Community compliance to interventions for lymphatic filariasis elimination morbidity management and disability prevention in Kibaha District, Tanzania

Abstract

Background: Lymphatic filariasis (LF) is a neglected tropical disease caused by the filarial worms in the genus Wuchereria bancrofti, Brugia malayi and B. timori. The adult worms cause damage to the lymphatic system and can lead to abnormal enlargement of body parts, causing temporary or permanent disability. The national program for the elimination of lymphatic filariasis in Tanzania has been ongoing since the year 2000, through annual mass drug administration (MDA) of Ivermectin (IVM) and Albendazole (ALB). Another supplement intervention againstLF is through mosquito control such as use of long-lasting insecticidal nets (LLINs) and to alleviate suffering and disability by introducing basic measures such as foot hygiene and hydrocelectomy. Whereas noncompliance to intervention programs has been recognized as one of the major factors that lead to persistence of transmission of LF there is paucity of information on the level of compliance in the endemic communities where persistence of transmission of lymphatic filariasis has been maintained. This study sought to assess the level of compliance with the identified interventions for LF elimination, morbidity management and disability prevention, vector controland the underlying reasons for community compliance and non-compliance to identified interventions. Objective: To assess the level of compliance to identified interventions for the elimination and morbidity management and disability prevention for lymphatic filariasis in Kibaha district Tanzania. Methodology: A cross-sectional study involving both quantitative and qualitative methods of data collection was carried out in two (2) study populations. The first study population included 395 standard one primary school children who never participated in MDA. These were tested for Circulating Filarial Antigen (CFA). The second population included 420 community members and people with hydrocele and elephantiasis aged 15 years and above who are eligible for participation in the MDA programs. The closed questionnaire interviews and Focus group discussions (FGDs) were used to assess compliance with interventions. The quantitative data was organized to obtain proportions and their 95% CI; the association between variable were measured by the Chi-square test, bivariateand multivariate logistic regression at a significance level of 0.05. The qualitative data were organized in themes by content analysis. Results Out of 395 school children tested for the presence of circulating filarial antigen (CFA); the prevalence of CFA was found to be 0.3% indicating active transmission of filariasis. There was no association between duration of residence, gender, and age of the children with being infected.Out of 420 community member interviewed; the majority (89.5%) were found to be aware of LF-MDA program.There were significant associations between gender of individual and duration of residence in the village with the level of awareness of LF-MDA program (AOR=2.5, 95% Cl= 1.4-5.0) and (AOR=2.9, 95% Cl= 1.4-5.8) respectively. Most of the participants (99.3%) were found to be aware of mosquito control interventions. However, there were significant associations between gender of the individual and age of individual with the level of awareness to mosquito interventions (χ 2=4.44;df=1 p=0.035) and (χ 2=12.668; p=0.015) respectively. Moreover, the majority were found to have participated in LF-MDA and regularly had usage of LLINS, 76%, and 78.3% respectively. Gender and duration of residence were found to be significantly associated with participation in LF-MDA (AOR=2.2, 95% Cl= 1.4-3.3) and (AOR=2.3, 95% Cl= 1.4-4.0) respectively. Most of the respondents were found to have heard about hydrocelectomy and/or foot hygiene practices. However, the majority reported to have never participated in the hydrocelectomy campaign while most of the respondents with lymphoedema practice foot hygiene interventions. Conclusion: Majority of individuals in the study area have shown that they participate or complywith possible LF interventions to disrupt transmission. However there are a few individuals who are non-compliant. Moreover, knowledge of disease and benefits of possible interventions were shown to be determinants of noncompliance to interventions. Recommendation: Health education on knowledge of the disease and benefits of possible interventions should be emphasized.