Predictors of compliance in mass drug administration for the treatment and prevention of Lymphatic Filariasis in Marach District, Uganda

Abstract

Preventive chemotherapy using Mass Drug Administration (MDA) is the current global control strategy for eliminating Lymphatic Filariasis (LF) that is recommended by the World Health Organization (WHO). To interrupt LF transmission in LF endemic areas, WHO recommends an epidemiological coverage of at least more than 65 percent in 5 MDA rounds. MDA non-compliance is a public health issue that undermines MDA's effort to interrupt LF transmission and hence eliminate LF from being a public health burden in Uganda. Understanding factors affecting MDA compliance is imperative to improve future MDA implementation outcomes. This study set out to examine the factors associated with LF MDA compliance in the Maracha district. A cross-sectional survey using the cluster sampling method was conducted in 2018 four months after MDA implementation in the Maracha district among 1,112 respondents using a structured face-to-face survey questionnaire. A multiple logistic regression model was used to identify factors explaining MDA drug compliance. The study showed that there was a discrepancy between the MDA program coverage reported at the district level and coverage validated. In addition, the study showed the likelihood of being MDA non-compliant was significantly increased for persons who did not have knowledge about LF control and MDA programs, as well as persons who did not practice good primary health care. In addition, it showed that the older a person got the less likely they were to comply with MDA. Therefore, person’s knowledge about LF control and MDA programs, good primary health care practice were good predictors of MDA compliance. In contrary, person’s level of education, sex, occupation, and religion were not significantly associated with MDA compliance. The LF program should design MDA sensitization programs to target age groups and females at risk for noncompliance before, during and after MDA. The LF program should review its IEC material to ensure that the disease risk factors are addressed in the IEC material to increase LF knowledge among the community members living in LF endemic communities.