title: Qualitative analysis of the impact of a lymphatic filariasis elimination programme using mass drug administration on Misima Island, Papua New Guinea.
abstract: BACKGROUND
  Papua New Guinea is the only endemic country in the Western Pacific Region that has not yet introduced a countrywide programme to eliminate lymphatic filariasis. However, on Misima Island in Milne Bay Province, government and private sectors have collaborated to implement a pilot elimination programme. Although interim evaluation indicated that the programme has been parasitologically successful, an appreciation that sustainable health gains depend on understanding and accommodating local beliefs prompted this qualitative study.
  
  
  METHODS
  We investigated Misima community members knowledge and attitudes about lymphatic filariasis and the elimination programme. A combination of focus groups and key informant interviews were used to explore participants perceptions of health; knowledge of the aetiology and symptoms of filariasis, elephantiasis and hydrocele; attitudes towards the disease and mass drug distribution; and the social structure and decision-making protocols within the villages.
  
  
  RESULTS
  Focus group discussions proved inferior to key informant interviews for gathering rich data. Study participants did not consider lymphatic filariasis ("pom") a major health problem but were generally positive about mass drug administration campaigns. A variety of conditions were frequently and incorrectly attributed to filariasis. Participants expressed the belief that individuals infected with filariasis always had visible manifestations of disease. A common misconception was that taking drugs during campaigns provided long-term immunity against disease. The role of mosquito vectors in transmission was not generally appreciated and certain clinical presentations, particularly hydrocele, were associated with supernatural forces. Multiple adverse events were associated with mass drug administration campaigns and most study participants mentioned community members who did not participate in campaigns.
  
  
  CONCLUSIONS
  Important issues requiring educational intervention and elimination activity modification in the Misima region were identified during this study. Research outcomes should assist Papua New Guinea in developing and implementing a national elimination strategy and inform discussions regarding the appropriateness of current elimination strategies.
authors.affiliation: World Health Organization Collaborating Centre for the Control of Lymphatic Filariasis, James Cook University, Douglas, Townsville, 4811, Australia. shona-wynd@jcu.edu.au
authors.forename: Shona
authors.initials: S
authors.lastname: Wynd
authors.forename: Jaime
authors.initials: J
authors.lastname: Carron
authors.forename: Billy
authors.initials: B
authors.lastname: Selve
authors.forename: Peter A
authors.initials: PA
authors.lastname: Leggat
authors.forename: Wayne
authors.initials: W
authors.lastname: Melrose
authors.forename: David N
authors.initials: DN
authors.lastname: Durrheim