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

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. Author summary Elephantiasis is targeted for elimination according to World Health Assembly resolution of 1997. There is need to determine if spread of infection has been stopped by conducting evaluations in areas that have received at least 5 rounds of treatment at minimum levels of 65% coverage. There are areas that cannot qualify for evaluations due to their achievement of low coverage. We conducted a study in Kaloleni sub-county to identify barriers of community participation in the campaign, develop and test strategies for improved treatment uptake for recommendation to the Programme Implementers. The study involved collecting quantitative data from systematically randomly sampled household heads and qualitative data from purposively selected key stakeholders. The identified strategies were tested in experimental sites while the usual treatment strategies were applied in control sites. The results showed an increase in community participation in MDA and in persons who considered the treatment as necessary. The strategies may have contributed to decreased proportions of persons who expressed problems with drugs swallowing due to size, number and taste, to positive perceptions of the drugs and should be applied for improved treatment uptake. The communities need robust health education on elephantiasis and importance of consistency in drug uptake.