Mass drug administration for elimination of lymphatic filariasis: Recent experiences from a district of West Bengal, India

Abstract

Background:Annual mass drug administration (MDA) with diethyl carbamazine (DEC) and Albendazole is the most cost-effective strategy to control lymphatic filariasis (LF).Materials and Methods:The aim of the present study was to assess the coverage and the compliance of MDA, to elicit factors that influenced compliance, to document side-effects reported and to assess the awareness of the community regarding the disease and MDA program in Bankura district, West Bengal after 2012 round of MDA. Multistage cluster sampling method was adopted. Total four clusters; three villages and one urban municipality ward were selected. In each cluster, minimum 30 families were randomly selected and the head or any responsible family member was interviewed using a pre-designed, pre-tested schedule after taking written informed consent. Data were compiled and analyzed using SPSS 19.0.Results:Total eligible population was 683 among which 98.8% received both the drugs. About 5% of the recipients took none of the drugs. More than two-thirds of the families took unsupervised dose. Drug compliance rate was significantly lower in urban (90.7%) than in the rural clusters (95.7%) (z = 2.46, P < 0.05). Effective coverage rate was significantly lower in urban than in the rural clusters (87.4% vs. 95.3%; z = 3.57, P < 0.01). Coverage compliance gap was higher in urban (5.7%) than in rural cluster (3.9%). Fear of side-effects was the main reason for non-compliance. Reported side-effects were few, mild, and transient. Around 60% of the surveyed families were aware about the MDA program whereas, 67% of them heard about LF. Only 41% families were provided information, education, and communication in last 15 days before MDA. Major sources of information for the surveyed families were leaflets (20.3%) and poster (9.8%).Conclusions:Widespread rural urban variation in performance status, poor social mobilization activities, lack of supervised dosing, and lack of knowledge of the community about the disease and the program are the major areas of concern.

Mass Drug Administration Coverage Evaluation for Elimination of Lymphatic Filariasis in Nagpur District of Maharashtra

“…Similar findings were observed by Ghosh S et al where effective coverage rate was significantly lower in urban areas (87.4%) as compared to rural area (95.3%). [16] This is in contrary to study done by Bhatia M et al in Madhya Pradesh where effective coverage rate was significantly higher in urban areas (75.53%) as compared to rural area (65.65%). [13] Coverage compliance gap is a better indicator to assess the effectiveness of MDA program.…”

“…[18] Different studies gave different explanations for reason for non-compliance [9][10][11][12][13][14][15][16][17] In this study, only 6 persons (1.38%) had mild adverse reactions like nausea, vomiting, mild fever etc after consuming DEC. Consistent results were reported by Jothula KY etal, Prasad V G et al found 1.14%, 1.81% of adverse effects after consuming DEC. (12), (19) This study showed 86.67% households were aware regarding MDA activity from various sources like ASHA, anganwadi workers, health workers, mike announcement etc.…”

A qualitative study to assess community barriers to malaria mass drug administration trials in the Gambia

“…The number of pills and tablet size may vary across different ACT combinations, and the quantity of pills has been reported to deter compliance in sub-Saharan Africa [22]. Similar problems have been found in lymphatic filariasis MDA trials, with non-compliance resulting from fear of side-effects despite drugs being well-tolerated by participants [23,24]. …”

Directly observed treatment increases drug compliance in lymphatic filariasis mass drug administration

“…Actually the antifilariasis drugs were handed over to the health cadres, to be subsequently distributed to the residents. (17)(18)(19) The MDA program in the Pabean region used a combination of DEC, albendazole and paracetamol, administered once annually for a minimum of 5 years. The dose of DEC is 6 mg/ kgBW, albendazole 400 mg for all age groups, and paracetamol 10 mg/kgBW.…”