The Role of Personal Opinions and Experiences in Compliance with Mass Drug Administration for Lymphatic Filariasis Elimination in Kenya

Abstract

BackgroundThe main strategy adopted for Lymphatic Filariasis (LF) elimination globally is annual mass drug administration (MDA) for 4 to 6 rounds. At least 65% of the population at risk should be treated in each round for LF elimination to occur. In Kenya, MDA using diethylcarbamazine citrate (DEC) and albendazole data shows declining compliance (proportion of eligible populations who receive and swallow the drugs) levels (85%–62.8%). The present study's aim was to determine the role of personal opinions and experiences in compliance with MDA.Methods/FindingsThis was a retrospective cross-sectional study conducted between January and September 2009 in two districts based on December 2008 MDA round. In each district, one location with high and one with low compliance was selected. Through systematic sampling, nine villages were selected and interviewer-based questionnaires administered to 965 household heads or adult representatives also systematically sampled. The qualitative data were generated from opinion leaders, LF patients with clinical signs and community drug distributors (CDDs) all purposively selected and interviewed. Sixteen focus group discussions (FGDs) were also conducted with single-sex adult and youth male and female groups. Chi square test was used to assess the statistical significance of differences in compliance with treatment based on the records reviewed.The house-to-house method of drug distribution influenced compliance. Over one-quarter (27%) in low compared to 15% in high compliance villages disliked this method. Problems related to size, number and taste of the drugs were more common in low (16.4%) than in high (14.4%) compliance villages. Reasons for failure to take the drugs were associated with compliance (p<0.001). The reasons given included: feeling that the drugs were not necessary, CDD not visiting to issue the drugs, being absent and thinking that the drugs were meant for only the patients with LF clinical signs. A dislike for modern medicine prevailed more in low (6.7%) than in high (1.2%) compliance villages. Experience of side effects influenced compliance (P<0.001). The common side effects experienced included giddiness, fever, headache and vomiting. Social support, alcohol and substance use were not associated with compliance in both types of villages (p>0.05).Conclusions/SignificanceCommunity sensitization on treatment, drugs used, their regimen and distribution method involving all leaders should be strengthened by the Programme Implementers. The communities need to be made aware of the potential side effects of the drugs and that health personnel are on standby for the management of side effects in order to build confidence and increase the compliance levels.

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

“…Hodges et al, 2012 [23]/Sierra Leone/June 2010–2011Programme evaluation11,824 participants interviewed in the end process evaluation of hard to reach (HTR) sites.(Urban and rural settings)12 districts and 4 large towns from southern, eastern and northern provinces.To identify the challenges to effective mass drug administration implementation for LF and the corrective measures taken.Challenges affecting MDA for implementation included: late country delivery of ivermectin, the availability and motivation of unpaid CHVs, remuneration for CHWs, rapid urbanization and employment seeking population migrations.‘In process’ monitoring ensured modifications of LF MDA were made in a timely manner to ensure effective coverage was finally attained in HTR locations.Community participation and Coverage10. Njomo1 et al, 2012 [24]/Kenya/December 2008Mixed- method studyQuantitative data: 965 household heads or adult representatives. Qualitative data: IDIs with 80 LF patients, 80 opinion leaders and 15 CDDs.…”

Increasing Coverage in Mass Drug Administration for Lymphatic Filariasis Elimination in an Urban Setting: a Study of Malindi Town, Kenya

“…The CDDs followed by other villagers were the most common sources of MDA information across the three socio-economic strata, while the hospital and radio were less common sources of information in the three areas indicating possible lack of reliability of information from CDDs by majority of those in the high socio-economic strata. Similarly, a study on social mobilization and compliance with MDA in rural Kenya [28] revealed that the health professionals did not play a frontline role in disseminating information on MDA suggesting that the information received by some of the community members may have been inadequate and/or incorrect. CDDs and other villagers are non- health professionals who should not be entirely relied upon to disseminate the information.…”

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

“…in Kenya reported “feeling that the drugs were not necessary,” being absent and thinking that the drugs were meant for only patients with LF as major causes of non-compliance. [13] Weerasooriya et al . reported that use of other medicines, a lack of feeling of the necessity for them and forgetting among reasons of non-compliance in Sri Lanka in 2007.…”

“…Experience of side-effects including giddiness, fever, headache, and vomiting influenced compliance in Kenya ( P < 0.001). [13]…”