Community views on mass drug administration for filariasis: a qualitative evidence synthesis

17 Feb 2022

What was studied in this synthesis?

Mass drug administration (MDA) involves the regular delivery of treatment medicines to whole populations, regardless of whether an individual has the disease or not, and aims to prevent onward transmission (passing from one person to another). It is currently recommended for some disease control programmes in low‐ and middle‐income countries, including the parasitic disease lymphatic filariasis, which can result in swollen limbs and disability. For governments and their health service this is a large logistical task requiring money and staff, and success depends on communities taking the medicines given. 

In this review, we looked for studies that explored how people view and experience these programmes. We collected all relevant studies and included 29 in this synthesis.

What was the aim of this synthesis?

In this synthesis of qualitative research, we aimed to explore people's views on MDA programmes for treating lymphatic filariasis in low‐ and middle‐income countries. 

Key messages 

People must weigh up a number of factors before deciding to take the medicines. Not everyone benefits from MDA and some may experience harms. The decision to adhere therefore, depends on a complex balance between their trust in the government distributing the medicines; their prior understanding of the disease and the knowledge they receive on the programme; their experience of harms; the influence of family, neighbours, and health staff; and their experience and perception of the people distributing the medicines. 

What were the main findings?

We included 29 studies in our analysis. The studies covered a broad range of countries in Africa, South‐East Asia, and South America, although most were conducted in India. These studies primarily explored the views and experiences of community members and those distributing the medicines in low‐income countries where lymphatic filariasis is considered a problem. From the data, four themes emerged.

People weigh up benefits and harms before participating. People understand they can reduce the suffering, stigma and costs of developing the disease (high confidence); however, these benefits do not always mesh with their experiences (high confidence). In particular, side effects are frightening and unwelcome (high confidence); and these effects are amplified through rumour and social media (moderate confidence).

Many people are suspicious of MDA programmes. When people lack a detailed explanation for the programme and their experiences of it, they often develop explanations based on the historical backdrop and level of trust people have in relevant authority figures (high confidence), although some have unwavering faith in their government and by extension the programme (moderate confidence).

Programmes expect compliance, and this can become coercive and blaming. Health workers and community members stigmatize non‐compliance, which can become coercive (moderate confidence), so communities may appear to comply publicly, but privately reject treatment (moderate confidence).

Community distributors are often not respected or valued. They have little authority (moderate confidence), and the behaviour of some damages the MDA programme's reputation (high confidence). Communities want information about programmes to help make decisions about participation, but drug distributors are not sufficiently informed, or skilled in this communication (high confidence).

We were unable to assess the impact of programme design on communities' perception of the programme and decision to adhere as these aspects were too similar across all studies. 

How up to date was this synthesis?

We searched for studies published before 8 April 2021.

Neglected tropical diseases