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Predictors of Compliance in Mass Drug Administration for the Treatment and Prevention of Lymphatic Filariasis in Leogane, Haiti

The global strategy for the elimination of lymphatic filariasis (LF) is based on annual mass drug administration (MDA) to interrupt transmission. Noncompliance with MDA represents a serious programmatic obstacle for the LF program because systematically noncompliant individuals may serve as a reservoir for the parasite and permit recrudescence of infection. Using a survey questionnaire concerning practices, beliefs, and attitudes towards MDA, we assessed differences between noncompliant individuals and compliant individuals in Leogane, Haiti (n = 367) after four years of treatment. A logistic regression model showed the odds of being noncompliant were significantly increased for women (odds ratio = 2.74, 95% confidence interval = 1.12–6.70), as well as for people who lacked knowledge about both LF and programs to eliminate infection. Public health programs should be designed to target people who are at risk for systematic noncompliance.

Received July 6, 2007. Accepted for publication October 25, 2007.

Acknowledgments: We thank the project staff in Leogane and the people living in the sentinel sites and Michael Deming for assistance with the sampling strategy for the case-control study.

Financial support: The study was supported by the Emerging Infections Program of CDC and by a grant from the Bill & Melinda Gates Foundation to the University of Notre Dame. Abigail Viall was supported by an Emerging Infectious Disease fellowship from the Association of Public Health Laboratories.

Disclaimer: The views of the authors are their own and do not necessarily represent those of CDC.

^* Address correspondence to Patrick J. Lammie, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Mailstop F-36, 4770 Buford Highway, Atlanta, GA 30341. E-mail: pjl1{at}cdc.gov

Authors’ addresses: Jeffrey T. Talbot, Center for Biostatistics and AIDS Research, Harvard University, 677 Huntington Avenue, Boston, MA 02215. Abigail Viall, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Mailstop D-21, 1600 Clifton Road, Atlanta, GA 30333. Abdel N. Direny and Madsen Beau de Rochars, Hopital Ste. Croix, Leogane, Haiti. David G. Addiss, Fetzer Institute, 9292 West KL Avenue, Kalamazoo, MI 49009. Thomas G. Streit, Center for Global Health, University of Notre Dame, 351 Galvin Hall, Notre Dame, IN 46556. Els Mathieu, Division of Parasitic Diseases Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, GA 30341. Patrick J. Lammie, Division of Parasitic Diseases Mailstop F-36, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341.