Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-26T18:49:58.227Z Has data issue: false hasContentIssue false
  • English
  • Français

DILEMMAS OF COMMUNITY-DIRECTED MASS DRUG ADMINISTRATION FOR LYMPHATIC FILARIASIS CONTROL: A QUALITATIVE STUDY FROM URBAN AND RURAL TANZANIA

Published online by Cambridge University Press:  29 July 2016

William Kisoka ,
Declare Mushi ,
Dan W. Meyrowitsch ,
Mwele Malecela ,
Paul E. Simonsen  and
Britt P. Tersbøl
William Kisoka
Affiliation:
National Institute for Medical Research, Dar es Salaam, Tanzania Tumaini University, Kilimanjaro Christian Medical College, Moshi, Tanzania
Declare Mushi
Affiliation:
Tumaini University, Kilimanjaro Christian Medical College, Moshi, Tanzania
Dan W. Meyrowitsch
Affiliation:
Global Health Section, Department of Public Health, University of Copenhagen, Denmark
Mwele Malecela
Affiliation:
National Institute for Medical Research, Dar es Salaam, Tanzania
Paul E. Simonsen
Affiliation:
Department of Veterinary Disease Biology, University of Copenhagen, Denmark
Britt P. Tersbøl*
Affiliation:
Global Health Section, Department of Public Health, University of Copenhagen, Denmark
*
1Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

There has in recent years been a growing interest in the social significance of global health policy and associated interventions. This paper is concerned with neglected tropical disease control, which prescribes annual mass drug administration to interrupt transmission of, among others, lymphatic filariasis. In Tanzania, this intervention is conducted through community-directed distribution, which aims to improve drug uptake by promoting community participation and local ownership in the intervention. However, the average uptake of drugs often remains too low to achieve the intended interruption of transmission. The qualitative research presented here followed the implementation of mass drug administration in Lindi and Morogoro Regions, Tanzania, in 2011 to understand the different forms of involvement in the campaign and the experiences of stakeholders of their part in community-directed distribution. Some health care workers, community leaders and drug distributors were generally positive about the intervention, emphasizing that the drugs were welcome. Other stakeholders, including the drug-receiving population, reported facing a number of dilemmas of uncertainty, authority and exclusion pertaining to their roles in the intervention. These dilemmas should be of interest to donors, policymakers and implementers. Community-directed distribution relies on social relations between the many different stakeholders. Successful and justifiable interventions for lymphatic filariasis require implementers to recognize the central role of sociality and that the voices and priorities of people count.

Type
Research Article
Information
Journal of Biosocial Science , Volume 49 , Issue 4 , July 2017 , pp. 447 - 462
Copyright
Copyright © Cambridge University Press, 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allen, T. & Parker, M. (2011) The ‘Other Diseases’ of the Millennium Development Goals: rhetoric and reality of free drug distribution to cure the poor’s parasites. Third World Quarterly 32, 91–117.CrossRefGoogle ScholarPubMed
Allen, T. & Parker, M. (2012) Will increased funding for neglected tropical diseases really make poverty history? The Lancet 379, 1097–1098.CrossRefGoogle ScholarPubMed
Amazigo, U. V., Leak, S. G., Zoure, H. G., Njepuome, N. & Lusamba-Dikassa, P. S. (2012) Community-driven interventions can revolutionise control of neglected tropical diseases. Trends in Parasitology 28, 231–238.CrossRefGoogle ScholarPubMed
Biehl, J. & Petryna, A. (2013) When People Come First: Critical Studies in Global Health. Princeton University Press, Princeton.Google Scholar
The CDI Study Group (2010) Community-directed interventions for priority health problems in Africa: results of a multicountry study. Bulletin of the World Health Organization 88, 509–518.CrossRefGoogle Scholar
Chami, G. F., Kontoleon, A. A., Bulte, E., Fenwick, A., Kabatereine, N. B., Tukahebwa, E. M. & Dunne, D. W. (2016) Profiling nonrecipients of mass drug administration for schistosomiasis and hookworm infections: a comprehensive analysis of praziquantel and albendazole coverage in community-directed treatment in Uganda. Clinical Infectious Disease 16, 62.Google Scholar
Cornwall, A. & Brock, K. (2005) What do buzzwords do for development policy? A critical look at ‘participation’, ‘empowerment’ and ‘poverty reduction’. Third World Quarterly 26, 1043–1060.CrossRefGoogle Scholar
Creswell, J. W. (2007) Qualitative Inquiry and Research Design. Choosing Among Five Approaches, 2nd edn. Sage Publications, CA.Google Scholar
Hardon, A. & Moyer, E. (2014) Medical technologies: flows, frictions and new socialities. Anthropology & Medicine 21(2), 107–112.CrossRefGoogle ScholarPubMed
Homeida, M., Braide, E., Elhassan, E., Amazigo, U. V., Liese, B., Benton, B. et al. (2002) APOC’s strategy of community-directed treatment with ivermectin (CDTI) and its potential for providing additional health services to the poorest populations. Annals of Tropical Medicine & Parasitology 96(Supplement 1), S93–S104.CrossRefGoogle Scholar
Katabarwa, M. N., Habomugishab, P., Agunyob, S., McKelveyc, A. C., Ogwengd, N., Kwebiihae, S. et al. (2010) Traditional kinship system enhanced classic community-directed treatment with ivermectin (CDTI) for onchocerciasis control in Uganda. Transactions of the Royal Society of Tropical Medicine and Hygiene 104(4), 265–272.CrossRefGoogle ScholarPubMed
Keating, J., Yukich, J. O., Mollenkopf, S. & Tediosi, F. (2014) Lymphatic filariasis and onchocerciasis prevention, treatment, and control costs across diverse settings: a systematic review. Acta Tropica 135, 86–95.CrossRefGoogle ScholarPubMed
Kisinza, W. N., Kisoka, W. J., Mutalemwa, P. P., Njao, J., Tenu, F., Nkya, T. et al. (2008) Community directed interventions for malaria, tuberculosis and vitamin A in onchocerciasis endemic districts of Tanzania. Tanzania Journal of Health Research 10, 232–239.Google ScholarPubMed
Kisoka, W. J., Simonsen, P. E., Malecela, M. N., Tersbøl, B. P., Mushi, D. L. & Meyrowitsch, D. W. (2014) Factors influencing drug uptake during mass drug administration for control of lymphatic filariasis in rural and urban Tanzania. PLoS One 9, e109316.CrossRefGoogle ScholarPubMed
Kisoka, W. J., Tersbøl, B. P., Meyrowitsch, D. W., Simonsen, P. E. & Mushi, D. L. (2016) Community members’ perceptions of mass drug administration for control of lymphatic filariasis in rural and urban Tanzania. Journal of Biosocial Science 48, 94–112.CrossRefGoogle ScholarPubMed
Krentel, A., Fischer, P. U. & Weil, G. J. (2013) A review of factors that influence individual compliance with mass drug administration for elimination of lymphatic filariasis. PLoS Neglected Tropical Diseases 7(11), e2447.CrossRefGoogle ScholarPubMed
Kyelem, D., Biswas, G., Bockarie, M. J., Bradley, M. H., El-Setouhy, M., Fischer, P. U. et al. (2008) Determinants of success in national programs to eliminate lymphatic filariasis: a perspective identifying essential elements and research needs. American Journal of Tropical and Medicine and Hygiene 79(4), 480–484.Google ScholarPubMed
Lock, M. & Nguyen, V. K. (2006) An Anthropology of Biomedicine . John Wiley & Sons Ltd, Chichester.Google Scholar
Marsland, R. (2006) Community participation the Tanzanian way: conceptual contiguity or power struggle? Oxford Development Studies 34, 65–79.CrossRefGoogle Scholar
Ministry of Health and Social Welfare (2009) Tanzania NTD Country Plan for 2009 – 2014. Ministry of Health and Social Welfare, Tanzania.Google Scholar
National Bureau of Statistics (2013) 2012 Population and Housing Census. Dar es Salaam, United Republic of Tanzania.Google Scholar
Ottesen, E. (2006) Lymphatic filariasis: treatment, control and elimination. Advances in Parasitology 61, 395–441.CrossRefGoogle ScholarPubMed
Prince, R. J. & Marsland, R. (2013) Making and Unmaking Public Health in Africa: Ethnographic and Historical Perspectives. Ohio University Press, Athens.Google Scholar
Parker, M. & Allen, T. (2013) Will mass drug administration eliminate lymphatic filariasis? Evidence from northern coastal Tanzania. Journal of Biosocial Science 45, 517–545.CrossRefGoogle ScholarPubMed
Parker, M., Allen, T. & Hastings, J. (2008) Resisting control of neglected tropical diseases: dilemmas in the mass treatment of schistosomiasis and soil-transmitted helminths in north-west Uganda. Journal of Biosocial Science 40, 161–181.CrossRefGoogle ScholarPubMed
Petryna, A., Lakoff, A. & Kleinman, A. (2006) Global Pharmaceuticals: Ethics, Markets, Practices. Duke University Press, Durham.Google Scholar
Samsky, A. (2012) Scientific sovereignty: how international drug donation programs reshape health, disease, and the state. Cultural Anthropology 27, 310–332.CrossRefGoogle ScholarPubMed
Simonsen, P. E., Derua, Y. A., Magesa, S. M., Pedersen, E. M., Stensgaard, A. S., Malecela, M. N. & Kisinza, W. N. (2014b) Lymphatic filariasis control in Tanga Region, Tanzania: status after eight rounds of mass drug administration. Parasites & Vectors 7, 507.CrossRefGoogle ScholarPubMed
Simonsen, P. E., Fischer, P. U., Hoerauf, A. & Weil, G. J. (2014a) The filariasis. In Farrar, J., Hotez, P. J., Junghanss, T., Kang, G., Lalloo, D. & White, N. J., (eds) Manson’s Tropical Diseases, 23rd edn. Elsevier Saunders, pp. 736–765.Google Scholar
Singer, M. & Bulled, N. (2012) Interlocked infections: the health burdens of syndemics of neglected tropical diseases. Annals of Anthropological Practice 36, 328–345.CrossRefGoogle Scholar
Wayland, C. & Crowder, J. (2002) Disparate views of community in primary health care: understanding how perceptions influence success. Medical Anthropology Quarterly 16, 230–247.CrossRefGoogle ScholarPubMed
WHO (2013a) Regional Strategic Plan for Neglected Tropical Diseases in the African Region 2014 – 2020. World Health Organization, Brazzaville.Google Scholar
WHO (2013b) Lymphatic Filariasis: Managing Morbidity and Preventing Disability: An Aide-Mémoire for National Programme Managers. URL: http://apps.who.int/iris/bitstream/10665/85347/1/9789241505291_eng.pdf Google Scholar
WHO (2016) Lymphatic Filariasis Fact Sheet. URL: http://www.who.int/mediacentre/factsheets/fs102/en/ Google Scholar
WHO/APOC (2007) Revitalising Health Care Delivery in Sub-Saharan Africa. The Potential of Community-Directed Interventions to Strengthen Health Systems. World Health Organization and African Programme for Onchocerciasis Control .CrossRefGoogle Scholar
WHO/TDR (2008) Community-Directed Interventions for Major Health Problems in Africa: A Multi-Country Study. Final Report. World Health Organization and Special Programme for Research and Training in Tropical Diseases, Geneva.Google Scholar
Zakus, J. D. & Lysack, C. L. (1998) Revisiting community participation. Health Policy Planning 13, 1–12.CrossRefGoogle ScholarPubMed
Zhang, Y., MacArthur, C., Mubila, L. & Baker, S. (2010) Control of neglected tropical diseases needs a long-term commitment. BMC Medicine 8, 67.CrossRefGoogle Scholar