Journal Club presentation

1. Mass Drug Administration Coverage
Evaluation Survey For Lymphatic
Filariasis In Bagalkot And Gulbarga
Districts
Author: Prakash Kurubarahalli Patel
Indian Journal Of Community Medicine 2012; 37(2):101-6.

2. INTRODUCTION
Lymphatic filariasis is endemic in 83 countries, with more than 1 billion
people at risk of infection.
Estimated 5.1 million DALY loss.
Global programme to eliminate LF through MDA started in 1999.
Govt. of India began a nationwide MDA campaign in 2004
MDA with single dose of DEC and albendazole was used for elimination in
all endemic districts.

3. AIMS & OBJECTIVES
 Assess coverage of MDA against LF in Bagalkot and Gulbarga
districts of Karnataka state.

4. STUDY DESIGN
Multi stage Cluster sampling
1 urban cluster 3 rural cluster (3 PHC)
1 sub center
1 village (50 houses)
By
Random
sampling
150 Households in each cluster, & totally 1,228 individuals were surveyed.
House to house survey was conducted , Performa filled via personal interview

5. MATERIALS & METHODOLOGY
Place of study: Bagalkot and Gulbarga in Karnataka state.
Type of Study : Cross-sectional study.
Study period: 22-2-2010 to 27-2-2010 (5 days)
Inclusion criteria:
 All the eligible population who belong to the MDA campaign area.
Exclusion Criteria:
 Pregnant and lactating women
 Children below two years of age and
 Seriously ill persons.

6. Investigator : Was trained informally in the regional office for health and
family welfare, Bangalore in all aspects of coverage survey.
Drug distributors
 Health workers
 Anganwadi workers
 Accredited social health activist and
 Student volunteers
Training
 A formal training program was organized to all the staff (PHC
medical officers and health workers)
 A training manual was distributed to the participants

7. Ethical issues: As it is a non-interventional & non-invasive study,
no ethical issues were involved.
Outcome measures: MDA coverage rate, Compliance rate
Analysis and statistical methods
 The data were, computed in Microsoft Excel & analyzed
using the statistical program SPSS-10.
 Chi-square test was used to indicate the difference in
proportions.
 P value <0.05 was considered as significant.

8. RESULTS
•Total study population was 1228 individuals from 8 clusters (1 urban + 3
rural )
TABLE I: Socio- demographic characteristics of the respondents
Variables Bagalkot district (n=616)
Percentage
Gulbarga district n=612
Percentage
Age: 15- 59 yrs 62.7% 63.9%
Sex ratio (M:F) 49.5: 50.5 46.9:53.1
Education
Illiterate
primary
31.7%
29.5%
36.1%
26.3
Occupation
Students
House wives
Unskilled person
33.6%
28.2%
18.3%
37.1%
17.2%
29.2%

9. TABLE:II
DISTRIBUTION OF STUDY POPULATION BASED ON CONSUMPTION OF TABLETS
TABLETS
CONSUMED
BAGALKOT DISTRICT
(N=597)
percent
GULBARGA DISTRICT
(N=595)
Percent
DEC+ Albendazole 78.6% 38.8%
DEC only 1.6% 0.0%
DEC incomplete
dosage
1.0% 12.4%
Albendazole only 0.0% 0.0%
No tablets 18.8% 48.8%

10. TABLE: III : Reason for not consuming tablets
REASON FOR NON-CONSUMPTION
BAGALKOT DISTRICT
N=147
Percent
GULBARGA DISTRICT
N=381
Percent
ODD RATIO- CI
Did nor receive tab 27.9 15.2 -
Not present at home 18.4 10 -
Drug given at home but
no information
9.5 3.7 -
Too small to take drugs 8.8 3.7 -
Too many tablets 6.1 0 -
Fear of side effects 5.4
4.1
51.2 18.2(8.6-38.1)
Forgot to take 4.1 1.6 -
Fear to give drugs to
children's
3.4 4.7 1.4(0.5-3.8)
Other reasons 3.5 5.5 1.6(0.6-4.4)
Exclusion criteria 12.9 4.4 -

11. Table 4: Distribution of study subjects according to compliance (DEC+albendazole)

12. CONCLUSION
The MDA coverage and compliance should be given at most
importance.
Effective drug delivery strategies needed to improve the
compliance
Even with 54-75% treatment coverage, can reduce LF
transmission very appreciably.
Better treatment coverage and a few more rounds of MDA
may achieve total interruption of transmission.

13. LIMITATIONS
The study was conducted after 3 months of MDA campaign (recall
bias)
The Survey assessed only the coverage aspect and not the entire
MDA implementation programme.
Exclusion criteria was not followed properly by drug distributers.
Interviewer was informally trained (Measurement bias)
Short time span for the study.

14. LEARNING
LF endemic areas in India.
LF prophylaxis
Cluster sampling methods.
Cross sectional study.

15. THANK YOU