High coverage of mass drug administration for lymphatic filariasis in rural and non-rural settings in the Western Area, Sierra Leone

Abstract

BackgroundLymphatic filariasis elimination programs are based upon preventative chemotherapy annually in populations with prevalence more than or equal to 1%. The goal is to treat 80% of the eligible, at risk population yearly, for at least 5 years, in order to interrupt transmission and prevent children from becoming infected. This level of coverage has been a challenge in urban settings. Assessing the coverage in a rapidly growing urban/non-rural setting with inadequate population data is also problematic. In Sierra Leone, a 5-day preventative chemotherapy campaign was carried out in the Western Area including the capital: Freetown. An intensive, social mobilization strategy combined traditional and modern communication channels. To aid dissemination of appropriate information Frequently Asked Questions were developed and widely circulated. The population of the Western Area has grown faster than projected by the 2004 National Census due to the post-war settlement of internally displaced persons. As a reliable denominator was not available, independent monitoring was adapted and performed "in process" to aid program performance and "end process" to assess final coverage.ResultsIn 5 days 1,104,407 eligible persons were treated. Using the projected population from the 2004 census this figure represented coverage of 116% in the Urban Western Area and 129% in the Rural Western Area. Independent monitors interviewed a total of 9,253 persons during the 2 End Process days representing 1% of the projected population. Of these, 85.8% recalled taking both ivermectin and albendazole (Urban: 85.2%, Rural: 87.1%). No serious adverse drug reactions were reported.ConclusionThe paper presents the key elements of success of the social mobilization and implementation strategy and describes the independent monitoring used to estimate final coverage in this urban/non-rural setting where the current population size is uncertain. This implementation strategy and Independent Monitoring tool could be useful in similar, rapidly growing cities implementing lymphatic filariasis elimination programs.

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

“…Richards et al, 2011 [36]/Nigeria/not statedLF programme reportSample was not stated (Rural and Urban setting) Plateau and Nasarawa states.To report on our 12-year effort to eliminate LF in Plateau and Nasarawa states, which was the first LF elimination effort to be launched in Nigeria.MDA for LF treatment in urban areas cannot rely on community volunteers and traditional leadership structures.In urban areas, rather than house to house, treatments were organized in central locations that served as distribution posts, commonly near a neighborhood church, mosque, health clinic or hospitalCommunity participation and coverage13. Hodges el al, 2010 [22]/Sierra Leone/2010Cross sectional study9249 participants were interviewed(Urban and rural setting).Freetown.To report the implementation strategy, social mobilization, the high coverage achieved in the urban western area and rural western area of Freetown, and the relative cost needed for each person treated during an MDA for LF.Key elements of success for social mobilization and implementation strategy (use of pretested IEC materials including FAQs, radio phone-ins, mobile texts, expert contact and government key stakeholder buy-in).Describes the independent monitoring used to estimate final coverage in this urban/non-rural setting where the current population size is uncertain.Suggests an implementation strategy and independent monitoring tool that could be useful in similar, rapidly growing cities implementing lymphatic filariasis elimination programmesCommunity participation, coverage and programme sustainability14. Malecela et al, 2009 [43]/ Tanzania/ 2000–2009LF elimination programme reportNationalTo report on the progress made by the Tanzania LF elimination programme.Establishment of morbidity management programme helped to alleviate patient suffering, reduce social stigma and community support for MDA for LF.Community participation and programme sustainability15.…”

“…West and East AfricaGhana, Kenya, Mali, Nigeria, Sierra Leone and TanzaniaInvolvement of key health systems representatives and local leaders in health education. ( n  = 7) [22, 23, 25, 34, 36, 37, 41]. West and East AfricaGhana, Kenya, Mali, Sierra Leone and Tanzania.Selection, training and financial incentives provided to CDDs ( n  = 5) [22, 25, 34, 35, 37, 45], and provision of mobile phones and other forms of motivation [45] ( n  = 1) …”

“…Use of traditional leadership and community structures for health education programmes in rural areas was essential for achieving maximum community participation [22, 25, 34]. Involving the community and local structures in MDA for LF programme implementation activities created a sense of ownership by the communities resulting in higher levels of participation. Innovative and locally relevant means to conduct health education The use of innovative, locally relevant and context specific strategies by community led health education programmes facilitated implementation of MDA for LF [22, 23, 36, 37]. A study from Sierra Leone showed that use of innovative and more “modern” sensitization approaches such as the recurrent dissemination of information on frequently asked questions (FAQs), community radio stations (as platforms for phone-ins, text messaging and chatting with LF experts) as well as use of social media, enabled the reaching of individuals and institutions that had otherwise been unaware of MDA for LF [22].…”

“…Two Nigerian studies further reported that conducting knowledge attitude and practices (KAP) surveys enabled the LF programme to design target specific, responsive and widely accepted IEC materials [36, 42]. Other benefits included being able to incorporate local understandings and terminologies of LF related conditions on the IEC materials. Partnerships and collaborations Partnerships and collaborations were essential for sustained and successful implementation of MDA for LF [22, 23, 36, 37, 40, 42, 43]. One of the main reasons for a successful MDA for LF programme in Togo, despite limited resources and political challenges, was formation of strategic international partnerships with institutions like the United States’ Center for Disease Control and Prevention (CDC), Health Development International (HDI) and the Department for International Development (DfID) [39].…”

Benchmarking the Cost per Person of Mass Treatment for Selected Neglected Tropical Diseases: An Approach Based on Literature Review and Meta-regression with Web-Based Software Application

“…Of the 34 studies identified in our review, only 8 referred explicitly to eradication (yaws) or elimination (LF, onchocerciasis) as a programme objective. [11][15][16][17][18][19][20][21] Only one of those directly compared the costs of control and elimination strategies (for onchocerciasis), involving annual and biannual (twice yearly) mass treatment respectively; the difference is determined by the number of rounds rather than by so-called “last mile” costs. [21]…”