Awareness and coverage of mass drug administration for elimination of lymphatic filariasis: a community based cross sectional study in Nepal.

Lymphatic filariasis (LF) is among the major public health problems in Nepal. The disease is a major cause of morbidities primarily, lymphedema of legs and hydrocele and it impedes socio economic development in many endemic areas of the country. This study is aimed at exploring the understanding of people about mass drug administration (MDA) of the said disease and the status of compliance of MDA in Nepal. This study is a cross sectional study carried out among 894 household samples in three of the sixty LF endemic districts. The selected districts were Dhading, Kapilvastu and Kailali. The sentinel surveillance of sites in three districts constituted the sampling frame at the first stage. The peripheral health care centers in the sentinel sites constituted the sampling frame at the second stage of sampling. The coverage of MDA was 95.5 %. However, the compliance was less. Only 71.6 % of the respondents who took the drugs from health workers swallowed the diethyl carbamazine (DEC) completely, other did not swallow. In the present study, majority of respondents reported that they had heard or seen persons with side effects of DEC in their community. A total of 20 % of respondents reported that they had side effects after having DEC and only 3.9 % of these side effects were treated. The Female Community Health volunteers (FCHVs), health workers and radio/Television (TV) were the chief sources of MDA related information. This study recommends for a concerted public health action combining effective drug delivery mechanism and sound public awareness campaigns. The community people need to be made aware beforehand about the location, time of drug distribution. Also public awareness of the DEC should be conducted so that people would trust it and comply with the drug regime. Along with the health workers and radio/TV that has been used traditionally, we recommend mobilization of FCHVs in the public awareness campaigns the MDA campaigns.

Health-seeking behaviors and self-care practices of people with filarial lymphoedema in Nepal: a qualitative study.

Background. Lymphatic filariasis is endemic in Nepal. This study aimed to investigate health-seeking behaviors and self-care practices of people with filarial Lymphoedema in Nepal. Methods. A cross-sectional study was conducted using qualitative methods in three endemic districts. Twenty-three patients with current Lymphoedema were recruited in the study. Results. Hydrocele was found to be a well-known condition and a major health problem in the studied communities. People with Lymphoedema primarily sought health care from traditional healers, whereas sometimes home-based care was their first treatment. Later Ayurvedic and allopathic hospital-based care were sought. Respondents reported various psychological problems such as difficulty in engaging in sexual intercourse, anxiety, worry and stress, depression, low self-esteem, feeling weak, fear of being abandoned, and fear of transmitting disease to the children. Standard foot care practices except washing were largely absent. Conclusions. Lymphoedema in the limbs and hydrocele were found to be major health problems. The traditional health care providers were the first contact of care for the majority of respondents. Only a few patients had been practicing standard foot care practices.