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Table 1 Characteristics of included studies

From: A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa

Author/Country/MDA for LF period Study type Sample characteristics/ Context (setting and areas where MDA for LF was implemented) Study objectives Study findings Outcomes
1. Kisoka et al., 2016 [44]/Tanzania/May and August 2011 Qualitative study Interviews with 21 CDDs, 11 community leaders, 6 religious leaders and 18 FGDs with community members representing adults and adolescents.
(Urban and Rural settings)
Morogoro and Lindi regions.
To gain insight into targeted community members’ perceptions and experiences of LF, the drugs distributed and the phenomenon of MDA, so as to indicate ways of improving the intervention and the interaction between populations and the intervention for future campaigns. Investment in appropriate dissemination of accurate and timely MDA for LF information is essential for guaranteeing community support for the programme. Successful MDA for LF implementation and community participation
2. Bogus et al., 2015 [33]/Liberia/June 2013 Cross sectional study Interviewed 140 community leaders from 32 villages. (Rural setting)
Lofa County, Kolahun District.
To assess community leaders’
knowledge and attitudes regarding resumption of MDA for NTDs after the Ebola virus disease epidemic (EVD).
Shift in national health systems priorities regarding funding, research and development due to EVD.
Temporally halt to all MDA for LF activities in EVD affected areas.
Fears in the community that EVD and MDA might be linked, hence affecting compliance/coverage
Programme sustainability, community participation and coverage
3. Kisoka et al., 2014 [21]/Tanzania/May and August 2011 Cross sectional household survey Data was collected from 3279 adults above 15 years of age.
(Urban and Rural settings) Lindi and Morogoro regions.
To assess, through household questionnaires, the associations between selected predictors and individual drug uptake shortly after the implementation of MDA in two rural and two urban Districts in Tanzania Drug uptake relied more on easily modifiable provider-related factors than on individual perceptions and practices in the target population.
Motivation of drug distributors to visit all households (repeatedly when residents are absent) are likely to have considerable potential for increasing drug uptake.
4. Madon et al., 2014 [45]/Tanzania/not stated Qualitative study 15 key informants
interviews with Voluntary health workers (VHWs), village leaders and health officials. 4 FGDs with VHWs. 4 FGDs with village health committee members.
(Rural setting)
Pwani region, Mukurunga district.
To relate the conceptualization of mobile telephony in the health sector to the NTD Control programmes in Tanzania Providing mobile phones to VHWs helped to increase the efficiency of their routine NTD work, boosting motivation and self-esteem. Community participation
5. Njomo et al., 2014 [25]/ Kenya/May 2011 and October 2012 Mixed methods Quantitative data collected from 947 household heads. Qualitative data; 12 FGDs with single sex adult and youth male and female groups. 3 FDGs with CDDs. 40 IDIs with opinion leaders and health personnel.
(Urban setting)
Malindi district.
To identify, design and test strategies that could be used to develop guidelines for achieving high treatment coverage in an urban setting and to identify possible pitfalls that could be a hindrance to achieving high treatment coverage in such urban settings. Activities identified to improve Urban MDA for LF coverage: adequate engagement of key health systems and community personnel, at all stages of the programme. Use of appropriate, innovative context specific strategies to create awareness in Urban settings. Employ appropriate drug distribution strategies. Coverage and programme sustainability
6. Offei et al., 2014 [38]/Ghana/ 2012 Cross sectional household survey Data collected from 384 household heads or any responsible adult above 18 years.
(Rural setting)
Ahanta-West District.
To explore the level of compliance to the LF programme by the people of Ahanta West District and also estimate coverage during the 2012 MDA programme year. Improved health education focusing on the safety of drugs and the importance of MDA needs to be undertaken before and during the drug distribution exercises to improve and sustain uptake. Coverage/compliance
7. Sodahlon et al., 2013 [39]/Togo/2000–2009 LF programme report National To describe the elements that proved successful in the national strategy to address LF in Togo. Identified various factors required for national LF programme success:
Sustained political commitment, integration with existing interventions, innovative resource mobilization in environment totally lacking resources and building of very strong partnerships (internal and external)
Successful implementation, programme sustainability and coverage
8. Dembele et al., 2012 [37]/Mali/2005–2011 Integrated NTD control programme report National To report on the progress made by the integrated national NTD control programme in Mali, drawing from objectives achieved, documented experiences and pertinent lessons learned of the program from 2007 to 2011, and focusing on only aspects of integrated MDA activities. For the long-term sustainability, NTD programmes require to be integrated into primary healthcare systems at local level.
Delays in drugs reaching the country resulted in MDA postponement, which not only increased the difficulty in the campaign but also minimized the impact of MDA.
Local collaborations with the African Programme for Onchocerciasis Control (APOC) and the Onchocerciasis Control Programme (OCP) was essential to sustaining the Mali NTD integration programme.
Achieved Improved national geographical coverage achieved for LF from 25% in 2006 to 100% in 2009.
Community participation, programme sustainability and coverage
9. Hodges et al., 2012 [23]/Sierra Leone/June 2010–2011 Programme evaluation 11,824 participants interviewed in the end process evaluation of hard to reach (HTR) sites.
(Urban and rural settings)
12 districts and 4 large towns from southern, eastern and northern provinces.
To identify the challenges to effective mass drug administration implementation for LF and the corrective measures taken. Challenges affecting MDA for implementation included: late country delivery of ivermectin, the availability and motivation of unpaid CHVs, remuneration for CHWs, rapid urbanization and employment seeking population migrations.
‘In process’ monitoring ensured modifications of LF MDA were made in a timely manner to ensure effective coverage was finally attained in HTR locations.
Community participation and Coverage
10. Njomo1 et al., 2012 [24]/Kenya/December 2008 Mixed- method study Quantitative data: 965 household heads or adult representatives. Qualitative data: IDIs with 80 LF patients, 80 opinion leaders and 15 CDDs. 16 FGDs with single sex-adults and youths, stratified in males and females
(Rural setting)
Kwale and Malindi districts.
To determine the role of personal opinions and experiences in compliance with MDA for LF. Drug distribution methods influence compliance to MDA for LF.
Lack of perceived benefits of MDA for LF and risk perception contribute to low compliance.
Side effects experiences contribute to low compliance
11. Njomo et al., 2012 [35]/Kenya/2008 Qualitative study 15 CDDs, 80 opinion leaders, 80 LF patients, 5 health personnel, 4 LF coordinators and the national programme managers were interviewed. 16 FGDs were conducted with single-sex adult and youth male and female groups.
(Rural and urban settings)
Kwale and Malindi districts.
To Identify factors associated with CDDs’ motivation and their influence on community compliance to MDA for LF treatment with a view of suggesting mitigating measures. Factors that influence CDDs’ motivation were: higher education level, trust and familiarity with community members, being trained on LF and an innate desire to help their communities. Community participation and Programme sustainability
12. Richards et al., 2011 [36]/Nigeria/not stated LF programme report Sample was not stated (Rural and Urban setting) Plateau and Nasarawa states. To report on our 12-year effort to eliminate LF in Plateau and Nasarawa states, which was the first LF elimination effort to be launched in Nigeria. MDA for LF treatment in urban areas cannot rely on community volunteers and traditional leadership structures.
In urban areas, rather than house to house, treatments were organized in central locations that served as distribution posts, commonly near a neighborhood church, mosque, health clinic or hospital
Community participation and coverage
13. Hodges el al, 2010 [22]/Sierra Leone/2010 Cross sectional study 9249 participants were interviewed
(Urban and rural setting).
To report the implementation strategy, social mobilization, the high coverage achieved in the urban western area and rural western area of Freetown, and the relative cost needed for each person treated during an MDA for LF. Key elements of success for social mobilization and implementation strategy (use of pretested IEC materials including FAQs, radio phone-ins, mobile texts, expert contact and government key stakeholder buy-in).
Describes the independent monitoring used to estimate final coverage in this urban/non-rural setting where the current population size is uncertain.
Suggests an implementation strategy and independent monitoring tool that could be useful in similar, rapidly growing cities implementing lymphatic filariasis elimination programmes
Community participation, coverage and programme sustainability
14. Malecela et al., 2009 [43]/ Tanzania/ 2000–2009 LF elimination programme report National To report on the progress made by the Tanzania LF elimination programme. Establishment of morbidity management programme helped to alleviate patient suffering, reduce social stigma and community support for MDA for LF. Community participation and programme sustainability
15. Mohammed et al., 2006 [40]/Tanzania (Zanzibar)/2001–2006 LF elimination programme report National To highlight the progress of a national LF programme and identify the components required to ensure success through the phases of conception, resource mobilization, Implementation and monitoring. Components to ensure success of MDA for LF: Mobilize interest from non-governmental development organizations (partnership approaches).
Identify the need for morbidity control implementation programme (Including policy on hydrocele surgery).
Establish system for monitoring adverse events.
Successful implementation, programme sustainability and community participation
16. Wamae et al., 2006 [41]/ Kenya/Not stated Mixed methods study 360 households were sampled, with 720 persons interviewed. 65 semi-structured interviews with CDDs, health workers and key informants; and 14 FGDs.
(Rural setting)
Kilifi and Malindi
To compare the effectiveness of a drug delivery strategy based on mass-treatment by the regular health service with that of community-directed with health system involvement at the implementation stage only. Community directed treatment + health services arm of the study achieved higher MDA for LF treatment coverage of 88%, compared to the health systems arm which recorded 46.5%. Coverage, community participation and Programme sustainability
17. Hopkins et al., 2002 [42]/Nigeria/March 2000 Integrated NTD control programme report (pilot)- Sample was not stated
(Rural setting)
Plateau and Nasarawa states.
To report on a collaborative effort by the Ministries of Health of Plateau and Nasarawa States, the Federal Ministry of Health and The Carter Center to incorporate health education and Treatment for LF elimination and SH control into ongoing Onchocerciasis activities. Knowledge Attitudes and Practices (KAP) Survey, a foundation for preparing Health education materials.
Integration of LF and SH initiatives within the established onchocerciasis programmes strengthened the latter’s sustainability by capitalizing on cost savings and broadening the program benefits and popularity.
Community participation programme sustainability
18. Gyapong et al., 2001 [34]/Ghana/Not stated Mixed method study 810 households were interviewed for the quantitative data.
Qualitative sample size not clearly stated.
(Rural setting)
Builsa, Kassena and Nankana Districts.
To Compare the effectiveness of a delivery strategy based on mass-treatment by the regular health-care system with that of a system of community directed treatment only involving the health services at the level of implementation Health staff and the target communities appreciated the community directed treatment + health services (ComDT/HS) approach more than the health services (HST) stand-alone approach, and were more willing to participate in the community-directed scheme.
Method used to distribute the drugs had a marked effect on coverage.
The treatment coverage achieved by ComDT/HS (74.5%) was much higher than that of HST (43.5%)
The ComDT/HS approach was recommended, especially for areas where access to health facilities is poor and the health workers are over-stretched
Community participation, programmes sustainability and coverage.