Strengthening of mass drug administration implementation is required to eliminate lymphatic filariasis from India: an evaluation study.
OBJECTIVE
The mass drug administration (MDA) is one of the strategies to eliminate lymphatic filariasis in India. Eleven districts are endemic for the disease in Madhya Pradesh state of India, which conduct MDA activities annually. A mid-term evaluation was conducted with the objectives to review the progress of the single dose of di-ethyl-carbamazine (DEC) administration, and to understand the functioning of the programme to recommend mid-term amendments.


METHODS
A qualitative cross-sectional study was conducted in three endemic districts of Madhya Pradesh between July and October 2007. The teams of faculty members from medical college visited the study districts and collected data by desk review, indepth interviews, on site observations, and from the community.


RESULTS
The filaria units in these districts were understaffed. There were no night clinics in two out of the three districts. The sufficient number of trainings for MDA were conducted without any mechanism for quality assurance. There was erratic and inadequate supply of DEC tablets, leading to the postponement of MDA activity, twice. The evaluated coverage with DEC tablets was much lower than that reported by the district officials. The tablet intake was not ensured by the distributors and the compliance rate was in the range of 60-70%. The IEC activities were conducted in limited areas, and there were prevailing myths and misconceptions, contributing to low compliance rate. There was no proper recording of the data on filariasis with gross mismatch at district headquarters and peripheral health facilities. A proportion of community members developed side effects following DEC tablet intake and had to visit private health facilities for treatment.


CONCLUSIONS
This evaluation study noted that MDA is restricted to tablet distribution only and the major issues of implementation in compliance, health education, side effect and morbidity management, and the logistics were not being given due attention. The implementation should be strengthened immediately in the MDA programme in India to achieve the goal of LF elimination by 2015.
Lahariya
Chandrakant
C
Department of Community Medicine, Gajra Raja Medical College and Associated Hospitals, Gwalior, India. ck1800@rediffmail.com
Mishra
Ashok
A
D000328:Adult; D002648:Child; D003153:Community Health Services / Q000458:organization & administration; D003150:Community Health Workers / Q000193:education; D003256:Community Participation; D003430:Cross-Sectional Studies; D003625:Data Collection; D004049:Diethylcarbamazine / Q000008:administration & dosage* / Q000009:adverse effects / Q000600:supply & distribution; D004334:Drug Administration Schedule; D004605:Elephantiasis, Filarial / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D005369:Filaricides / Q000008:administration & dosage* / Q000009:adverse effects / Q000600:supply & distribution; D006266:Health Education / Q000191:economics / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006284:Health Plan Implementation; D006801:Humans; D007194:India / Q000453:epidemiology; D008509:Medication Systems / Q000458:organization & administration*; D009936:Organizational Innovation; D016730:Program Development; D013607:Tablets; D000078329:Workforce; D016903:Drug Monitoring
D005369:Filaricides; D013607:Tablets; D004049:Diethylcarbamazine