Exploratory study investigating factors influencing mass drug administration (MDA) compliance for lymphatic filariasis in Samoa

Successful elimination of lymphatic filariasis (LF) requires a multi-faceted approach. In Samoa, persistent transmission in residual areas, despite many years of mass drug administrations (MDAs), may be in part due to systematic MDA non-compliance of infected individuals. These indi-viduals could potentially remain as reservoirs of infection, thus impeding successful elimination of LF in Samoa. Data were available for five villages where epidemiological prevalence studies are cur-rently being conducted. Individuals testing posi-tive for LF and children aged 7 to 10 years were asked to participate in a small questionnaire de-signed to ascertain: 1) level of knowledge of LF, (2) compliance, and, (3) a small number of select risk factors. For the dataset from infected per-sons, there was a significant association between MDA compliance and knowledge of LF and, for the children, this association also extended to use of mosquito protection. Of those infected, 33% admitted to being systematically non-compliant. This exploratory study highlights the need for re-structuring current educational campaigns and their deliverance to appropriately target children and the systematically non-compliant infected indi-viduals. In order to improve compliance, focus needs to be on motivation by informing the indi-viduals of the benefits of MDA compliance versus the dire effects of disease. These findings are critical for the Samoan LF program and should help initiate updating current educational material to improve compliance. Without securing higher rates of compliance amongst those infected, suc-cessful elimination of LF in Samoa will be chal-lenging.