Participation in three consecutive mass drug administrations in Leogane, Haiti

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Abstract
In the global effort to eliminate lymphatic filariasis, mass drug administrations (MDAs) are organised annually. The success of this strategy depends on achieving high levels of drug coverage, which reduce the number of persons with circulating microfilariae and consequently transmission. Persons who consistently fail to participate in MDAs represent a potential threat to the goal of filariasis elimination. We wanted to know the drug coverage, the proportion of persons who were systematically non-compliant and factors associated with this behaviour. We conducted three surveys following the third annual MDA of a filariasis elimination program in Leogane, Haiti: (1) a total population survey to determine coverage; (2) an adult survey to determine non-compliance and associated factors and (3) an urban survey to make a rural-urban comparison. During the third MDA, the overall surveyed coverage was 78.5% [95% confidence interval (CI) 74.4-82.6] A survey among adult population showed coverage estimates for persons >14 years old of 59.4% (95% CI 52.0-66.7), 61.0% (95% CI 55.0-67.4) and 67.3% (95% CI 60.5-74.0), for the first, second and third MDA respectively. The coverage in rural areas (78.3%) was significantly higher than in urban areas (68.3%, P < 0.05). Of the population > 14 years of age, 18% never took the drugs during any of three MDAs. These persons did not differ significantly from MDA participants by age, gender or other characteristics that we assessed. More research is needed to identify characteristics of systematically non-compliant persons in order to refine health education messages and improve distribution strategies to increase drug coverage.