Improving Mass Drug Administration for Lymphatic Filariasis Elimination after Pre-Transmission Assessment Survey Failure: A Mixed Methods Study in Nepal

Background

Since 2003, MDA program has been conducting till date in Nepal. The program was initiated in all districts in 2013 and later in 2017 it was stopped in more than half of the districts. Nepal is one of the first countries in the global program to achieve 100% geographical coverage, reaching all 63 districts out of 77 districts with MDA. About 48 out of 63 have stopped MDA and are on post-MDA surveillance. The remaining 15 districts have failed the pre-TAS/TAS for at least once. Of these 15 districts, this study is based on Parbat and Bardiya.

Objectives of the Study

The overall purpose of the project is:

To gather in-depth insights on factors that are associated with MDA coverage and compliance in Bardiya and Parbat. In other words, the study gathers in-depth insights into individual, community, health system and programmatic factors associated with MDA coverage and compliance, with the goal of providing actionable insights into how to adapt and tailor field strategies to improve MDA in districts that have failed pre-TAS in Nepal. In addition to the broader objective, this study has specific objectives as well. These are ranged from individual level, community to programmatic aspects. For example, at the individual level, the study seeks to explore the rate systematic non-compliance among people or groups of individual across the communities while on the other side study explores role of sociocultural factors for motivations and professional quality of life during MDA among others.

Methodology

The mixed methods study design including; qualitative, quantitative, observation and rapid ethnographic data collection along with participatory stakeholders’ workshops. Further, for the quantitative study; the population study includes the adults of aged 18 years and above, who reside in the two selected districts; Bardiya and Parbat at the time of survey. For the qualitative study; the study population include community members, local community and government leaders and health staff in both of the study districts and a few national-level government and NGO staff based in Kathmandu.