Factors associated with the acceptance of mass drug administration for the elimination of lymphatic filariasis in Agusan del Sur, Philippines

Background: Mass drug administration (MDA) has been one of the strategies endorsed by the World Health Assembly for lymphatic filariasis (LF) elimination. Many factors, however, affect the acceptability of the MDA in the Philippines with acceptability defined as the ingestion of drugs - diethylcarbamazine and albendazole during MDA. These drugs were mainly distributed in fixed sites and mopping up activities were conducted through house-to-house visits to increase treatment coverage. The aim of conducting the study was to determine the MDA acceptance rate among a population endemic for LF, and the factors associated with MDA acceptance. Methods: In April 2005, a stratified cluster survey involving 437 respondents aged 18 years old and above in Agusan del Sur, Philippines was conducted. Key informant interviews and focused group discussions were performed among community leaders and health service providers. Descriptive statistics and coverage estimates were calculated with appropriate sampling weights applied to all analyses. Factors assessed for association with receipt of antifilarial drugs and MDA acceptance were respondents' socio-demographic characteristics, knowledge, attitudes, beliefs and perceptions on LF. Pearson chi-squared test was used to determine factors associated with MDA acceptance. Results: Results showed that 63.3% of the sampled population received the antifilarial drugs; of these, 94.5% ingested the drugs, yielding an acceptance rate of 60%. Half of the sampled population received the drugs from a fixed site, while only 13% was mopped up. A majority of the sampled population were aware of LF and MDA. Knowledge on LF prevention, cause, treatment and diagnosis and adverse events was low to moderate. Knowledge on LF and perceived benefits of antifilarial drugs were found to be associated with MDA acceptance (p = 0.08). Health workers remain the front liners in the MDA implementation. Local government units were aware of LF and MDA, but support was insufficient. Conclusion: The proportion of the sampled population that received and ingested the antifilarial drugs was much lower than the reported coverage. The target coverage rate of 85% may be achieved with sufficient groundwork for MDA, buy-in from the local government, greater efforts exerted to increase the people's knowledge on LF and MDA and their understanding of perceived benefits of the drugs. These would contribute to the successful elimination of LF in the province.