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Coverage Evaluation and Compliance of Mass Drug Administration Campaign in Nanded District of Maharashtra

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Coverage Evaluation and Compliance of Mass Drug Administration Campaign in Nanded District of Maharashtra ORIGINAL ARTICLE pISSN 0976 3325│eISSN 2229 6816 Open Access Article www.njcmindia.org Coverage Evaluation and Compliance of Mass Drug Administration Campaign in Nanded District of Maharashtra Nazia Aram M Khan1, Prakash L Gattani2, Ismail A Inamdar3, Vijay K Domple4, Madhukar B Nina5 Financial Support: None declared ABSTRACT Conflict of Interest: None declared Copy Right: The Journal retains the copyrights of this article. However, re- Background: Lymphatic filariasis (LF) is endemic in 83 countries production of this article in the part or and territories. In view with the global elimination, mass drug total in any form is permissible with administration (MDA) with single dose of diethyl carbamazine due acknowledgement of the source. and albendazole tablets was carried out for the eligible population in Nanded district. The study was conducted to assess coverage, How to cite this article: compliance and reasons for noncompliance to MDA in Nanded Khan NAM, Gattani PL, Inamdar IA, district. Domple VK, Nina MB. Coverage Evaluation and Compliance of Mass Method: A community-based cross-sectional study was done by Drug Administration Campaign in house-to-house visit in Nanded district. Three rural and one urban Nanded District of Maharashtra. Natl J clusters of Nanded district, Maharashtra, were selected. A predes- Community Med 2017; 8(11):684-687. igned questionnaire was used to collect information. Drug cover- age, compliance, effective coverage, coverage–compliance gap Author’s Affiliation: 1Assist Professor; 2Prof and Head; (CCG), reasons for noncompliance were studied. Statistical analy- 3Asso Prof, Dept of Community Medi- sis was done by SPSS version 16. cine, Dr. Shankarrao Chavan Govern- Results: The total numbers of houses surveyed were 120. Cover- ment Medical College, Nanded; 4Asso age rate was 94.40%, and compliance rate, CCG, effective coverage Prof, Dept of Community Medicine, Govt Medical College, Yeotmal; 5Post rate was 51.81%, 8.48%, and 48.91%, respectively. The compliance graduate student, Dept of Community of drugs by eligible population was slightly higher in urban area Medicine, Dr. Shankarrao Chavan Govt (95.41%) than the rural area (90.56%). Major reasons for non con- Medical College, Nanded sumption of drug were empty stomach during Drug distributor (DD) visit. Correspondence Dr. Ismail A Inamdar Conclusion: The drug compliance need to be improved. Issues like [email protected] fear of side effects should be addressed through effective behavior change communication strategies. Date of Submission: 24-10-17 Date of Acceptance: 23-11-17 Key words: Mass drug administration, Lymphatic filariasis, cover- Date of Publication: 30-11-17 age, compliance INTRODUCTION fection.4 In India, Culex quinquefasciatus is the main vector transmitting about 99.4% of filariasis infec- One of the major public health and socioeconomic tions due to Wuchereria Bancrofti .5 The annual mass problem came across by many developing coun- drug administration (MDA) program to eliminate tries in the world is Lymphatic filariasis (LF).1 It is lymphatic filariasis (PLEF) was implemented in endemic in 83 countries. More than a billion people India, in 11 endemic districts in 1997. By 2007 the are at risk of infection. Nearly 120 million people program has been started in all 250 known en- are affected worldwide of whom about 40 million demic districts providing protection to 600 million with overt disease are in need of treatment. It is people making it the largest national public health one of the world′s leading causes of permanent intervention.6,7 There have been 9–11 rounds of and long-term disability with an estimated 5.1 mil- MDA in all LF endemic districts. There has been lion disability adjusted life years (DALYs) are lost decrease of overall microfilaria rate from 1.24% in due to this disease. 2,3 2004 to 0.44% in 2014 showing the great achieve- About 40% of the global filariasis burden is in In- ment of the programme Elimination of lymphatic dia. 50% of the world’s population is at risk of in- Filariasis.8 National Journal of Community Medicine│Volume 8│Issue 11│Nov 2017 Page 684 Open Access Journal │www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816 Nowadays there is a strategy to administer a once- ily member who had knowledge about family were yearly, single-dose, two-drug regimen (Albenda- interviewed. For instance, if the house was locked zole with Diethylcarbamazine (DEC)) to interrupt then the adjacent house was selected. So, a total of transmission of LF in communities .9 65% epidemi- 120 houses were surveyed from the four clusters. ological drug coverage is the goal to be achieved Statistical analysis: The data obtained was entered for 4–6 years.10 The objective of MDA is to reduce in excel sheet and analyzed using Statistical Pack- the level of microfilaraemia in infected individuals age for the Social Sciences (SPSS), version 16. so that transmission cannot be sustained, even af- ter MDA has been stopped.11,12 The working definitions adopted for drug cover- age and drug compliance as per NVBDCP guide- lines are as follows:11 MATERIAL AND METHODS Drug coverage: It is the number of eligible persons This is cross-sectional observational study. A semi- who received DEC during MDA campaign. It is structured questionnaire designed by the Depart- calculated as the total number of persons who re- ment of Health, Government of Maharashtra was ceived drug divided by eligible population and is used as the study tool. Interview was undertaken expressed as percentage. in April 2017 by a team of faculty members of the Drug compliance: It is the number of persons who Department of Community Medicine of Dr. ingested DEC in presence of a DD during MDA Shankarrao Chavan Government Medical College campaign. It is calculated as the total number of Nanded. As provided in the government protocol persons who ingested drug divided by total num- the study was conducted in 4 clusters of 30 families ber of persons who received the drug and is ex- each in the district of Nanded. pressed as percentage. Since 90% of the population of the district reside in Coverage–Compliance Gap (CCG): It refers to the the rural area having high MDA coverage the rural people who got the drug but did not consume due blocks were stratified into high (>95%), medium to various reasons. It is calculated as the total (85-95%) and low (<85%) reported coverage cate- number of persons who did not consumed the gories. Then multistage sampling design was drug divided by the eligible population of the area adopted. Taluqas with highest, Medium and low- and is expressed in percentage. est coverage selected were Kandhar, Loha and Mudkhed respectively. From these taluqas each Effective coverage rate: It is the end product of PHC was selected in second stage. From Kandhar coverage by the health system and compliance by taluqa PHC with highest coverage Panshevadi was community. The percentage for effective coverage selected, Sonkhed PHC from Loha taluqa with in- was calculated after taking total number of people termediate coverage was selected and Mugat PHC who were eligible for receiving DEC tablets as de- with lowest coverage from Mudkhed taluqa was nominator (Effective coverage = No. of people who selected. In the third stage from each PHC one had ingested sufficient dose of DEC tablets in pres- subcentre and from that subcentre one village was ence of DD/Total people eligible for receiving the selected. Then Bahadarpur sub-centre and finally DEC tablets × 100). Bahadarpur village was picked up form Pan- shevadi . Similarly Sonkhhed village was picked up form Sonkhed subcentre and Sonkhed PHC. RESULTS Patharmala village was selected from Mugat sub- Nanded district was selected as the study area. centre and Mugat PHC. From the urban area out of This district is one of the 14 endemic districts of two areas of Cidco and Taroda, cidco area was se- Maharashtra. As per the 2011 census, the total lected by lottery method . Out of the total four population of the district was 33,61,292 out of ward from Cidco, one ward was selected by lottery which 24,47,394 was rural population and 9,13,898 method . From that ward, 30 houses were selected is urban. Four clusters, including one from urban randomly. The eligible population did not include and three from rural areas, were studied. pregnant and lactating women, children below two years of age and seriously ill persons. Informed A total 120 households (90 rural and 30 urban) consent in form of oral consent was obtained from were surveyed, yielding a population of 578. Of the participants Each of these four clusters was 578 individuals, 554 were found to be eligible for surveyed. Standing at the centre of the cluster the drug administration (95.84%). paths were numbered. Two paths were selected Compliance rate, CCG, and effective coverage rate randomly for house to house visit by two survey- are shown in Table 2. Of 554 eligible persons, 523 ors. Then the first house was chosen randomly received DEC by a DD. Overall coverage rate of (Government of India, 1990). All the 30 houses study population was found to be 94.40%. were covered. Head of the family or any other fam- National Journal of Community Medicine│Volume 8│Issue 11│Nov 2017 Page 685 Open Access Journal │www.njcmindia.org pISSN 0976 3325│eISSN 2229 6816 Table 1: Distribution of surveyed population not found to be significantly different in urban ar- eas and the rural areas. Name of area Total Population Eligible Population surveyed population Of 554, 523 (94.40%) persons received the drug. Of Patharmala 1304 146 140 them 507 (91.51%) consumed the drug. The re- Bahadarpur 4264 151 149 maining (n = 47), although eligible, did not con- Sonkhed 5995 167 156 sumed the drug for various reasons as shown in Cidco 5624 114 109 Total 17187 578 554 Table 4.
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