Factors determining noncompliance to mass drug administration for lymphatic filariasis elimination

Mass Drug Administration (MDA) for Lymphatic Filariasis (LF) elimination has been implemented worldwide and in India with a goal of eliminating the disease by 2020 and 2015 respectively. Compliance to MDA is less than adequate to achieve the goal in the desired time. This study aims to identify the factors related to awareness, acceptability and attitude and the role of certain theoretical constructs of health belief model in determining the compliant behavior to MDA. Within a cross-sectional study done in Thiruvananthapuram district of Kerala, India, undertaken to determine coverage, a comparison was done between compliant and noncompliant individuals. 300 households were selected using cluster sampling technique, for estimation of coverage of MDA. From these households, 99 noncompliant and 70 compliant individuals were selected as cases and controls. The independent factors determining noncompliance were client attitude of not perceiving the need with an adjusted odds ratio (OR) of 2.52 (1.29-4.92), an unfavorable provider attitude with an adjusted OR of 2.14 (1.05-4.35) and low drug administrator acceptability with an adjusted OR of 2.01 (1.01-3.99). In MDA, the person giving the drug to the beneficiary is the most important person, whose attitude and acceptability determines compliance. More rigorous selection and training for capacity building of drug administrators are essential to enhance the compliance level. Alternate drug delivery strategies, besides house to house campaign by voluntary drug administers also needs to be implemented.