通过群体药物给药消除淋巴丝虫病：来自印度西孟加拉邦一个地区的近期经验。
Mass drug administration for elimination of lymphatic filariasis: Recent experiences from a district of West Bengal, India.
作者信息
Ghosh Santanu, Samanta Amrita, Kole Seshadri
机构信息
Department of Community Medicine, Bankura Sammilani Medical College and Hospital, West Bengal, India.
出版信息
Trop Parasitol. 2013 Jan;3(1):67-71. doi: 10.4103/2229-5070.113917.
BACKGROUND
Annual mass drug administration (MDA) with diethyl carbamazine (DEC) and Albendazole is the most cost-effective strategy to control lymphatic filariasis (LF).
MATERIALS AND METHODS
The aim of the present study was to assess the coverage and the compliance of MDA, to elicit factors that influenced compliance, to document side-effects reported and to assess the awareness of the community regarding the disease and MDA program in Bankura district, West Bengal after 2012 round of MDA. Multistage cluster sampling method was adopted. Total four clusters; three villages and one urban municipality ward were selected. In each cluster, minimum 30 families were randomly selected and the head or any responsible family member was interviewed using a pre-designed, pre-tested schedule after taking written informed consent. Data were compiled and analyzed using SPSS 19.0.
RESULTS
Total eligible population was 683 among which 98.8% received both the drugs. About 5% of the recipients took none of the drugs. More than two-thirds of the families took unsupervised dose. Drug compliance rate was significantly lower in urban (90.7%) than in the rural clusters (95.7%) (z = 2.46, P < 0.05). Effective coverage rate was significantly lower in urban than in the rural clusters (87.4% vs. 95.3%; z = 3.57, P < 0.01). Coverage compliance gap was higher in urban (5.7%) than in rural cluster (3.9%). Fear of side-effects was the main reason for non-compliance. Reported side-effects were few, mild, and transient. Around 60% of the surveyed families were aware about the MDA program whereas, 67% of them heard about LF. Only 41% families were provided information, education, and communication in last 15 days before MDA. Major sources of information for the surveyed families were leaflets (20.3%) and poster (9.8%).
CONCLUSIONS
Widespread rural urban variation in performance status, poor social mobilization activities, lack of supervised dosing, and lack of knowledge of the community about the disease and the program are the major areas of concern.
背景
每年使用乙胺嗪（DEC）和阿苯达唑进行群体服药（MDA）是控制淋巴丝虫病（LF）最具成本效益的策略。
材料与方法
本研究的目的是评估群体服药的覆盖率和依从性，找出影响依从性的因素，记录报告的副作用，并评估西孟加拉邦班库拉区在2012年一轮群体服药后社区对该疾病和群体服药项目的认知情况。采用多阶段整群抽样方法。共选取了四个整群；三个村庄和一个城市市政区病房。在每个整群中，随机选取至少30户家庭，在获得书面知情同意后，使用预先设计、预先测试的时间表对户主或任何负责的家庭成员进行访谈。使用SPSS 19.0对数据进行整理和分析。
结果
总符合条件人口为683人，其中98.8%的人接受了两种药物。约5%的接受者未服用任何一种药物。超过三分之二的家庭服用了无人监督的剂量。城市地区（90.7%）的药物依从率显著低于农村整群（95.7%）（z = 2.46，P < 0.05）。城市地区的有效覆盖率显著低于农村整群（87.4%对95.3%；z = 3.57，P < 0.01）。城市地区的覆盖依从差距（5.7%）高于农村整群（3.9%）。对副作用的恐惧是不依从的主要原因。报告的副作用很少，症状轻微且短暂。约60%的受访家庭了解群体服药项目，而67%的家庭听说过淋巴丝虫病。在群体服药前的最后15天内，只有41% 的家庭获得了信息、教育和宣传。受访家庭的主要信息来源是传单（20.3%）和海报（9.8%）。
结论
城乡在执行情况上存在广泛差异、社会动员活动不佳、缺乏监督给药以及社区对疾病和项目缺乏了解是主要关注领域。
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