Addressing barriers of community participation and access to mass drug administration for lymphatic filariasis elimination in Coastal Kenya using a participatory approach

PLoS Negl Trop Dis. 2020 Sep 16;14(9):e0008499. doi: 10.1371/journal.pntd.0008499. eCollection 2020 Sep.

Abstract

Since the prioritization of Lymphatic Filariasis (LF) elimination in 1997, progress has been made in reducing disease transmission and burden. Validation of elimination through Transmission Assessment Surveys (TAS) in implementation units (IUs) that have received at least 5 rounds of mass drug administration (MDA) and achieved minimum threshold of 65% treatment coverage is required. There are IUs that do not qualify for TAS due to achievement of low treatment coverage. This study sought to identify barriers of community participation and access to MDA, develop and test strategies to be recommended for improved uptake. Two wards in Kaloleni sub-county, Kilifi county with an average treatment coverage of 56% in 2015, 50.5% in 2016 were purposively sampled and a quasi-experimental study conducted. Through systematic random sampling, 350 (pre-intervention) and 338 (post-intervention) household heads were selected and interviewed for quantitative data. For qualitative data, 16 Focus Group Discussions (FGDs) with purposively selected community groups were conducted. Participatory meetings were held with county stakeholders to agree on strategies for improved community participation in MDA. The quantitative data were analyzed using STATA version 14.1, statistical significance assessed by chi square test and qualitative data by QSR NVIVO version 10. The identified strategies were tested in experimental sites during the 2018 MDA and the usual MDA strategies applied in control sites. The results showed an increase in community participation and access to MDA in both sites 80.6% (pre-intervention), 82.9% (post-intervention). The proportion of participants who considered the treatment as necessary significantly (p = 0.001) increased to 96.2% from 88.3% and significantly dropped for those with drug swallowing problems associated with: size (p<0.001), number (p<0.027) and taste (p = 0.001). The implemented strategies may have contributed to increased participation and access to MDA and should be applied for improved treatment uptake. Health education on disease aetiology and importance of drug uptake in all rounds is key to program's success.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Community Participation / methods*
  • Deglutition Disorders
  • Elephantiasis, Filarial / drug therapy*
  • Elephantiasis, Filarial / prevention & control
  • Family Characteristics
  • Female
  • Filaricides / therapeutic use
  • Focus Groups
  • Health Education*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Kenya
  • Male
  • Mass Drug Administration / methods*
  • Middle Aged

Substances

  • Filaricides

Grants and funding

This work received financial support from the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD) NTDSC 138D, which is funded at the Task Force for Global Health primarily by the Bill & Melinda Gates Foundation, by the UK aid from the British government and by the United States Agency for International Development through its Neglected Tropical Diseases Program. The funders had no role in the design of this study, data collection and analyses, decision to publish or preparation of the manuscript.