Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya.
PLoS Negl Trop Dis. 2020 Sep 16;14(9):e0008499. doi: 10.1371/journal.pntd.0008499. eCollection 2020 Sep.
Since the prioritization of Lymphatic Filariasis (LF) elimination in 1997, progress has been made in reducing disease transmission and burden. Validation of elimination through Transmission Assessment Surveys (TAS) in implementation units (IUs) that have received at least 5 rounds of mass drug administration (MDA) and achieved minimum threshold of 65% treatment coverage is required. There are IUs that do not qualify for TAS due to achievement of low treatment coverage. This study sought to identify barriers of community participation and access to MDA, develop and test strategies to be recommended for improved uptake. Two wards in Kaloleni sub-county, Kilifi county with an average treatment coverage of 56% in 2015, 50.5% in 2016 were purposively sampled and a quasi-experimental study conducted. Through systematic random sampling, 350 (pre-intervention) and 338 (post-intervention) household heads were selected and interviewed for quantitative data. For qualitative data, 16 Focus Group Discussions (FGDs) with purposively selected community groups were conducted. Participatory meetings were held with county stakeholders to agree on strategies for improved community participation in MDA. The quantitative data were analyzed using STATA version 14.1, statistical significance assessed by chi square test and qualitative data by QSR NVIVO version 10. The identified strategies were tested in experimental sites during the 2018 MDA and the usual MDA strategies applied in control sites. The results showed an increase in community participation and access to MDA in both sites 80.6% (pre-intervention), 82.9% (post-intervention). The proportion of participants who considered the treatment as necessary significantly (p = 0.001) increased to 96.2% from 88.3% and significantly dropped for those with drug swallowing problems associated with: size (p<0.001), number (p<0.027) and taste (p = 0.001). The implemented strategies may have contributed to increased participation and access to MDA and should be applied for improved treatment uptake. Health education on disease aetiology and importance of drug uptake in all rounds is key to program's success.
自 1997 年将淋巴丝虫病（LF）的消除作为优先事项以来，在减少疾病传播和负担方面取得了进展。在接受至少 5 轮大规模药物治疗（MDA）并达到至少 65%的治疗覆盖率最低阈值的实施单位（IU）中，需要通过传播评估调查（TAS）进行消除验证。由于治疗覆盖率低，有些 IU 不符合 TAS 的条件。本研究旨在确定社区参与和获得 MDA 的障碍，制定和测试策略，以提高吸收率。基利菲县卡洛莱尼分区的两个区，2015 年的平均治疗覆盖率为 56%，2016 年为 50.5%，进行了有针对性的抽样和准实验研究。通过系统随机抽样，选择了 350 名（干预前）和 338 名（干预后）户主进行定量数据访谈。对于定性数据，对有针对性选择的社区群体进行了 16 次焦点小组讨论（FGD）。与县利益攸关方举行参与式会议，就改善 MDA 社区参与的战略达成一致。使用 STATA 版本 14.1 分析定量数据，使用 QSR NVIVO 版本 10 分析定性数据。在 2018 年 MDA 期间，在实验点测试了确定的战略，并在对照点应用了通常的 MDA 战略。结果显示，两个地点的社区参与度和 MDA 可及性均有所提高，分别为 80.6%（干预前）和 82.9%（干预后）。认为治疗是必要的参与者比例显著增加（p = 0.001），从 88.3%增加到 96.2%，而那些认为药物吞咽有问题的参与者比例显著下降，与药物大小（p<0.001）、数量（p<0.027）和味道（p = 0.001）有关。实施的战略可能有助于提高 MDA 的参与度和可及性，应加以应用以提高治疗吸收率。在所有轮次中开展关于疾病病因和药物摄入重要性的健康教育是计划成功的关键。
