Lymphatic filariasis elimination status: Wuchereria bancrofti infections in human populations and factors contributing to continued transmission after seven rounds of mass drug administration in Masasi District, Tanzania

Individual longitudinal compliance to neglected tropical disease mass drug administration programmes, a systematic review

Repeated distribution of preventative chemotherapy (PC) by mass drug administration forms the mainstay of transmission control for five of the 20 recognised neglected tropical diseases (NTDs); soil-transmitted helminths, schistosomiasis, lymphatic filariasis, onchocerciasis and trachoma. The efficiency of such programmes is reliant upon participants swallowing the offered treatment consistently at each round. This is measured by compliance, defined as the proportion of eligible participants swallowing treatment. Individually linked longitudinal compliance data is important for assessing the potential impact of MDA-based control programmes, yet this accurate monitoring is rarely implemented in those for NTDs. Longitudinal compliance data reported by control programmes globally for the five (PC)-NTDs since 2016 is examined, focusing on key associations of compliance with age and gender. PubMed and Web of Science was searched in January 2022 for articles written in English and Spanish, and the subsequent extraction adhered to PRISMA guidelines. Study title screening was aided by Rayyan, a machine learning software package. Studies were considered for inclusion if primary compliance data was recorded for more than one time point, in a population larger than 100 participants. All data analysis was conducted in R. A total of 89 studies were identified containing compliance data, 57 were longitudinal studies, of which 25 reported individually linked data reported by varying methods. The association of increasing age with the degree of systematic treatment was commonly reported. The review is limited by the paucity of data published on this topic. The varying and overlapping terminologies used to describe coverage (receiving treatment) and compliance (swallowing treatment) is reviewed. Consequently, it is recommended that WHO considers clearly defining the terms for coverage, compliance, and longitudinal compliance which are currently contradictory across their NTD treatment guidelines. This review is registered with PROSPERO (number: CRD42022301991).

Risk Factors of Noncompliance to Preventive Mass Drug Administration for Eliminating Lymphatic Filariasis: A Case-Control Study in Jawi District, Northwest Ethiopia

Background. High compliance is crucial for the success of a mass drug administration program to achieve lymphatic filariasis elimination. However, the presence of persistently noncompliant individuals might delay the elimination target. Besides, although context-based research is essential to designing effective strategies, only a few studies have focused on identifying factors that play a role in noncompliance with mass drug administration in Africa. Therefore, this study was conducted to identify the factors associated with noncompliance to prevent mass drug administration using ivermectin-with-albendazole for the elimination of lymphatic filariasis in Northwest Ethiopia. Methods. A case-control study was conducted in Jawi District, Northwest Ethiopia. All individuals who are permanently living in the study area and registered on the annual chemotherapy registration book since 2015 were included in this study. A two-proportion formula was used to estimate the required sample size and 348 cases and 348 controls were selected by identification number on the village chemotherapy registration book using a systematic sampling technique. Data were collected by face-to-face interviews using a structured questionnaire developed through an intensive literature review. Then, data were entered and cleaned by using the EPI DATA software, and analyses were conducted using SPSS version 26. Finally, a logistic regression analysis technique was applied to identify the risk factors using adjusted odds ratio as measures of effect. Results. A total of 690 (99.1%) participants, 345 cases and 345 controls, were included in the study. Younger age (AOR = 1.60; 95%CI: 1.10, 2.33), female sex (AOR = 1.56; 95%CI: 1.24, 3.93), thought of not being susceptible to the disease (AOR = 2.36, 95%CI: 1.80, 4.32), lack of disease knowledge (AOR = 1.88; 95% CI: 1.38, 3.81), fear of drug side effect (AOR = 2.45; 95% CI:1.23, 4.86), and not participating in community drug distributors selection (AOR = 2.58; 95% CI: 1.70, 3.91) were found to be the risk factors significantly associated with noncompliance. Conclusion. Noncompliance with lymphatic filariasis mass drug administration therapy was associated with specific demographic, individual, program, and drug delivery characteristics. This finding has important implications for program effectiveness and would be used to accelerate the elimination of lymphatic filariasis in the study area and other endemic settings.