“…, I don’t think the disease is real, some people have just taken pictures to scare us to take the medications”: A qualitative study exploring perceptions about mass drug administration acceptance for lymphatic filariasis in Ghanaian communities

doi:10.21203/rs.3.rs-2477374/v1

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Research article

“…, I don’t think the disease is real, some people have just taken pictures to scare us to take the medications”: A qualitative study exploring perceptions about mass drug administration acceptance for lymphatic filariasis in Ghanaian communities

https://doi.org/10.21203/rs.3.rs-2477374/v1

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Background

Mass drug administration (MDA) is a means of delivering safe and affordable essential evidence-based interventions based on the principles of preventive chemotherapy, where various populations or sub-population groups are offered treatment without individual diagnosis. Several communities have been provided with MDA (i.e., Ivermectin and Albendazole) with the aim of eliminating Lymphatic Filariasis (LF) from Ghana. Notwithstanding the administration of 13 rounds of MDA from 2005 to 2019, the prevalence of LF as at 2020 in some communities is still high. The aim of this study is to explored perceptions about MDA acceptance for LF in Ghanaian communities.

Methods

A qualitative research design using a descriptive phenomenology and narrative inquiry was used in the study to either purposively or randomly select community members, patients, and community drug distributors in 12 communities in the Bono region of Ghana. In-depth interviews and focus group discussions were used to collect data. Interviews were transcribed verbatim and analyzed using thematic analysis in NVivo 12 software.

Results

The results show that chronic clinical symptoms of LF influenced community members’ perception and acceptance of the MDA intervention. Also, community members perceived that the acceptability and uptake of the MDA intervention could be improved by including patients in the programme, carrying out continuous education, and engaging in social mobilization activities in the communities.

Conclusions

There is an urgent need to educate and engage communities with regard to the critical role MDA intervention can play to eliminate LF from Ghana.

Lymphatic filariasis

mass drug administration

perceptions

communities

implementation research

Ghana

These results have a broad application for understanding the acceptability of Mass Drug Administration from different perspectives: patients, community member, and community drug distributors.
The use of both in-depth interviews and focus group discussions to corroborate findings of each within the socio-cultural context in which the study was situated provides a unique methodological insight to how to study such communities.
The study reveals that the acceptability and uptake of the MDA intervention could be improved by including patients in the programme, a finding that hitherto was difficult to locate.

Lymphatic filariasis (LF), commonly referred to as elephantiasis, is a vector-transmitted parasitic infectious disease of poverty categorized under the bracket of neglected tropical diseases (NTDs). The disease manifest when filarial parasites, including Wuchereria bancrofti, responsible for 90% of cases, Brugia malayi, and Brugia timori are transmitted from one infected human to an uninfected human through a mosquito vector (WHO, 2018). The disease manifestation causes pain, permanent physical disability, mental health issues, and social exclusion, in most instances hindering patients from advancing socio-economically, resulting in inevitable poverty and stigma (WHO, 2018; Ottesen, 2006; Ton, Mackenzie, & Molyneux, 2015). Elimination of the disease is feasible, with multiple approaches proposed and applied to break transmissions, including vector control, Mass Drug Administration (MDA), Preventive Chemotherapy (PC), and social, civic, and environmental modification to ensure long term change.

One hundred and twenty million people worldwide are estimated to be infected with LF, of which 40 million have expressed the clinical manifestation of LF, with the disease accounting for approximately $2.8 million disability-adjusted life years (DALYs) (5). In Sub-Saharan Africa only Togo and Malawi have reached the elimination target after being declared free of LF (WHO, 2018a; WHO, 2020). In Ghana, 98 out of the 216 districts were endemic to LF. By 2015, 83 of the 98 districts attained the transmission assessment survey (TAS) and are currently under post-mass drug administration surveillance, with the other 15 districts being identified as ‘hotspot’ areas (Ahorlu, Koka, Adu-Amankwah, Otchere, & de Souza, 2018; Ghana NTDP, 2019; Minetti et al., 2019). These 15 hotspot districts are still in need of MDA treatment with a treatable population of 1,169,357 (Ghana NTDP, 2019). As the disease could be transmitted from an infected person to an uninfected person, inability to eliminate it countrywide simply means that there is the risk of spread to the general population, thereby eroding the gains and efforts that have been made in eliminating the diseases in many communities. Lymphatic filariasis has no cure but adherence to treatment through annual or biannual preventive chemotherapy and morbidity management prevents the adverse effect and spread of the disease (King, 2020; WHO, 2018). Evidence shows that the MDA treatment is efficacious in breaking transmission in an endemic area after 5–6 rounds of drug intervention.

Mass drug administration is a strategy applied towards controlling, managing, and eliminating NTDs in the at-risk population. The approach seeks to distribute efficacious, safe, and inexpensive drugs to an area or country once or twice every year (8,9). In the case of LF, a regimen combination of drugs including, albendazole (ALB), diethylcarbamazine (DEC), and ivermectin (IVM) are distributed to individuals in endemic and co-endemic with other neglected diseases (Biritwum, Garshong, et al., 2017; Fang & Zhang, 2019; Gyapong, Owusu, da-Costa Vroom, Mensah, & Gyapong, 2018). MDA has proven to be a more acceptable and effective means of prevention of infection and breaking transmission. However, after the expected rounds of treatment, some communities still struggle with new LF infections (Biritwum, de Souza, et al., 2017; Dicko, Coulibaly, Sangaré, Sarfo, & Nortey, 2019). In one of the hotspot areas (Sunyani West district), LF prevalence is 6.6% after the district had received 13 rounds of regiment treatment of Ivermectin and Albendazole with an average of 86.7% coverage (Ghana NTDP, 2019). The overall reporting of the LF MDA coverage data has surpassed the 65% recommended by WHO in most of the Ghanaian hotspot districts since the inception of the program (15,16).

The inability to eliminate LF in these hotspot districts after several rounds of administration of the drugs suggest that perhaps the MDA is not acceptable by the people living in these communities. The assessment of intervention acceptability is critical in ensuring the success of intervention implementation as it can influence the extent of treatment compliance enforced by the CDDs and subsequent treatment outcomes (17). The aim of this study is to explored perceptions of patients, community members and community drug distributers about MDA acceptance for lymphatic filariasis in Ghanaian communities.

Study Design

This study employed a qualitative research method using a descriptive phenomenology and narrative inquiry to understand the essence of lived individual experiences regarding MDA and LF.

Sample

The study population is categorized into four; community members; community mobilizers or influencers; LF MDA community drug distributors; and patients with advanced/chronic LF clinical manifestations. The study was conducted in the Sunyani West District, Chiraa Subdistrict, in the Bono Region of Ghana which has one health centre, two clinics, one maternal home, one private clinic, and three Community-based Health Planning and Services (CHPS) - primary healthcare facility.

Sampling And Recruiting

A total of 44 individuals participated in both in-depth interviews and focus group discussions. Focus Group Discussions (FGD) and In-depth Interviews (IDIs) were conducted with community members across all the selected communities. While the IDIs were done with 3 different groups; the patients with clinical manifestation of LF; CDDs; and community members, FGDs were conducted among community members, taking into consideration the age and gender of the participants. The study employed a purposive sampling technique to select respondents within the communities, taking into consideration the dynamics of the population, including individuals who have never missed the MDA intervention and adamant refusers of the MDA intervention. Patients interviewed were selected through the community health worker or community drug distributors and District Disease Control Officer. An existing patient register, CDDs volunteer register, and a list of MDA refusers were used to purposively select study participants. The determination of advanced/chronic LF was based on Community Drug Distributors and the District Disease Control Officer's previous assessment of such patients during the previous contact. For CDDs, the recruitment of respondents was done through the District Disease Control Officer and the chief CDD in the district. The IDIs and FGDs lasted for between 20 to 45 minutes and an average of one hour 10 minutes respectively and these were conducted in the community health centres. The concept of saturation was applied as a determinant of when to stop conducting the interviews.

Inclusion And Exclusion Criteria

We included individuals between age 18 and above who had resided in the selected communities for more than a year. This is because individuals who had resided in the selected communities for more than a year would have been exposed or not exposed to the MDA exercise and hence would have formed opinion about the MDA intervention delivery. We excluded community members who declined to participate in the study or were incapacitated to be interviewed.

Data Collection Tools

Pre-tested semi-structured interview guides and topic guides were used to ensure that the aim of the study was covered. These interview guides and questions were specifically developed for the study and were informed by literature. The interview and study guides were translated from English into the local language (Twi). Different questions and topic guides were developed for the interviews covering the patients, CDDs, community members, and the FGD. The interview guides had questions that sought information about participants’ socio-demographic data, knowledge on LF and MDA, experience taking or not taking MDA, patient experiences, CDDs’ experiences, perception of the program/intervention, and best practices in taking the intervention.

Ethical Consideration

Permission to conduct the study in the study region was sought from Bono Regional Health Directorate in Sunyani, Sunyani West District Health Directorate, which was subsequently granted (reference number: GHS/BR/GA/GM.18/20). In addition, the study was approved by the Ghana Health Services Ethical Review Committee (reference number: GHS/RDD/ERC/Admin/App/20/128).

Data Analysis

Interviews were audio recorded and transcribed in their entirety, and verbatim transcripts were imported to NVivo 12 for analysis. A codebook was created and used to analyze the data according to the aim of the study. Any new themes emerging during coding prompted changes to the codebook. Thematic analysis was then performed using both inductive and deductive approaches to populate and identify codes (18). Thorough coding was applied to the transcripts to ensure exhaustive analysis. All identified codes and were grouped into broad themes and subthemes that represented participants perceptions about MDA and LF in the communities.

Socio-Demographic Characteristics

Majority of the participants in both the IDIs and FGDs were between 30–44 years old consisting of almost equal number of males and females. Also, majority of the participants were involved in the FGDs compared to the IDIs and the highest level of education of most of them was high school education. Community members constituted the largest category of participants with the majority of the participants indicating that they belong to the Islamic region. All of the respondents reported that they have seen the MDA activities taking place in the community. Also, all the CDDs had participated in multiple rounds of the MDA program for LF and all the patients interviewed had visible clinical manifestations of the disease. Table 1 below shows a summary of the socio-demographic characteristics of the respondents.

Table 1

Socio-Demographic Characteristics
Participants’ Characteristics		Number of Participants
In-Depth Interviews			Focus Group Discussions
Age (years)
18–29		3	10
30–44		8	13
45–54		3	3
55–64		1	0
Total		15	26
Education Level
No Education		1	0
Primary/Middle School		6	8
JHS/SHS		8	15
Tertiary		3	3
Total		18	26
Religion
Christian		9	12
Islam		9	14
Total		18	26
Sex
Female	9			12
Male	9			14
Total	18			26
Community group
Patients	4			0
Community Members	8			26
CDDs	6			0
Total	16			26
Occupation
Trader	6			5
Farmer	5			0
Formal Employment	3			4
Student	0			6
Other	4			11
Total	18			26
Marital Status
Single	5			14
Married	12			12
Divorced	0			0
Widowed	1			0
Total	18			26

Lived Experiences Of Mda Intervention Implementation

The experiences of community members were explored regarding implementation of the MDA intervention to understand and identify successes, failures, and new strategies to improve implementation of the intervention as well as to assess individuals’ perceived risk, susceptibility, severity of LF, and barriers and facilitators.

Knowledge And Perception Of Lf

The knowledge and perception of LF varied widely among community members. The cause of transmission of LF was explained quite accurately, which demonstrates an understanding of the disease:

“Please elephantiasis (Gyepim) is caused by mosquitos…if I have the disease and I get bitten by a mosquito, and it bites another person, that person can get it” (Women FDG, 26-54y/o).

On the other hand, some participants did not really give an accurate understanding of LF, but attributed the transmission to non-scientific methods.

“I believe it originates from walking barefooted in marshy and stagnant water, so I think if we avoid such instances, it will not make us get the disease. Again, since it is caused by worms, I make sure I de-worm regularly” (2nd Mixed FGD, 26-54y/o).

Among younger participants, it was believed that the disease was non-communicable and so there is no need to be afraid of it or take measures to prevent it.

“For me, I perceive the disease to be genetic. If it is not in your family, you cannot have it” (Youth Men-FGD, 18-29y/o).

Participants also associated LF with its visible manifestation, especially swollen legs and knew that LF resulted in hydrocele, breast enlargement, and toughening of the skin in the affected area. Furthermore, most of them said that they had ever seen LF patients in the community.

“It causes extreme swelling of the legs and makes the skin around the infected leg to become rough …I saw a picture of a man whose scrotum has been enlarged due to this disease, and also, I saw a picture of a woman who has a swollen breast with harden and thicken skin” (Female 29y/o Community member-IDI).

Knowledge And Perception Of The Mda Intervention

In order to understand how the community experienced the MDA intervention since its inception and when they first encountered the intervention their views were explored. Also, experiences of the CDDs were explored to understand the MDA intervention implementation, the community experiences, challenges, and other community factors that may have influenced uptake or refusal of the intervention. A respondent expressed their knowledge of the intervention:

“I know that for about ten years now, periodic mass drug distribution is done by the Ghana Health Service to prevent one from getting the disease. They usually move from house to house to dose the various households. They also educate us, saying that if we take the drugs, it will prevent us from acquiring the disease”. (1st Mixed FGD, 26-54y/o).

Interestingly, some male youth participants believed that the MDA intervention for LF was meant to scare people to take the drugs for a disease that is not real. Negative perceptions of the MDA intervention acted as a barrier to the successful uptake and adherence to the intervention.

“Mmmm, with the disease, I don’t think it is real, I think some people have just taken some pictures to scare us to take the medications” (Youth Men FGD, 18-29y/o).

“…me? Still, I don’t think I would take it. Unless maybe in the picture, I see that those with the disease have been cured after taking the medications; with that, I would take it, but with just pictures alone, I won’t. … you know, with the infected man we were talking about, he was once working with my father, and my father never took the medications, but he never got the disease. … I don’t see the essence of the programme since those with the disease don’t get cured by taking it, and even if you don’t have the disease too, you don’t feel anything after taking it” (Youth Men FGD, 18-29y/o).

Knowledge And Perception About The Drugs

Respondents perceived the drug to be very efficacious and that it heals other diseases too. The positive perception of the drug served as an encouragement to continue taking the drugs among the community members.

“…sometimes, someone can even come and ask whether that particular year there would not be administering the drug. There was this time when one man could not even see properly, so when we gave him the drugs …he later took it, he can clearly see now…” (CDD-IDI, Male, 48y/o).

There was also general confusion on whether the drug was meant for curative purposes or prevention, which hindered the uptake of the drugs because of the evidence that those with the disease do not get cured after taking the drugs.

“For me, I have realized that there are some few people in the community with the disease who have been taking the drugs for some time now and yet, the disease is still present with them, so how can I be convinced that the drug can help someone like me without the disease, so that’s why I don’t take it” (Youth Men FGD, 18-29y/o).

Some participants also expressed general fear that the drug accelerated or even caused the disease in some instances, which prevented them from taking it.

“It is true, and I think this is because back in 1999 when the mass drug distribution started, I was feeling okay, but my woes started when I took the drugs. Some people are even saying that the number of people with the disease has increased… ..they also say that it facilitates the manifestation of the disease” (Female 35y/o, Patient-IDI).

Some drug practices were a barrier to taking the drugs, the lack of transparency with the drug, like the expiry date prevents some people from taking the drugs.

“… but what I don’t understand is that we don’t even get to see the expiry date of the drugs. All we know is that they come and administer the drugs to us, and we also take them. I believe that is what is even making people get the disease more” (Youth Men FGD, 18-29y/o).

Other respondents insinuated that the community played the main role in causing others to refuse to take the drugs:

“Most of the bad experiences we share about the drugs in our communities deters others from taking the drugs. Some will just exaggerate when they are talking about the drugs making it seem it has no positive side” (2nd Mixed FGD, 26-54y/o).

Furthermore, it was thought that members of the community and at the household level controlled the uptake of drugs.

“I have witnessed a woman advising her daughter not to take the drugs because she claims it is unwholesome for human consumption. The child heeded to her advice and threw the drugs away after the volunteer left…” (2nd Mixed FGD, 26-54y/o).

Also, timing of the intervention was thought to influence uptake of the drugs. Community drug distributors said that the intervention almost always coincides with the religious fasting season (i.e., Ramadhan) and this influenced uptake of the intervention:

“One thing I have observed is that the time for the drug administration is usually around the time Muslims also do their fasting, and when a Muslim is fasting, he/she will not take the drug, so if you can do something about that too…” (CDD-IDI, Male, 60y/o).

Most of the community members said that the CDDs instructed them to take the drug immediately and in their presence (i.e., DOTS for adherence). Further, they said that the CDDs should not just approximate the dosage meant for people but this should be based on a measurement of the height of individuals:

“the volunteers (i.e., CDD) should make sure they measure each and everybody before they give the drug out. This work is not like tailoring, where one can assume somebody else’s measurement. Even professional tailors don’t always get it right with measurements. Again, as African’s we are very superstitious, so if you leave my drugs with a neighbour and something bad happens to me, I might say that my neighbour has cast a spell on the drugs that is why I am feeling the side effects of the drugs” (2nd Mixed FGD, 26-54y/o).

Community Attitudes And Perceptions About Lf Patients

The FGD respondents interviewed observed that the LF patients faced stigma and ostracization in the community. A patient expressed how the disease has negatively affected her life and how the inclusion of the patients in the MDA intervention could negatively affect the community.

“On several occasions... It has even affected my love life. The man I was dating earlier ditched me to marry another woman. I am dating another person now, and when we decided to get married, his family members objected…” (Patient-IDI, 35y/o, Female).

Social Mobilization

Most of the participants believed that the intervention lacked largely in the social mobilization aspects, and this affected its success.

“In the past, when we are about to start the distribution of the drugs, we were pre-informed to make announcements in the community very early. We go to information centres, churches, mosques, markets, and almost all social gatherings available to educate the populace and announce the day of commencement of the program. …” (CDD-IDI, Male 35y/o).

A community member suggested that education on the disease should be continuous and not only during the program and also recommended the use of motion picture for community mobilization.

“I suggest that the education on the program should be intensified before, during, and after the mass drug distribution program” (Com-Member-IDI, Female 38y/o).

“…I believe the biggest motivator has been the periodic video shows that precede the mass drug distribution. It takes time to explain more advantages of taking the drugs and also gives in-depth information about the disease itself” (CDD-IDI, Female 49y/o).

Drug Distributors Factors

Some of the community members said that the CDDs are not well presented in terms of dressing and appearance, which they believed made uptake of the drug unattractive and unappealing:

“The attire that some of the volunteers’ wear dumping your appetite for the drugs, it really discourages you and makes you question the authenticity of the drugs” (1st Mixed FGD, 26-54y/o).

Finally, some respondents also believed that the CDDs coming from the same community hinders the acceptance of the drugs.

“I think sometimes there should be reshuffling among the volunteers, just like the Jehovah Witness, when one comes today, another person will come another day, by so doing you might not know they are coming to distribute the drugs, if not, me for instance if I see them coming, I would run away” (Youth Men-FGD18-29y/o)

This study’s focus was to describe the community’s lived experiences as a means of understanding the challenges and opportunities available in the implementation of the program and how to increase uptake. The study also sought to explore patients’ roles in the larger MDA picture in the Chiraa community. According to the study findings, MDA’s success is not only based on coverage; it also depends on a myriad of social factors such as demographics, perceptions, and beliefs in a community that influence the reaction to program implementation either facilitating or undermining its uptake. This confirms the findings of (Ahorlu et al., 2018; Njomo et al., 2020; Kisoka et al., 2016). The findings indicate that part of the community understood the program's benefits and perceived that the annual uptake of the drugs prevents the disease encouraging them to participate yearly. Most community members trusted that the drugs were efficacious indicating improved perception of the MDA program. However, some were skeptical about drug uptake and did not see the drug as essential this acted as a barrier. This skepticism greatly manifested among the male youths which impacted the drug uptake supporting (Njomo et al., 2020).

The study identified that the CDDs are the cornerstone of community-directed drug distribution. They had the ability to track the progress of the MDA program and identify loopholes in implementation. Their motivation seemed to be strong, altruistic, and intrinsic but was waived by the MDA program's low financial motivation and organizational issues (Gyapong et al., 2018). The study data indicated that there was mistrust between the community and the CDD practices. Legge et al., study shows that trust between the implementer and the recipient increases demand and uptake of MDA drugs and that when broken (2020). However, CDDs also acted as motivation and as a cue to action for taking the drugs. Apart from drug distribution, the CDDs in Chiraa worked as educators for the MDA program, which contrasts with the findings made in (Kisoka et al., 2016), where CDDs portrayed little knowledge of the disease causation and its transmission.

The findings confirmed (23) study in Ghana on the timing of the MDA program drug distribution in the community and its effect on the uptake of the drugs by community members. The findings confirmed that how the community perceived the drugs directly impacted MDA drug uptake in households. In a study to assess barriers to the MDA drug uptake (Ahorlu et al., 2018) explains that social structures in the community act as a determinant for drug uptake for MDA, with parents controlling uptake among children and matriarchy or patriarchy decided for every household member. Also, non-adherence to DOTS is expressed by community members in different ways where some thought it was forceful, and others thought it was a necessary procedure for accountability. However, the study findings found that CDDs delegated the roles of distribution to the available members in the community in the event that they did not want to return to the household. This suggests a non-adherence to the program fidelity (Ames et al., 2019).

The study raised the trust issue between the community and government health interventions. This is replicated in numerous studies where there was distrust between the government and community creating a perception of the drugs distributed acting as a barrier to uptake (25). Furthermore, unending rounds of the program implementation reduced motivation, community resources and general adherence toward the program causing fatigue.

The study found that having a clinical manifestation of the disease that is very visible affected how the community will view them. Some were openly ostracized, affecting their businesses; this also has been cited as the effect of almost all neglected tropical diseases (26). The findings also indicated that the community was motivated by the fear of the disease and perceived it as a threat to the quality of life. As such, the need to include patients in the program. In understanding community engagement (27) study shows that photos of LF patients effective increased drug uptake.

There was general agreement that if the program utilized the information, education and communication platforms in the community, then there would increase in acceptance and uptake of the drugs. The MDA programs are mostly underserved and poorly advertised; thus, there is a growing need to include platforms such as social media where the young population can easily be reached out (Biritwum, Garshong, et al., 2017). The sentiments on the drug packaging were that improper and unpresentable packaging destroyed the efficacy of the drug. Also, the drug packaging show lack of transparency over vital issues such as the expiry date for the drugs. Drug packaging could be leveraged as a tool to help in spreading knowledge, community mobilization, establishing trust and authenticity of the intervention and their actors such as the CDDs (Krentel et al., 2016, 2017).

Limitation Of The Study

The study utilized a qualitative approach, which limited the generalization of the results to the whole community in Chiraa and other hotspot regions in Ghana, given the socio-cultural. Also, as purposive sampling used, it appears that gatekeepers identified community members that were “close” to them. Finally, due to the method used to understand lived experiences, the participants were interviewed on what they had observed since inception or when they first experience the program. This could have led to recall bias affecting the reliability of the data collected.

The findings provide a key snapshot of where the Ghanaian community is with regards to MDA for LF. While there is basic knowledge of the disease in the community, there are lapses in the delivery of the preventive chemotherapy drugs to the community. To ensure that the disease is eliminated, a reassessment and application of the findings to the program is required. It is also important to target key population like the youth who were presented in the finding as being most skeptical. Finally, there should be adoption and leveraging of contemporary messaging techniques to ensure wider outreach.

CDD

Community Drug Distributors

CHPS

Community-based Health Planning and Services

DOTs

Directly Observed Therapy Shortcourse

IDI

In-Depth Interview

Lymphatic Filariasis

MDA

Mass Drug Administration

Ethics approval

The study was approved by the Ghana Health Services Ethical Review Committee (reference number: GHS/RDD/ERC/Admin/App/20/128).

Consent to participate

All study participants provided the consent to participate in the study after the participant information sheet and consent form were read and explained to them. Participants were also given a copy of the consent form for reference.

Consent for publication

All participants provided written informed consent before participating in the study, which included consent to publish anonymous quotes from individual participants.

Availability of data and materials

The dataset (which includes individual transcripts) is not publicly available due to confidentiality agreement signed by participants.

Competing interests

The authors declare that they have no competing interests.

Funding
The study was funded by World Health Organization- Tropical Disease Research (WHO/TDR) under the Post-Graduate Training scheme. The funder financed Ms. Muroka’s Masters degree and research project. The funder was not involved in study design, collection, analysis or interpretation of data.

Authors information, Affiliations, Contributions

Ms. Trusila Muroka, (Principal author, proposal development, data collection, data analysis, manuscript development).

Student, Department of Social and Behavioural Sciences, School of Public Health,

University of Ghana.

[email protected] (Correspondent)

Co-author

Dr. Franklin Glozah, (Supervisor, proposal development, quality checking, analysis, manuscript development).

Senior Lecturer, Department of Social and Behavioural Sciences, School of Public Health,

University of Ghana

[email protected]

Individual Contributions

All authors were involved in the development of study proposal.

TM conducted review and synthesis of literature for the manuscript.

TM collected the analyzed and interpreted the study data on community perception of LF in Chiraa community.

FC supervised the development of the final dissertation and was a key contributor in the organization of the manuscript.

All authors worked on the organization of the manuscript and read and approved the manuscript for submission.

Acknowledgment

We gratefully acknowledge study participants from Chiraa community for taking the time to participate in this study.

WHO. Global Programme to Eliminate Lymphatic Filariasis. WHO. 2017;
Ottesen EA. Lymphatic Filariasis: Treatment, Control and Elimination. Vol. 61, Advances in Parasitology. 2006. p. 395–441.
Lymphatic filariasis [Internet]. [cited 2019 Nov 19]. Available from: https://www.who.int/news-room/fact-sheets/detail/lymphatic-filariasis
Ton TGN, Mackenzie C, Molyneux DH. The burden of mental health in lymphatic filariasis. 2015;
WHO. Global programme to eliminate lymphatic filariasis: progress report, 2019 [Internet]. WHO. 2020 [cited 2021 Jul 7]. Available from: https://www.who.int/publications/i/item/who-wer9543
Minetti C, Tettevi EJ, Mechan F, Prada JM, Idun B, Biritwum NK, et al. Elimination within reach: A cross-sectional study highlighting the factors that contribute to persistent lymphatic filariasis in eight communities in rural Ghana. PLoS Negl Trop Dis. 2019;13(1).
Ahorlu CSK, Koka E, Adu-Amankwah S, Otchere J, de Souza DK. Community perspectives on persistent transmission of lymphatic filariasis in three hotspot districts in Ghana after 15 rounds of mass drug administration: a qualitative assessment. BMC Public Health [Internet]. 2018 [cited 2019 Oct 10];18(1):238. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29433461
Webster JP, Molyneux DH, Hotez PJ, Fenwick A. The contribution of mass drug administration to global health: Past, present and future. Vol. 369, Philosophical Transactions of the Royal Society B: Biological Sciences. Royal Society of London; 2014.
de Souza DK, Dorlo TPC. Safe mass drug administration for neglected tropical diseases. Vol. 6, The Lancet Global Health. Elsevier Ltd; 2018. p. e1054–5.
Fang Y, Zhang Y. Lessons from lymphatic filariasis elimination and the challenges of post-elimination surveillance in China. Infect Dis Poverty. 2019 Dec;8(1).
Biritwum N-K, Garshong B, Alomatu B, de Souza DK, Gyapong M, Kyelem D. Improving drug delivery strategies for lymphatic filariasis elimination in urban areas in Ghana. PLoS Negl Trop Dis [Internet]. 2017 May [cited 2019 Oct 10];11(5):e0005619. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28493966
Gyapong JO, Owusu IO, da-Costa Vroom FB, Mensah EO, Gyapong M. Elimination of lymphatic filariasis: current perspectives on mass drug administration. Res Rep Trop Med. 2018 Mar;Volume 9:25–33.
Biritwum N-K, de Souza DK, Marfo B, Odoom S, Alomatu B, Asiedu O, et al. Fifteen years of programme implementation for the elimination of Lymphatic Filariasis in Ghana: Impact of MDA on immunoparasitological indicators. Prichard RK, editor. PLoS Negl Trop Dis [Internet]. 2017 Mar 23 [cited 2019 Nov 18];11(3):e0005280. Available from: http://dx.plos.org/10.1371/journal.pntd.0005280
Dicko I, Coulibaly YI, Sangaré M, Sarfo B, Nortey PA. Non-compliance to mass drug administration associated with the low perception of the community members about their susceptibility to lymphatic filariasis in Ankobra, Ghana. Infect Disord Drug Targets [Internet]. 2019 Feb 6 [cited 2019 Oct 15]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/30727921
Molyneux DH. Advancing toward the Elimination of Lymphatic Filariasis. N Engl J Med [Internet]. 2018 Nov 8 [cited 2020 Jan 28];379(19):1871–2. Available from: http://www.nejm.org/doi/10.1056/NEJMe1811455
Ramaiah KD, Ottesen EA. Progress and Impact of 13 Years of the Global Programme to Eliminate Lymphatic Filariasis on Reducing the Burden of Filarial Disease. PLoS Negl Trop Dis. 2014;8(11).
Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1):88.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006 Jan;3(2):77–101.
Ahorlu CSK, Koka E, Adu-Amankwah S, Otchere J, De Souza DK. Community perspectives on persistent transmission of lymphatic filariasis in three hotspot districts in Ghana after 15 rounds of mass drug administration: A qualitative assessment. BMC Public Health [Internet]. 2018 Feb 13 [cited 2020 Sep 19];18(1):1–10. Available from: https://link.springer.com/articles/10.1186/s12889-018-5157-7
DW N, BW K, LW K, C O, WP O, HM S. Implementation challenges and opportunities for improved mass treatment uptake for lymphatic filariasis elimination: Perceptions and experiences of community drug distributors of coastal Kenya. PLoS Negl Trop Dis [Internet]. 2020 Dec 1 [cited 2021 Jul 7];14(12):1–21. Available from: https://pubmed.ncbi.nlm.nih.gov/33370300/
Kisoka WJ, Tersbøl BP, Meyrowitsch DW, Simonsen PE, Mushi DL. COMMUNITY MEMBERS’ PERCEPTIONS of MASS DRUG ADMINISTRATION for CONTROL of LYMPHATIC FILARIASIS in RURAL and URBAN Tanzania. J Biosoc Sci. 2016 Jan 1;48(1):94–112.
Legge H, Kepha S, Prochazka M, Halliday K, Pullan R, Gwayi-Chore MC, et al. Implementer and recipient perspectives of community-wide mass drug administration for soil-transmitted helminths in Kwale county, Kenya. PLoS Negl Trop Dis [Internet]. 2020 Apr 1 [cited 2020 Sep 21];14(4):1–18. Available from: https://pubmed.ncbi.nlm.nih.gov/32310966/
Manyeh AK, Ibisomi L, Ramaswamy R, Baiden F, Chirwa T. Exploring factors affecting quality implementation of lymphatic filariasis mass drug administration in Bole and Central Gonja Districts in Northern Ghana. Fischer PU, editor. PLoS Negl Trop Dis [Internet]. 2020 Aug 17 [cited 2020 Sep 21];14(8):e0007009. Available from: https://dx.plos.org/10.1371/journal.pntd.0007009
Ames HMR, Zuske M, King JD, Steinmann P, Bosch-Capblanch X. Community and Drug Distributor Perceptions and Experiences of Mass Drug Administration for the Elimination of Lymphatic Filariasis: A Rapid Review of Qualitative Research. Adv Parasitol. 2019 Jan 1;103:117–49.
Kusi C, Steinmann P, Merten S. The fight against lymphatic filariasis: Perceptions of community drug distributors during mass drug administration in coastal Kenya. Infect Dis Poverty [Internet]. 2020 Mar 2 [cited 2020 Sep 22];9(1):22. Available from: https://idpjournal.biomedcentral.com/articles/10.1186/s40249-020-0638-1
Perera M, Whitehead M, Molyneux D, Weerasooriya M, Gunatilleke G. Neglected patients with a neglected disease? A qualitative study of lymphatic filariasis. PLoS Negl Trop Dis. 2007 Nov;1(2).
Silumbwe A, Halwindi H, Zulu JM. How community engagement strategies shape participation in mass drug administration programmes for lymphatic filariasis: The case of Luangwa District, Zambia. Stolk WA, editor. PLoS Negl Trop Dis [Internet]. 2019 Nov 27 [cited 2020 Oct 21];13(11):e0007861. Available from: https://dx.plos.org/10.1371/journal.pntd.0007861
Krentel A, Gyapong M, Mallya S, Boadu NY, Amuyunzu-Nyamongo M, Stephens M, et al. Review of the factors influencing the motivation of community drug distributors towards the control and elimination of neglected tropical diseases (NTDs). Friedman JF, editor. PLoS Negl Trop Dis [Internet]. 2017 Dec 6 [cited 2019 Nov 17];11(12):e0006065. Available from: https://dx.plos.org/10.1371/journal.pntd.0006065
Krentel A, Damayanti R, Titaley CR, Suharno N, Bradley M, Lynam T. Improving Coverage and Compliance in Mass Drug Administration for the Elimination of LF in Two ‘Endgame’ Districts in Indonesia Using Micronarrative Surveys. PLoS Negl Trop Dis [Internet]. 2016 Nov 3 [cited 2020 Oct 13];10(11). Available from: /pmc/articles/PMC5094770/?report=abstract

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“…, I don’t think the disease is real, some people have just taken pictures to scare us to take the medications”: A qualitative study exploring perceptions about mass drug administration acceptance for lymphatic filariasis in Ghanaian communities

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Version 1

Abstract

Contributions To The Literature

Background

Method

Study Design

Sample

Sampling And Recruiting

Inclusion And Exclusion Criteria

Data Collection Tools

Ethical Consideration

Data Analysis

Results

Socio-Demographic Characteristics

Lived Experiences Of Mda Intervention Implementation

Knowledge And Perception Of Lf

Knowledge And Perception Of The Mda Intervention

Knowledge And Perception About The Drugs

Community Attitudes And Perceptions About Lf Patients

Social Mobilization

Drug Distributors Factors

Discussion

Limitation Of The Study

Conclusion

Abbreviations

Declarations

References

Supplementary Files

Status:

Version 1