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Lymphatic filariasis: education leads to big increases in numbers who comply with treatment

19 Jul 2010

Paul Chinnock

Source: PLoS Neglected Tropical Diseases (see original article or PDF)

Citation: Cantey PT, Rout J, Rao G, Williamson J, Fox LM (2010). Increasing Compliance with Mass Drug Administration Programs for Lymphatic Filariasis in India through Education and Lymphedema Management Programs. PLoS Negl Trop Dis 4(6): e728.

Many people who are at risk of a serious parasitic infection do not participate in the annual drug treatment programmes used to control it. An educational campaign has been shown to increase compliance rates.

Nearly 1.3 billion people worldwide are at risk of infection with the parasite that causes lymphatic filariasis (LF). Around 45% live in one country – India. Infected individuals may develop long-term complications, such as grossly swollen limbs from lymphoedema. Elimination of LF requires mass drug administration (MDA) to 80% or more of those at risk, on an annual basis for five or more years. Those who develop the symptoms of LF should also be taught about self-care of their affected limbs – lymphoedema management education.

The cost of the drugs used in MDA is low but many LF control programmes have had limited success. One reason for this is that many people in endemic countries are reluctant to comply with the annual treatment; they are not convinced of the benefits and fear the possibility of adverse effects. India’s National Vector Borne Disease Control Programme has run across this problem in many areas, including the state of Orissa. In 2007 a community-based educational campaign was launched in 90 Orissa villages (total population around 8,000) with the aim of increasing treatment rates. According to new research, this campaign has been highly successful.

Researchers used a cluster survey to compare adherence rates in 30 villages in each of three areas: those where there was no education programme (52.9% adherence), those where the community-based programme was in operation (75.0%), and those where community education on the benefits of treatment was combined with education on lymphoedema management (90.2%). The differences between the three groups are highly significant.

It is noteworthy that, while the standard education programme was effective, combining it with lymphoedema management education (which is important in its own right) increased compliance further still. This finding demonstrates the need to integrate long-term public health measures to eliminate LF with the provision of care to individuals with the distressing symptoms of the disease.

The researchers also noted deficiencies in the MDA programme, and proposed interventions to correct them. Barriers to adherence that were identified included fear of side effects, and lack of recognition of personal benefits. Predictors of adherence that were found to be amenable to educational intervention were: 1) knowing about MDA days in advance, 2) knowing that everyone is at risk for LF, 3) knowing that the drug administration was for LF, and 4) knowing at least one component of the techniques taught in the lymphoedema management programme.

Over 99% of households agreed to participate in the survey, so the findings may be regarded as reliable. While they do not necessarily apply to urban areas or areas outside the state, the authors rightly suggest that LF elimination programmes facing difficulties in achieving the necessary level of drug compliance should consider evaluating their education campaigns using similar methods and integrating lymphoedema management with LF elimination efforts.

An independent commentary [1], published in the same issue of PLoS NTDs as the research itself, says the results highlight the importance of lymphoedema care and suggest that community awareness of its availability and benefits may be the key to increasing acceptance of mass drug administration. According to the commentary, the Orissa findings, “…will stimulate a fresh and vigorous discussion regarding the relationship between the dual programmatic goals of interrupting transmission and reducing current LF-related suffering”.

Reference

1. Addiss DG (2010). Global Elimination of Lymphatic Filariasis: Addressing the Public Health Problem. PLoS Negl Trop Dis 4(6): e741. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20614015

2010 Cantey et al.

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