Coverage and compliance to mass drug administration for lymphatic filariasis elimination in a district of Kerala, India

Mass drug administration (MDA) for lymphatic filariasis elimination is a strategy of administering Diethylcarbamazine (DEC) tablets to all individuals above 2 years of age annually. It has been implemented in India and Kerala since 1997. A high coverage is essential for interruption of transmission in four to six years time, which is the average reproductive life span of the adult worm. The objectives of the study were to estimate the coverage and compliance of MDA for 2007 in Thiruvananthapuram district of Kerala, India; to explore the association of sociodemographic variables with compliance and to find the reasons for noncompliance to the drug. A cross-sectional survey was conducted using the probability proportionate to size cluster sampling technique. Three hundred households were selected for estimation of coverage and all individuals in these households, above two years of age, excluding pregnant and bedridden elderly patients were studied for determining compliance. Coverage was 52.3% (95% Cl 44.3, 60.3). Compliance was 39.5% (95% Cl 34.2, 45.0). Urban coverage was significantly lower than rural coverage. Compliance was not significantly related to any sociodemographic variables, but significantly associated with who the drug administrator was. Major reasons for noncompliance were fear of side effects (30.6%) and not perceiving the need (21.2%). Alternate drug delivery strategies need to be implemented to improve the coverage and compliance. Targeted Information Education and Communication (IEC) focusing on the safety of drugs and the requirement of MDA, is the need of the hour.