Volume I - Issue 1 Academic Medical Journal of India 23 Evaluation of Coverage and Compliance to Mass Drug Administration (MDA) for Lymphatic Filariasis Elimination – A Qualitative Study Zinia T Nujum, a Remadevi S, a,b Regi Jose, g Nirmala C, a Rajmohanan K, d,e Indu PS, a S Muraleedharan Nair, d,f a. Department of Community Medicine, Medical College, Thiruvananthapuram; b. International Clinical Epidemiology Network (INCLEN); c. Department of Obstetrics and Gynecology, Medical College, Thiruvananthapuram; d. Clinical Epidemiology Resource & Training Centre, Medical College, Thiruvananthapuram; e. Department of Pediatrics, Medical College, Thiruvananthapuram; f. Department of Biostatistics (Retired), Medical College, Thiruvananthapuram; g. Department of Community Medicine, Sree Gokulam Medical College & Research Foundation, Thiruvananthapuram* Corresponding Author: Zinia T Nujum, TC IX /1044(1) Thekkadathu, Kallampally, Sreeparyam.P.O, Thiruvananthapuram, Kerala, India, Email: drzinia@gmail.com, Phone: 0471-2555333 / 9037356908 Abstract Introduction: Mass Drug Administration (MDA) programme for the elimination Lymphatic Filariasis (LF) has been implemented globally since 1997. Even after 15 years of implementation, the programme has not achieved the coverage required to eliminate the disease in the stipulated period of time. he purpose of this study was to evaluate the coverage and compliance to MDA as perceived by the stakeholders and to ind the reasons for noncompliance from a provider as well as client perspective. Qualitative methods like In-depth Interviews and Focus Group Discussions were used to conduct the study. None of the providers had perceived coverage of less than 70% or compliance of less than 30%. Non-realisation of the need for the programme and low drug-provider acceptability were major reasons Published on 9th November, 2013 www.medicaljournal.in November 2013 Cite this article as: Nujum ZT, S R, Jose R, C N, K R, P.s I, et al. Evaluation of Coverage and Compliance to Mass Drug Administration (MDA) for Lymphatic Filariasis Elimination – A Qualitative Study. Academic Medical Journal of India [Internet]. 2013 Nov 9;1(1). Available from: http://medicaljournal.in/ evaluation-coverage-compliance-mass-drug-administration-mda-lymphatic-ilariasis/ for noncompliance as perceived by the oicials and supervisors; whereas fear of side efects was the most common reason perceived by drug providers. From the client perspective, the presence of other morbidities was the most common reason for non-compliance. he false perception of high coverage by programme managers and other oicials can be a stumbling block towards improving programme efectiveness. Innovative strategies were suggested by some of the stakeholders to improve coverage and compliance. Keywords: Process Evaluation, Mass Drug Administration, MDA, Filariasis, Qualitative methods, In-depth interviews, Focus group discussion, Coverage Evaluation Introduction F ifty percentage of the world population at risk of Lymphatic Filariasis infection lives in India. he country alone contributes 40% of the global ilariasis disease load. 1 he total disability adjusted life years (DALY) lost in India due to this disease are around 2.06 million, resulting in an annual wage loss of USD 811 million. 2 In the state of Kerala in southern India, about 6 million people are at risk of the infection. he entire coastal area is endemic to the disease and there are several inland pockets of ilariasis in Kerala. 3 he strategies for global elimination of Lymphatic Filariasis (LF) has been well documented 4 and extensively reviewed. 5 Mass drug administration (MDA) is being implemented in India and Kerala since 1997. Transmission of Filariasis can be interrupted through MDA only if high coverage (85%) of drug administration is maintained for a period of 4 -6 years. Current approaches to drug delivery do not achieve this target. 6 Almost all published studies done to assess coverage of MDA have used the quantitative approach. A qualitative approach provides an excellent opportunity to tap in to the meanings and interpretations given by people to explain their behaviour. his study has been done using qualitative methods, as part of a process evaluation to get an insight into the provider perspective of coverage and compliance to MDA. It aims to explore the reasons for noncompliance from diferent stakeholder points of view in order to provide positive directions towards policy change for improving coverage and compliance. Methods his study was part of a larger study which also included a cross sectional study to evaluate coverage and compliance. 7 Study Design: Descriptive Qualitative methods like In-Depth Interviews (IDI) and Focus Group Discussions (FGD) were used to collect information from key stakeholders. IDI was the predominant method used. FGD was used to supplement the information obtained from IDI, for data triangulation and to ensure that the entire range of information was captured. Setting: Community setting of hiruvananthapuram district of Kerala, India. Study Population: Study population included the stakeholders in the programme from various categories namely ORIGINAL RESEARCH *See End Note for complete author details