A Quantitative and Qualitative Evaluation of Mass Drug Administration (MDA) program in three districts of Madhya Pradesh (India)

Introduction: Lymphatic filariasis (LF) is the world's second le ading cause of long-term disability. According to the World Health Organization, India, Indonesia, Ni geria and Bangladesh alone contribute about 70% of the infection worldwide. Mass drug administration of on e annual dose of diethylcarbamazine citrate and alb endazole is currently advocated by WHO for control of lymphatic filariasis. The state of Madhya Pradesh (MP), Indi a adopted MDA for elimination of LF in 2004. The aim of this study was to assess the effective coverage of MDA and to determine the causes of coverage compliance gap. Methodology: It was a cross-sectional survey in which both quantitative and qualitative data was collected fro m the study clusters by house-to-house surveys. Mul tistage random sampling method was used to select the clust ers. 30 household were covered in each cluster, cov ering 4 clusters per district; so in each district 120 hous eholds were surveyed. Results: The present study was conducted in three filariasis endemic districts of Madhya Prades h. The study covered a target population of 1863 fr om twelve clusters of which 94.09% (1753) were eligible for d rug consumption. The overall drug distribution rate (coverage) was 84.59% and the coverage compliance gap was 16.82%. Overall drug ingestion compliance was 80.10%. The overall effective coverage was 67.77% ( Z Score=3.6338, p=0.00014 ). The drug distribution rate (coverage) was much better in urban areas (92.55%) as compared to rural areas (82.45%) and therefore the effective co verage was much better in urban areas (75.53%) as against 65.6 5% in the rural areas. The most important reason of non- compliance was lack of awareness about the disease (47.45%). Understaffing was also reported in all th e districts and impact assessment data was not collected in any of the three districts. Conclusion: There is need of intensive health education campaigns to increase the level of scientific information about the disease. The cove rage activities should be prioritized equally with Behavior Change Communication (BCC) activities. The timings of drug distribution should be properly thought out.