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      Increasing Coverage in Mass Drug Administration for Lymphatic Filariasis Elimination in an Urban Setting: a Study of Malindi Town, Kenya

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          Abstract

          Introduction

          Implementation of Mass Drug Administration (MDA) in urban settings is an obstacle to Lymphatic Filariasis (LF) elimination. No urban-specific guidelines on MDA in urban areas exist. Malindi district urban area had received 4 MDA rounds by the time the current study was implemented. Programme data showed average treatment coverage of 28.4% (2011 MDA), far below recommended minimum of 65–80%.

          Methods

          To identify, design and test strategies for increased treatment coverage in urban areas, a quasi-experimental study was conducted in Malindi urban area. Three sub-locations with lowest treatment coverage in 2011 MDA were purposively selected. In the pre-test phase, 947 household heads sampled using systematic random method were interviewed for quantitative data. For qualitative data, 12 Focus Group Discussions (FGDs) with single sex adult and youth male and female groups and 3 with community drug distributors (CDDs) were conducted. Forty in-depth interviews with opinion leaders and self-administered questionnaires with District Public Health officers purposively selected were carried out. The quantitative data were analyzed using SPSS version 16 and statistical significance assessed by χ 2 test.The qualitative data were analyzed manually according to study's themes.

          Results and Discussion

          The identified strategies were implemented prior to and during 2012 MDA in two sub-locations (experimental) while in the third (control), usual MDA strategies were applied. In the post-test phase, 2012 MDA coverage in experimental and control sub-locations was comparatively assessed for effect of the newly designed strategies on urban MDA. Results indicated improved treatment coverage in experimental sub-locations, 77.1% in Shella and 66.0% in Barani. Central (control) sub-location also attained high coverage, 70.4% indicating average treatment coverage of 71%.

          Conclusion

          The identified strategies contributed to increased treatment coverage in experimental sites and should be applied in urban areas. Due to closeness of sites, spillover effects may have contributed to increased coverage in the control site.

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          Most cited references 15

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          The global programme to eliminate lymphatic filariasis.

           E Ottesen (2000)
          Ten years ago, no one foresaw that in the year 2000 there would be a Global Programme to Eliminate Lymphatic Filariasis (GPELF) that is already 2 years old, active in 18 of the 80 endemic countries, and operating under a wholly new paradigm in public health - a paradigm affirming that public/private sector partnerships are essential in sharing both responsibilities and responses to global health problems. What has driven the LF Elimination Programme to this point? Where it is now headed? What will be required to sustain its momentum? What will its impact be? These are the issues addressed below.
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            Prospects for elimination of bancroftian filariasis by mass drug treatment in Pondicherry, India: a simulation study.

            LYMFASIM, a microsimulation model for transmission and control of lymphatic filariasis, was used to simulate the effects of mass treatment, in order to estimate the number of treatment rounds necessary to achieve elimination. Simulations were performed for a community that represented Pondicherry, India, and that had an average precontrol microfilariae (MF) prevalence of 8.5%. When ivermectin was used, 8 yearly treatment rounds with 65% population coverage gave a 99% probability of elimination. The number of treatment rounds necessary to achieve elimination depended to a large extent on coverage, drug efficacy, and endemicity level. Changing the interval between treatment rounds mainly influenced the duration of control, not the number of treatment rounds necessary to achieve elimination. Results hardly changed with alternative assumptions regarding the type of immune mechanism. The potential impact of mass treatment with a combination of diethylcarbamazine and albendazole is shown under different assumptions regarding its efficacy. Human migration and drug resistance were not considered. Results cannot be directly generalized to areas with different vector or epidemiological characteristics. In conclusion, the prospects for elimination of bancroftian filariasis by mass treatment in Pondicherry seem good, provided that the level of population coverage is sufficiently high.
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              Coverage, compliance and some operational issues of mass drug administration during the programme to eliminate lymphatic filariasis in Orissa, India.

               Ramesh B Babu,  S. Kar (2004)
              This paper reports the coverage, compliance and other operational issues of mass drug administration (MDA) of diethylcarbamazine and albendazole under a programme to eliminate lymphatic filariasis (LF) in Orissa state of India. Both quantitative and qualitative methods were used to collect data from 90 villages and nine urban areas of four districts of Orissa, India. In Orissa, 67% of people older than 2 years had received the drugs during MDA and 42% had consumed them. About 25% of people had not taken the tablets although they received them. Urban areas recorded lower rates than rural areas. The paper discusses some policy/health system-, community- and drug-related issues that influenced coverage and compliance of MDA. It is essential to improve compliance in future rounds of MDA to achieve targets of control and eventual elimination of LF in a reasonable time frame.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                14 January 2014
                : 9
                : 1
                Affiliations
                [1 ]Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
                [2 ]Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
                [3 ]Malindi District Hospital, Ministry of Health, Malindi, Kenya
                Johns Hopkins University, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: DWN DAM NKN JK. Performed the experiments: DWN DAM NKN JK. Analyzed the data: DWN DAM NKN. Contributed reagents/materials/analysis tools: DWN DAM NKN. Wrote the paper: DWN. Social mobilization: DWN DAM NN JK. Read and approved the manuscript: DWN DAM .

                Article
                PONE-D-13-26775
                10.1371/journal.pone.0083413
                3891599

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Pages: 9
                Funding
                This study received support from the Neglected Tropical Diseases (NTDs) Support Centre at the Task Force for Global Health (Atlanta, GA, USA) with funding from the Bill & Melinda Gates Foundation grant #: OPP43922. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine
                Global Health
                Infectious Diseases
                Neglected Tropical Diseases
                Lymphatic Filariasis
                Parasitic Diseases
                Filariasis
                Lymphatic Filariasis
                Tropical Diseases (Non-Neglected)
                Filariasis
                Non-Clinical Medicine
                Health Care Policy
                Health Education and Awareness
                Communication in Health Care
                Socioeconomic Aspects of Health
                Public Health
                Behavioral and Social Aspects of Health
                Socioeconomic Aspects of Health
                Social and Behavioral Sciences
                Sociology

                Uncategorized

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