Ministry of Health and Medical Services, Dinem House, Suva, Republic of Fiji.
Epidemiology Consultant, London, United Kingdom.
PLoS One. 2020 Sep 18;15(9):e0238622. doi: 10.1371/journal.pone.0238622. eCollection 2020.
Assessing the quality of mass drug administration (MDA) rounds is a key component of lymphatic filariasis (LF) elimination programs. Routine collection of administrative coverage is unreliable, especially when pockets with low program coverage exist. To address this gap, we used lot quality assurance sampling (LQAS) following the 10th annual LF-MDA round in Fiji to explore whether there was any area in which target coverage was not reached. We also assessed the level of drug compliance and satisfaction with the LF-MDA implementation strategy.
METHODOLOGY/PRINCIPAL FINDINGS: We conducted a cross-sectional household survey in 3 divisions of Fiji. For LQAS, we defined 19 lots in 7 medical areas of the Suva sub-division and another 12 sub-divisions in the Central, Northern, and Eastern Divisions. A sample of 16 randomly selected household members was taken un each lot. We defined our decision rule as follows: if more than 1 person in a given lot did not swallow the medication, coverage was considered inadequate, i.e. less than 80%. Of the 7 lots in Suva sub-division and 12 lots in the 3 divisions, five and two lots, respectively, were identified as having inadequate coverage. The overall program coverage estimated from 304 samples was 92%, which was higher than the reported administrative coverage of 82%. About 98% of interviewees were offered the medication and 96% swallowed it. Non-participation arose from insufficient information on how to obtain the drugs. At least 92% were satisfied with the LF-MDA implementation strategy.
Areas of low program coverage with results discordant with the reported administrative coverage existed in both urban and rural settings. Drug compliance and satisfaction were high, even after repeated rounds. We recommend increasing efforts to deliver the service in those areas with inadequate program coverage, as well as conducting timely coverage assessment through LQAS for corrective action.
评估大规模药物治疗（MDA）轮次的质量是淋巴丝虫病（LF）消除规划的一个关键组成部分。常规收集行政覆盖数据不可靠，特别是在存在低规划覆盖率的地区。为了解决这一差距，我们在斐济第十次年度 LF-MDA 轮次后使用了批量质量保证抽样（LQAS），以探索是否存在任何未达到目标覆盖率的地区。我们还评估了药物合规性水平和对 LF-MDA 实施策略的满意度。
方法/主要发现：我们在斐济的 3 个地区进行了一项横断面家庭调查。对于 LQAS，我们在苏瓦分区的 7 个医疗区和中央、北部和东部分区的另外 12 个分区定义了 19 个批次。每个批次随机抽取 16 名随机选择的家庭成员作为样本。我们将决策规则定义为：如果给定批次中的 1 人以上未服用药物，则认为覆盖率不足，即低于 80%。在苏瓦分区的 7 个批次和 3 个分区的 12 个批次中，分别有 5 个和 2 个批次被确定为覆盖率不足。从 304 个样本中估计的总体方案覆盖率为 92%，高于报告的 82%行政覆盖率。约 98%的受访者获得了药物，96%的人服用了药物。不参与是由于缺乏获取药物的信息。至少 92%的人对 LF-MDA 实施策略表示满意。
在城乡地区都存在方案覆盖率低的地区，结果与报告的行政覆盖率不一致。即使在多次轮次后，药物合规性和满意度仍然很高。我们建议加大力度在方案覆盖率不足的地区提供服务，并通过 LQAS 进行及时的覆盖率评估以采取纠正措施。
