Ramaiah K D, Vijay Kumar K N, Hosein E, Krishnamoorthy P, Augustin D J, Snehalatha K S, Nanda B, Das P K
Vector Control Research Centre (Indian Council of Medical Research), Medical Complex, Indira Nagar, Pondicherry-605 006, India.
Ann Trop Med Parasitol. 2006 Jun;100(4):345-61. doi: 10.1179/136485906X105598.
In the mass drug administrations (MDA) that form the principal strategy of the Global Programme to Eliminate Lymphatic Filariasis, treatment coverages of at least 65%-80% will be needed if the programme is to be successful. In the Indian state of Tamil Nadu, where treatment coverages were typically <65%, a comprehensive strategy of advocacy and communication, called the "communication for behavioural impact" (COMBI) campaign, has been developed and implemented, in an attempt to improve treatment coverage. This strategy combined advocacy, aimed at state-, district- and village-level administrations, with communication activities targeted at individual communities. The main aim was to alter the behaviour of many of those included in the rounds of MDA, so that they would be more likely to accept and consume the diethylcarbamazine tablets offered to them. The COMBI campaign had two variants, COMBI(+) and the more intensive COMBI(+ +), each of which has been implemented in six districts. Both the variants included the "personal selling" of treatment, via door-to-door visiting by a total of 113,500 filaria-prevention assistants. These assistants were able to visit 34%-49% of the households in each target community. In the COMBI(+ +) districts, up to 44% and 38% of households received information on lymphatic filariasis and its elimination via television commercials and posters, respectively. Overall, 78% of the villages in the COMBI(+ +) districts and 33% of those in the COMBI(+) districts were considered to have had good exposure to the communication campaign. At the end of this campaign about 30% more people (than pre-campaign) believed that lymphatic filariasis could be eliminated and many of those targeted considered lymphatic filariasis to be a dreadful disease, knew that a particular day had been designated "Filaria Day", and thought that the tablets offered in MDA should be consumed to prevent or eliminate the disease. Apparently as the result of the COMBI campaign, drug consumption increased, from 33% of those living in endemic communities, to 37% in the COMBI(+) districts and to 49% in the COMBI(+ +). Coverages as high as 65%-73% were recorded among those who had had the maximum exposure to the communication campaign. These results indicate that the COMBI campaign favourably changed the perception and behaviour of the people towards the elimination of lymphatic filariasis. The costs of the COMBI(+) and COMBI(+ +) strategies were only U.S.$0.002 and U.S.$0.009 per capita, respectively.
在构成全球消除淋巴丝虫病计划主要策略的群体服药活动（MDA）中，若该计划要取得成功，至少需要65% - 80%的治疗覆盖率。在印度泰米尔纳德邦，其治疗覆盖率通常低于65%，于是制定并实施了一项名为“行为影响沟通”（COMBI）运动的全面宣传和沟通策略，以提高治疗覆盖率。该策略将针对邦、区和村级行政机构的宣传与针对各个社区的沟通活动相结合。主要目的是改变参与多轮群体服药活动的许多人的行为，使他们更有可能接受并服用提供给他们的乙胺嗪片。COMBI运动有两个变体，即COMBI(+)和更强化的COMBI(++)，每个变体都在六个区实施。两个变体都包括通过总共113,500名丝虫病预防助手挨家挨户走访来“个人推销”治疗。这些助手能够走访每个目标社区34% - 49%的家庭。在COMBI(++)区，分别有高达44%和38%的家庭通过电视广告和海报获得了关于淋巴丝虫病及其消除的信息。总体而言，COMBI(++)区78%的村庄和COMBI(+)区33%的村庄被认为对宣传活动有良好的接触。在这项活动结束时，相信淋巴丝虫病可以消除的人比活动前增加了约30%，许多目标人群认为淋巴丝虫病是一种可怕的疾病，知道有一个特定的日子被指定为“丝虫病日”，并且认为在群体服药活动中提供的药片应该服用以预防或消除这种疾病。显然，由于COMBI运动，药物服用率有所提高，从生活在流行社区的人群中的33%，提高到COMBI(+)区的37%和COMBI(++)区的49%。在对宣传活动接触最多的人群中，记录到的覆盖率高达65% - 73%。这些结果表明，COMBI运动有利地改变了人们对消除淋巴丝虫病的认知和行为。COMBI(+)和COMBI(++)策略的成本分别仅为人均0.002美元和0.009美元。
