title: DILEMMAS OF COMMUNITY-DIRECTED MASS DRUG ADMINISTRATION FOR LYMPHATIC FILARIASIS CONTROL: A QUALITATIVE STUDY FROM URBAN AND RURAL TANZANIA.
abstract: There has in recent years been a growing interest in the social significance of global health policy and associated interventions. This paper is concerned with neglected tropical disease control, which prescribes annual mass drug administration to interrupt transmission of, among others, lymphatic filariasis. In Tanzania, this intervention is conducted through community-directed distribution, which aims to improve drug uptake by promoting community participation and local ownership in the intervention. However, the average uptake of drugs often remains too low to achieve the intended interruption of transmission. The qualitative research presented here followed the implementation of mass drug administration in Lindi and Morogoro Regions, Tanzania, in 2011 to understand the different forms of involvement in the campaign and the experiences of stakeholders of their part in community-directed distribution. Some health care workers, community leaders and drug distributors were generally positive about the intervention, emphasizing that the drugs were welcome. Other stakeholders, including the drug-receiving population, reported facing a number of dilemmas of uncertainty, authority and exclusion pertaining to their roles in the intervention. These dilemmas should be of interest to donors, policymakers and implementers. Community-directed distribution relies on social relations between the many different stakeholders. Successful and justifiable interventions for lymphatic filariasis require implementers to recognize the central role of sociality and that the voices and priorities of people count.
authors.affiliation: *National Institute for Medical Research,Dar es Salaam,Tanzania.
authors.forename: William
authors.initials: W
authors.lastname: Kisoka
authors.affiliation: †Tumaini University,Kilimanjaro Christian Medical College,Moshi,Tanzania.
authors.forename: Declare
authors.initials: D
authors.lastname: Mushi
authors.affiliation: ‡Global Health Section,Department of Public Health,University of Copenhagen,Denmark.
authors.forename: Dan W
authors.initials: DW
authors.lastname: Meyrowitsch
authors.affiliation: *National Institute for Medical Research,Dar es Salaam,Tanzania.
authors.forename: Mwele
authors.initials: M
authors.lastname: Malecela
authors.affiliation: §Department of Veterinary Disease Biology,University of Copenhagen,Denmark.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Simonsen
authors.affiliation: ‡Global Health Section,Department of Public Health,University of Copenhagen,Denmark.
authors.forename: Britt P
authors.initials: BP
authors.lastname: Tersbøl
mesh_terms: D000328:Adult; D003906:Developing Countries; D004605:Elephantiasis, Filarial / Q000517:prevention & control* / Q000635:transmission; D005260:Female; D005369:Filaricides / Q000008:administration & dosage*; D014943:Global Health; D006291:Health Policy; D006801:Humans; D008297:Male; D000074381:Mass Drug Administration; D008875:Middle Aged; D058069:Neglected Diseases; D036301:Qualitative Research; D012424:Rural Population; D013636:Tanzania / Q000453:epidemiology; D016312:Treatment Refusal; D014505:Urban Population
chemical_list: D005369:Filaricides