Mid Term Assessment of Mass Drug Administration for Elimination of Lymphatic Filariasis in Tikamgarh and Chhatarpur Districts of Madhya Pradesh, India

Introduction: Lymphatic filariasis (LF) is a crucial public health menace in India. It is one of the leading causes of long-term permanent disability, accounting for more than 5 million disability-adjusted life years annually. The mass drug administration (MDA) is one of the strategies to eliminate LF in India. 11 districts are endemic for the disease in Madhya Pradesh, which conduct MDA activities annually. Objectives: (1) To review the progress of activities of the single dose of diethylcarbamazine (DEC) mass administration in Tikamgarh and Chhatarpur districts, (2) to make an independent assessment of the program implementation under process and outcome indicators, (3) to recommend mid-course correction and suggest necessary steps for further course of action. Methods: An assessment of MDA for LF activities carried out from July 29, 2013 to August 01, 2013 in two districts of Madhya Pradesh. The teams visited the study areas and collected both qualitative and quantitative data to make an independent assessment. The activities carried out as per the standard methodology developed by National Institute of Communicable Diseases, Delhi. Results: The sufficient number of training for MDA was conducted but without any mechanism for quality check. The impact assessment was done by the local authorities to understand the effect of the MDA. The filarial units in these districts had insufficient staff. There was an adequate supply of DEC tablets. The evaluated coverage with DEC tablets was much lower than that reported by the district officials, and the effective coverage was found to be 64.66% and 65.08% in Tikamgarh and Chhatarpur districts respectively. The tablet intake was not properly ensured by the distributors, and the compliance rate was between 74% and 78%. Lack of awareness was the most common reason reported for the non-compliance followed by improper counseling and absenteeism. Conclusion: This evaluation study observed that MDA is confined to tablet distribution only and the major issues of implementation in compliance, health education, side effect, and morbidity management need to be addressed.