Potential Contributing Factors for Declining Mass Drug Administration Coverage for Lymphatic Filariasis in Port-au-Prince, Haiti: A Qualitative Study of the Word on the Street Open Access
Wilkers, Lee (Spring 2019)
Lymphatic Filariasis (LF) is a mosquito-borne parasitic disease that affects nearly 120 million people globally. Causing lymphedema, elephantiasis, and hydrocele, LF is responsible for a profound degree of suffering and disability worldwide. The World Health Organization (WHO) recommends annual mass drug administration (MDA) to eliminate the disease in areas where it is endemic. The success of LF-MDA programs depends upon achieving and sustaining high levels of adherence to the treatment regimen for the duration of the campaign and minimizing “systemic non-compliance.” To effectively interrupt transmission of the disease, the WHO recommends a minimum coverage of 65% sustained for 4-6 years. In its first round of MDA in 2011-2012, Haiti’s National Program to Eliminate LF (NPELF) successfully achieved a 79% coverage in urban Port-au-Prince. In 2013, coverage fell below the WHO threshold and has since continued to decline year-over-year.
The objective of this study was to identify potential contributing factors that may be responsible for the observed decline in MDA coverage in Port-au-Prince over the 2011-2017 period. A retrospective qualitative case study was conducted to identify key factors contributing to the observed declines in coverage. The study involved brief ‘on-the-street’ interviews with a convenience sample of the general public in Tabarre (a high-coverage commune) and Carrefour (a low-coverage commune).
Specific rationales for non-compliance to LF-MDA discussed by participants were similar to those described in previous studies. These included, among others: fear and avoidance of adverse events, lack of availability of food to take with medication at distribution sites, frustrations with the program’s directly-observed treatment policy, and a general perception that the program lacks public health credibility. Beyond these specific rationales, the absence of differences in practice by program staff between high- and low-coverage areas suggests that issues of non-compliance may be due to broader aspects of the program’s design.
Analysis of participant responses within the broader context of the program’s design and the biosocial factors that mediate the LF-MDA ‘experience’ suggests that the issue of “systematic non-compliance” by prospective MDA participants has been overemphasized in the literature, and among the program partners, obscuring systemic weaknesses of the program itself.
Table of Contents
CHAPTER I: INTRODUCTION 9
1.1 Background 9
1.2 Introduction to the HELP Study 11
1.3 Purpose 13
1.4 Significance 13
CHAPTER II: LITERATURE REVIEW 14
2.1 Lymphatic Filariasis 14
2.2 Clinical Manifestations 15
2.3 Detection, Treatment, and Prevention 16
2.4 LF in Haiti 17
2.5 Mass Drug Administration 18
2.6 GPELF 19
2.7 LFMDA – Factors Affecting Compliance and Coverage 20
2.8 A Brief History of LF-MDA in Haiti 22
2.9 Challenges of the Last Mile to Elimination 23
CHAPTER III: METHODS 24
CHAPTER IV: RESULTS 31
CHAPTER V: DISCUSSION 39
About this Master's Thesis
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