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Nandha B, Meenakshy V, Abdul Khader N, Vijayakumar KN, Jambulingam P. Bridging the gap in outreach and compliance with mass drug administration for lymphatic filariasis elimination in an endemic district in Kerala, India: an intervention research approach. HEALTH EDUCATION RESEARCH 2019; 34:300-309. [PMID: 30805648 DOI: 10.1093/her/cyz005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/15/2019] [Indexed: 06/09/2023]
Abstract
Lymphatic filariasis (LF), a neglected tropical disease is targeted for elimination globally by 2020. National Health Policy of India set the goal by 2017 and annual single-dose mass drug administration (MDA) with anti-filarial drugs is in operation in endemic districts since 2004. Performance and effectiveness of MDA was diverse across the nation and prevalence of infection continues above threshold level in 50% of endemic districts which requires alternative strategies. National programme aims at achieving >65% consumption for transmission control. Post 10 rounds of MDA in an endemic district of Kerala state, a three-arm study identified determinants in gap in outreach and consumption, based on which context-dependent intervention using social group work and networking (SGWN) was implemented and impact assessed. A spill over effect with overall increase in coverage and consumption rates irrespective of arms apparently is due to inclusive improvement in MDA programme whereas, significant relative improvement in intervention arm reflects effectiveness of SGWN strategy. Though reduction in microfilaria prevalence in all arms was observed, it was significant between intervention and comparison arm. This study highlights need for context-dependent communication strategy to improve MDA for accelerating LF elimination by the targeted 2020.
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Affiliation(s)
- B Nandha
- Vector Control Research Centre, (Indian Council of Medical Research), Medical Complex, Indira Nagar, Pondicherry, India
| | - V Meenakshy
- Office of the Directorate of Health Services, Tiruvananthapuram, Kerala, India
| | | | - K N Vijayakumar
- Vector Control Research Centre, (Indian Council of Medical Research), Medical Complex, Indira Nagar, Pondicherry, India
| | - P Jambulingam
- Vector Control Research Centre, (Indian Council of Medical Research), Medical Complex, Indira Nagar, Pondicherry, India
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Titaley CR, Damayanti R, Soeharno N, Mu'asyaroh A, Bradley M, Lynam T, Krentel A. Assessing knowledge about lymphatic filariasis and the implementation of mass drug administration amongst drug deliverers in three districts/cities of Indonesia. Parasit Vectors 2018; 11:315. [PMID: 29801511 PMCID: PMC5970490 DOI: 10.1186/s13071-018-2881-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/29/2018] [Indexed: 11/29/2022] Open
Abstract
Background This research assesses knowledge amongst drug deliverers about the implementation of mass drug administration (MDA) for lymphatic filariasis (LF) in Agam District (West Sumatera Province), the City of Depok (West Java Province) and the City of Batam (Kepulauan Riau Province), Indonesia. Methods A cross-sectional survey was conducted from January to March 2015 at these three sites. Respondents were identified using purposive sampling (i.e. cadre, health worker or community representatives). A total of 318 questionnaires were accepted for analysis. Three outcomes were assessed: knowledge about LF; knowledge about MDA implementation; and was informed about MDA coverage. Logistic regression analyses were employed to examine factors associated with these three outcomes. Results Less than half of respondents were charactersised as having a high level of LF knowledge and less than half a high level of knowledge about MDA. The odds of having a high level of knowledge of LF was significantly lower in Batam City than Agam District, yet higher amongst health workers than cadres. Deliverers living in urban areas reported more feedback on MDA outcomes than in the rural district. Health workers received more feedback than cadres (P < 0.001). Deliverers perceived the difference between coverage (drug receipt) and compliance (drug ingestion) in the community. Conclusions There are variations in knowledge about LF and MDA as well as feedback across drug deliverers in MDA across geographical areas. Adaptation of the MDA guidelines, supportive supervision, increasing the availability of supporting materials and directly-observed therapy might be beneficial to improve coverage and compliance in all areas.
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Affiliation(s)
- Christiana R Titaley
- Center for Health Research Universitas Indonesia. Faculty of Public Health Universitas Indonesia, Depok, West Java Province, Indonesia.
| | - Rita Damayanti
- Center for Health Research Universitas Indonesia. Faculty of Public Health Universitas Indonesia, Depok, West Java Province, Indonesia
| | - Nugroho Soeharno
- Center for Health Research Universitas Indonesia. Faculty of Public Health Universitas Indonesia, Depok, West Java Province, Indonesia
| | - Anifatun Mu'asyaroh
- Center for Health Research Universitas Indonesia. Faculty of Public Health Universitas Indonesia, Depok, West Java Province, Indonesia
| | - Mark Bradley
- NTD's Global Health Programs, GSK, Brentford, UK
| | - Tim Lynam
- Reflecting Society Pty Ltd., Townsville, Queensland, Australia
| | - Alison Krentel
- Bruyere Research Institute, Ottawa, Canada.,London School of Hygiene and Tropical Medicine, London, UK
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Kshirsagar NA, Gogtay NJ, Garg BS, Deshmukh PR, Rajgor DD, Kadam VS, Thakur PA, Gupta A, Ingole NS, Lazdins-Helds JK. Efficacy and tolerability of treatment with single doses of diethylcarbamazine (DEC) and DEC plus albendazole (ABZ) for three consecutive years in lymphatic filariasis: a field study in India. Parasitol Res 2017; 116:2683-2694. [PMID: 28785847 DOI: 10.1007/s00436-017-5577-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/28/2017] [Indexed: 11/29/2022]
Abstract
Lymphatic filariasis (LF) affects 73 countries, causes morbidity and impedes socioeconomic development. We had found no difference in safety and micro (Mf) and macro filarial action of single-dose diethylcarbamazine (DEC) and DEC + albendazole (ABZ) in an F01 study done in India (year 2000). There was a programmatic need to evaluate safety and efficacy of multiple annual treatments (F02). Subjects (155) from the F01 study, meeting inclusion-exclusion criteria, were enrolled in F02 and treated with further two annual doses of DEC or DEC + ABZ. Efficacy was evaluated for Mf positivity by peripheral smear (PS) and nucleopore (NP) filter, circulating filarial antigen (CFA) and filarial dance sign (FDS) positivity and Mf count at yearly follow-up. Safety was assessed for 5 days after drug administration. Total of 139 subjects evaluated for efficacy (69 DEC and 70 DEC + ABZ group). Mf positivity prevalence declined progressively by 95% (PS), 66% (NP), and 95% (PS) and 86% (NP); CFA positivity prevalence declined by 15% and 9%; FDS by 100% each; Mf count declined by 75.5 and 76.9% with three annual treatment of DEC and DEC + ABZ, respectively. Addition of ABZ did not show any advantage over DEC given as three annual rounds for LF. DEC and DEC + ABZ were well tolerated. There was no correlation between result of CFA and FDS, (both claimed to be indicative of adult worm). Analysis of published studies and our data indicate that macrofilaricidal effect of DEC/DEC + ABZ may be seen in children and not adults, with three or more annual dosing.
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Affiliation(s)
- Nilima A Kshirsagar
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, New MS Building, 1st Floor, Parel, Mumbai, 400012, India. .,National Chair Clinical Pharmacology, ICMR Govt. of India, National Institute for Research in Reproductive Health (NIRRH), J. M. Street, Parel, Mumbai, 400012, India.
| | - N J Gogtay
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, New MS Building, 1st Floor, Parel, Mumbai, 400012, India
| | - B S Garg
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, 442102, India
| | - P R Deshmukh
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, 442102, India
| | - D D Rajgor
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, New MS Building, 1st Floor, Parel, Mumbai, 400012, India
| | - V S Kadam
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, New MS Building, 1st Floor, Parel, Mumbai, 400012, India
| | - P A Thakur
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, New MS Building, 1st Floor, Parel, Mumbai, 400012, India
| | - A Gupta
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, New MS Building, 1st Floor, Parel, Mumbai, 400012, India
| | - N S Ingole
- Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Wardha, 442102, India
| | - J K Lazdins-Helds
- World Health Organization (WHO), Special Program for Research and Training in Tropical Diseases, Product Research and Development, 20 Avenue Appia, Geneva 27, 1211, Geneva, CH, Switzerland
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Biritwum NK, Garshong B, Alomatu B, de Souza DK, Gyapong M, Kyelem D. Improving drug delivery strategies for lymphatic filariasis elimination in urban areas in Ghana. PLoS Negl Trop Dis 2017; 11:e0005619. [PMID: 28493966 PMCID: PMC5441634 DOI: 10.1371/journal.pntd.0005619] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 05/23/2017] [Accepted: 05/02/2017] [Indexed: 11/30/2022] Open
Abstract
The Global Program to Eliminate Lymphatic Filariasis (GPELF) advocates for the treatment of entire endemic communities, in order to achieve its elimination targets. LF is predominantly a rural disease, and achieving the required treatment coverage in these areas is much easier compared to urban areas that are more complex. In Ghana, parts of the Greater Accra Region with Accra as the capital city are also endemic for LF. Mass Drug Administration (MDA) in Accra started in 2006. However, after four years of treatment, the coverage has always been far below the 65% epidemiologic coverage for interrupting transmission. As such, there was a need to identify the reasons for poor treatment coverage and design specific strategies to improve the delivery of MDA. This study therefore set out to identify the opportunities and barriers for implementing MDA in urban settings, and to develop appropriate strategies for MDA in these settings. An experimental, exploratory study was undertaken in three districts in the Greater Accra region. The study identified various types of non-rural settings, the social structures, stakeholders and resources that could be employed for MDA. Qualitative assessment such as in-depth interviews (IDIs) and focus group discussions (FGDs) with community leaders, community members, health providers, NGOs and other stakeholders in the community was undertaken. The study was carried out in three phases: pre-intervention, intervention and post-intervention phases, to assess the profile of the urban areas and identify reasons for poor treatment coverage using both qualitative and quantitative research methods. The outcomes from the study revealed that, knowledge, attitudes and practices of community members to MDA improved slightly from the pre-intervention phase to the post-intervention phase, in the districts where the interventions were readily implemented by health workers. Many factors such as adequate leadership, funding, planning and community involvement, were identified as being important in improving implementation and coverage of MDA in the study districts. Implementing MDA in urban areas therefore needs to be given significant consideration and planning, if the required coverage rates are to be achieved. This paper, presents the recommendations and strategies for undertaking MDA in urban areas. The control of lymphatic filariasis depends on the treatment of entire endemic communities, ensuring that a greater proportion of the population is treated. In urban areas, this can be very difficult to achieve. In Ghana, parts of the Greater Accra Region, where the capital city is located, are also endemic for lymphatic filariasis. Treatment in these areas started in 2006, but the proportion of people treated has continuously been below the required programmatic coverage levels. To understand the reasons behind this, a study was undertaken in three endemic districts. The study was carried out in three stages; pre-treatment, treatment and post-treatment. Individuals and groups of people were interviewed in the pre-treatment phase, following which their concerns were used to plan and execute treatment activities. After treatment, some individuals were again interviewed to assess the effectiveness of the interventions. The results showed that the knowledge and behavior of community members towards the disease and treatment activities improved from the pre-treatment to the post-treatment reviews. Many factors were identified including, financial, management and leadership issues that should be considered when planning treatment activities in urban areas.
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Affiliation(s)
- Nana-Kwadwo Biritwum
- Neglected Tropical Diseases Program, Ghana Health Service, Accra, Ghana
- * E-mail:
| | - Bertha Garshong
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Bright Alomatu
- Neglected Tropical Diseases Program, Ghana Health Service, Accra, Ghana
| | - Dziedzom K. de Souza
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon-Accra, Ghana
| | | | - Dominique Kyelem
- Taskforce for Global Health, Decatur-Atlanta, Georgia, United States of America
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Hollingsworth TD, Adams ER, Anderson RM, Atkins K, Bartsch S, Basáñez MG, Behrend M, Blok DJ, Chapman LAC, Coffeng L, Courtenay O, Crump RE, de Vlas SJ, Dobson A, Dyson L, Farkas H, Galvani AP, Gambhir M, Gurarie D, Irvine MA, Jervis S, Keeling MJ, Kelly-Hope L, King C, Lee BY, Le Rutte EA, Lietman TM, Ndeffo-Mbah M, Medley GF, Michael E, Pandey A, Peterson JK, Pinsent A, Porco TC, Richardus JH, Reimer L, Rock KS, Singh BK, Stolk W, Swaminathan S, Torr SJ, Townsend J, Truscott J, Walker M, Zoueva A. Quantitative analyses and modelling to support achievement of the 2020 goals for nine neglected tropical diseases. Parasit Vectors 2015; 8:630. [PMID: 26652272 PMCID: PMC4674954 DOI: 10.1186/s13071-015-1235-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 12/01/2015] [Indexed: 12/30/2022] Open
Abstract
Quantitative analysis and mathematical models are useful tools in informing strategies to control or eliminate disease. Currently, there is an urgent need to develop these tools to inform policy to achieve the 2020 goals for neglected tropical diseases (NTDs). In this paper we give an overview of a collection of novel model-based analyses which aim to address key questions on the dynamics of transmission and control of nine NTDs: Chagas disease, visceral leishmaniasis, human African trypanosomiasis, leprosy, soil-transmitted helminths, schistosomiasis, lymphatic filariasis, onchocerciasis and trachoma. Several common themes resonate throughout these analyses, including: the importance of epidemiological setting on the success of interventions; targeting groups who are at highest risk of infection or re-infection; and reaching populations who are not accessing interventions and may act as a reservoir for infection,. The results also highlight the challenge of maintaining elimination 'as a public health problem' when true elimination is not reached. The models elucidate the factors that may be contributing most to persistence of disease and discuss the requirements for eventually achieving true elimination, if that is possible. Overall this collection presents new analyses to inform current control initiatives. These papers form a base from which further development of the models and more rigorous validation against a variety of datasets can help to give more detailed advice. At the moment, the models' predictions are being considered as the world prepares for a final push towards control or elimination of neglected tropical diseases by 2020.
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Affiliation(s)
| | - Emily R Adams
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | | | - Katherine Atkins
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Sarah Bartsch
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | | | | | - David J Blok
- Erasmus University Medical Center, 3015 CE, Rotterdam, Netherlands
| | | | - Luc Coffeng
- Erasmus University Medical Center, 3015 CE, Rotterdam, Netherlands
| | | | - Ron E Crump
- University of Warwick, Coventry, CV4 7AL, UK
| | - Sake J de Vlas
- Erasmus University Medical Center, 3015 CE, Rotterdam, Netherlands
| | - Andy Dobson
- Princeton University, New Jersey, NJ, 08544, USA
| | | | | | | | | | - David Gurarie
- Case Western Reserve University, Cleveland, OH, 44106, USA
| | | | | | | | | | - Charles King
- Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Bruce Y Lee
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Epke A Le Rutte
- Erasmus University Medical Center, 3015 CE, Rotterdam, Netherlands
| | - Thomas M Lietman
- University of California, San Francisco, San Francisco, CA, 94143, USA
| | | | - Graham F Medley
- London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Edwin Michael
- University of Notre Dame, South Bend, IN, 47556, USA
| | | | | | - Amy Pinsent
- Monash University, Melbourne, VIC, 3800, Australia
| | - Travis C Porco
- University of California, San Francisco, San Francisco, CA, 94143, USA
| | | | - Lisa Reimer
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Kat S Rock
- University of Warwick, Coventry, CV4 7AL, UK
| | | | - Wilma Stolk
- Erasmus University Medical Center, 3015 CE, Rotterdam, Netherlands
| | | | - Steve J Torr
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
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Irvine MA, Reimer LJ, Njenga SM, Gunawardena S, Kelly-Hope L, Bockarie M, Hollingsworth TD. Modelling strategies to break transmission of lymphatic filariasis--aggregation, adherence and vector competence greatly alter elimination. Parasit Vectors 2015; 8:547. [PMID: 26489753 PMCID: PMC4618540 DOI: 10.1186/s13071-015-1152-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 10/06/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With ambitious targets to eliminate lymphatic filariasis over the coming years, there is a need to identify optimal strategies to achieve them in areas with different baseline prevalence and stages of control. Modelling can assist in identifying what data should be collected and what strategies are best for which scenarios. METHODS We develop a new individual-based, stochastic mathematical model of the transmission of lymphatic filariasis. We validate the model by fitting to a first time point and predicting future timepoints from surveillance data in Kenya and Sri Lanka, which have different vectors and different stages of the control programme. We then simulate different treatment scenarios in low, medium and high transmission settings, comparing once yearly mass drug administration (MDA) with more frequent MDA and higher coverage. We investigate the potential impact that vector control, systematic non-compliance and different levels of aggregation have on the dynamics of transmission and control. RESULTS In all settings, increasing coverage from 65 to 80 % has a similar impact on control to treating twice a year at 65 % coverage, for fewer drug treatments being distributed. Vector control has a large impact, even at moderate levels. The extent of aggregation of parasite loads amongst a small portion of the population, which has been estimated to be highly variable in different settings, can undermine the success of a programme, particularly if high risk sub-communities are not accessing interventions. CONCLUSION Even moderate levels of vector control have a large impact both on the reduction in prevalence and the maintenance of gains made during MDA, even when parasite loads are highly aggregated, and use of vector control is at moderate levels. For the same prevalence, differences in aggregation and adherence can result in very different dynamics. The novel analysis of a small amount of surveillance data and resulting simulations highlight the need for more individual level data to be analysed to effectively tailor programmes in the drive for elimination.
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Affiliation(s)
- M A Irvine
- School of Life Sciences, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, UK.
| | - L J Reimer
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - S M Njenga
- Kenya Medical Research Institute (KEMRI), P.O. Box 54840, 00200, Nairobi, Kenya
| | - S Gunawardena
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - L Kelly-Hope
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - M Bockarie
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - T D Hollingsworth
- School of Life Sciences, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, UK
- Mathematics Institute, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, UK
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Rao RU, Nagodavithana KC, Samarasekera SD, Wijegunawardana AD, Premakumara WDY, Perera SN, Settinayake S, Miller JP, Weil GJ. A comprehensive assessment of lymphatic filariasis in Sri Lanka six years after cessation of mass drug administration. PLoS Negl Trop Dis 2014; 8:e3281. [PMID: 25393404 PMCID: PMC4230885 DOI: 10.1371/journal.pntd.0003281] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 09/19/2014] [Indexed: 11/19/2022] Open
Abstract
Background The Sri Lankan Anti-Filariasis Campaign conducted 5 rounds of mass drug administration (MDA) with diethycarbamazine plus albendazole between 2002 and 2006. We now report results of a comprehensive surveillance program that assessed the lymphatic filariasis (LF) situation in Sri Lanka 6 years after cessation of MDA. Methodology and Principal Findings Transmission assessment surveys (TAS) were performed per WHO guidelines in primary school children in 11 evaluation units (EUs) in all 8 formerly endemic districts. All EUs easily satisfied WHO criteria for stopping MDA. Comprehensive surveillance was performed in 19 Public Health Inspector (PHI) areas (subdistrict health administrative units). The surveillance package included cross-sectional community surveys for microfilaremia (Mf) and circulating filarial antigenemia (CFA), school surveys for CFA and anti-filarial antibodies, and collection of Culex mosquitoes with gravid traps for detection of filarial DNA (molecular xenomonitoring, MX). Provisional target rates for interruption of LF transmission were community CFA <2%, antibody in school children <2%, and filarial DNA in mosquitoes <0.25%. Community Mf and CFA prevalence rates ranged from 0–0.9% and 0–3.4%, respectively. Infection rates were significantly higher in males and lower in people who denied prior treatment. Antibody rates in school children exceeded 2% in 10 study sites; the area that had the highest community and school CFA rates also had the highest school antibody rate (6.9%). Filarial DNA rates in mosquitoes exceeded 0.25% in 10 PHI areas. Conclusions Comprehensive surveillance is feasible for some national filariasis elimination programs. Low-level persistence of LF was present in all study sites; several sites failed to meet provisional endpoint criteria for LF elimination, and follow-up testing will be needed in these areas. TAS was not sensitive for detecting low-level persistence of filariasis in Sri Lanka. We recommend use of antibody and MX testing as tools to complement TAS for post-MDA surveillance. Lymphatic Filariasis (LF, also known as “elephantiasis”) is a disabling and deforming disease that is caused by parasitic worms that are transmitted by mosquitoes. The Sri Lankan Anti-Filariasis Campaign provided five annual rounds of mass drug administration (MDA) with diethylcarbamazine and albendazole between 2002 and 2006 in all endemic areas (districts or implementation units), and this reduced infection rates to very low levels in all sentinel and spot check sites. Transmission Assessment Surveys (TAS, surveys for filarial antigenemia in primary school children) performed in 2012–2013 (about 6 years after the last round of MDA) showed that all 11 evaluation units in formerly endemic areas easily satisfied a key World Health Organization target for LF elimination programs. More comprehensive surveillance was performed with other tests to assess LF parameters in 19 study sites in the same eight districts. We detected evidence of persistent LF in all districts and evidence of ongoing transmission in several areas. Exposure monitoring (screening for anti-filarial antibodies in primary school children) and molecular xenomonitoring (detecting filarial DNA in mosquito vectors) were much more sensitive than TAS for detecting low level persistence of filariasis in Sri Lanka. These methods are complementary to TAS, and they are feasible for use by some national filariasis elimination programs. Results from this study suggest that TAS alone may not be sufficient for assessing the success of filariasis elimination programs.
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Affiliation(s)
- Ramakrishna U. Rao
- Department of Internal Medicine, Infectious Diseases Division, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | | | | | | | | | | | - Sunil Settinayake
- Anti Filariasis Campaign, Sri Lanka Ministry of Health, Colombo, Sri Lanka
| | - J. Phillip Miller
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Gary J. Weil
- Department of Internal Medicine, Infectious Diseases Division, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
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Babu BV, Babu GR. Coverage of, and compliance with, mass drug administration under the programme to eliminate lymphatic filariasis in India: a systematic review. Trans R Soc Trop Med Hyg 2014; 108:538-49. [PMID: 24728444 DOI: 10.1093/trstmh/tru057] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
India's mass drug administration (MDA) programme to eliminate lymphatic filariasis (PELF) covers all 250 endemic districts, but compliance with treatment is not adequate for the programme to succeed in eradicating this neglected tropical disease. The objective of our study was to systematically review published studies on the coverage of and compliance with MDA under the PELF in India. We searched several databases-PubMed/Medline, Google Scholar, CINAHL/EBSCO, Web of Knowledge (including Web of Science) and OVID-and by applying selection criteria identified a total of 36 papers to include in the review. Overall MDA coverage rates varied between 48.8% and 98.8%, while compliance rates ranged from 20.8% to 93.7%. The coverage-compliance gap is large in many MDA programmes. The effective level of compliance, ≥65%, was reported in only 10 of a total of 31 MDAs (5 of 20 MDAs in rural areas and 2 of 12 MDAs in urban areas). The review has identified a gap between coverage and compliance, and potentially correctable causes of this gap. These causes need to be addressed if the Indian programme is to advance towards elimination of lymphatic filariasis.
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Affiliation(s)
- Bontha V Babu
- Health Systems Research Division, Indian Council of Medical Research, New Delhi 110 029, India
| | - Gopalan R Babu
- Kerala Unit, National Institute of Virology, Indian Council of Medical Research, Alappuzha 688 005, India
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A review of factors that influence individual compliance with mass drug administration for elimination of lymphatic filariasis. PLoS Negl Trop Dis 2013; 7:e2447. [PMID: 24278486 PMCID: PMC3836848 DOI: 10.1371/journal.pntd.0002447] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The success of programs to eliminate lymphatic filariasis (LF) depends in large part on their ability to achieve and sustain high levels of compliance with mass drug administration (MDA). This paper reports results from a comprehensive review of factors that affect compliance with MDA. Methodology/Principal Findings Papers published between 2000 and 2012 were considered, and 79 publications were included in the final dataset for analysis after two rounds of selection. While results varied in different settings, some common features were associated with successful programs and with compliance by individuals. Training and motivation of drug distributors is critically important, because these people directly interact with target populations, and their actions can affect MDA compliance decisions by families and individuals. Other important programmatic issues include thorough preparation of personnel, supplies, and logistics for implementation and preparation of the population for MDA. Demographic factors (age, sex, income level, and area of residence) are often associated with compliance by individuals, but compliance decisions are also affected by perceptions of the potential benefits of participation versus the risk of adverse events. Trust and information can sometimes offset fear of the unknown. While no single formula can ensure success MDA in all settings, five key ingredients were identified: engender trust, tailor programs to local conditions, take actions to minimize the impact of adverse events, promote the broader benefits of the MDA program, and directly address the issue of systematic non-compliance, which harms communities by prolonging their exposure to LF. Conclusions/Significance This review has identified factors that promote coverage and compliance with MDA for LF elimination across countries. This information may be helpful for explaining results that do not meet expectations and for developing remedies for ailing MDA programs. Our review has also identified gaps in understanding and suggested priority areas for further research. Lymphatic filariasis (LF, also known as “elephantiasis”) is a deforming and disabling disease that is caused by roundworm parasites that are transmitted by mosquitoes. The Global Programme to Eliminate Lymphatic Filariasis is the largest public health intervention program attempted to date based on mass drug administration (MDA). MDA does not cure filarial infections, but it can reduce or interrupt transmission of new infections by clearing larval parasites from human blood so that they are not available for mosquitoes. High levels of participation are required for this strategy to work; guidelines from the World Health Organization call for at least 65% of the eligible population to take the medications annually for four to six years. MDA presents logistical challenges that require cooperation between donors, health ministries, and communities. The success of MDA depends on coverage (drug delivery) and compliance (people ingesting antifilarial drugs), which depends on individual interactions between drug distributors and the people who live in LF-endemic areas. This paper focuses on this last step of implementation with a comprehensive review of published and unpublished information on factors that affect compliance with MDA at the level of the individual. We have also provided an outline of current gaps in understanding and recommendations for further research.
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Mass drug administration under the programme to eliminate lymphatic filariasis in Orissa, India: a mixed-methods study to identify factors associated with compliance and non-compliance. Trans R Soc Trop Med Hyg 2008; 102:1207-13. [PMID: 18632125 DOI: 10.1016/j.trstmh.2008.05.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 05/27/2008] [Accepted: 05/27/2008] [Indexed: 11/24/2022] Open
Abstract
The present study aimed to identify the factors responsible for compliance and non-compliance of mass drug administration (MDA) under the programme to eliminate lymphatic filariasis (LF) from Orissa, India. It was based on both quantitative (through household MDA coverage survey) and qualitative data (through semi-structured interviews with heads of compliant and non-compliant households) collected during an MDA held in November 2005 in two districts of Orissa. In these districts, 83% of the eligible population received the drug (coverage) and only 49.5% people actually consumed the drug (compliance). Seventeen percent of the population did not even receive the drug. The predominant reason for not receiving the drug at household level was that the drug distributor did not visit the household, while the fear of adverse reactions is the predominant reason for not consuming it. The qualitative data revealed that the major contributor to taking the drug was the awareness that drug protects them from LF. Motivation by health workers was another reason for compliance. In many endemic areas, the issues related to non-compliance were taken casually during implementation. Hence, it is imperative to make the programme more efficient by addressing the issues linked to low compliance.
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Gunawardena S, Sri Ranganathan S, Fernandopulle R. Pharmacovigilance through consumer feedback (reporting) in the mass treatment of lymphatic filariasis using diethylcarbamazine and albendazole in two districts of Sri Lanka. Trop Med Int Health 2008; 13:1153-8. [PMID: 18631319 DOI: 10.1111/j.1365-3156.2008.02120.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To document the types and severity of adverse drug reactions to diethylcarbamazine and albendazole in randomly selected urban populations from Colombo and rural populations from Gampaha, Sri Lanka. METHODS Interviewers administered a pre-tested questionnaire to elicit information about the type and severity of adverse drug reactions experienced by recipients. Seeking medical treatment and requiring hospital admission for the adverse drug reactions were used as indicators for severity. The sample population was selected using the cluster sampling method. RESULTS Two thousand three hundred and nineteen persons aged 10 to 90 years (median 40.0) responded to the questionnaire; 63.9% of them had received and ingested the drugs. 12.6% reported that they had experienced adverse drug reactions, the proportion being similar in urban and rural areas (chi2 = 0.05; p = 0.82). Commonly reported reactions were drowsiness (34.7%), headache (23.1%), gastrointestinal symptoms (18.7%) and dizziness or faintness (11.9%). However, most symptoms were mild (96.3%) and did not interfere with daily activities or require medical attention. 3.2% said that they sought medical advice for their symptoms; one person (0.5%) who had severe abdominal pain was hospitalized. CONCLUSIONS Fewer people experienced adverse drug reactions than in previous years, possibly due to lower microfilariaemia prevalence after several rounds of mass drug administration against filariasis. Community awareness of adverse drug reactions is essential for improving compliance and for the success of the filariasis elimination programme.
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Affiliation(s)
- Sharmini Gunawardena
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
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