are frightening ...

Mass drug administration for neglected tropical disease control and elimination: a systematic review of ethical reasons

“…People with late-stage LF were those with the physical conditions of hydrocoele and elephantiasis, they suffered the most from the disease and yet did not benefit from the treatment 31…”

“…Amidst the positive community impact, individual harms, notably adverse effects, have been highlighted in numerous publications. Those often receive insufficient attention within programmes, leaving individuals to cope individually and incur economic losses through direct treatment costs and lost labour time 31 32 36 41. These individual harms stand in contrast with collective benefits and they demand attention due to their significant burden on affected people.…”

Patient adherence to tuberculosis treatment in the Indian subcontinent: systematic review and meta-synthesis of qualitative research

“…We used a quality assessment tool adapted from one developed by the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI centre) 37 38. Although non-validated, it was chosen for its detailed signalling questions, prior use within the author team and use in several other well-conducted qualitative evidence syntheses, including those published by Cochrane 39–41. The Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) guideline for transparency was followed in the reporting of synthesis of qualitative research42 (online supplemental annexure 2).…”

Factors Influencing Drug Compliance Among Adult with Lymphatic Filariasis in Indonesia: Findings From Nationwide Population-Based Health Survey

“…Several previous studies have identified barriers to drug LF implementation, including a lack of trust in DEC, fear of side effects, lack of drug distribution, forgetting to take the drug, becoming sick when DEC were given out, poor understanding, and individual direct experience. 2,3 To the best of our knowledge, there is limited evidence regarding the factors influencing drug compliance among LF-infected individuals, especially in Indonesia, although previous studies have demonstrated MDA compliance. We investigated factors associated with drug compliance among adult respondents diagnosed with LF over the past two years.…”

“…Several previous studies have identified barriers to drug LF implementation, including a lack of trust in DEC, fear of side effects, lack of drug distribution, forgetting to take the drug, becoming sick when DEC were given out, poor understanding, and individual direct experience. 2,3…”