Community-based lymphatic filariasis education in Orissa State, India, increased treatment compliance from around 50% to up to 90%, according to a study published June 29 in the open-access journal PLoS Neglected Tropical Diseases.

In their study, researchers from the U.S. Centers for Disease Control and Prevention, in partnership with the Church's Auxiliary for Social Action, an India-based non-governmental organization, and IMA World Health, a US-based non-governmental organization, identified barriers to compliance with India's MDA program for LF, and suggest that timely educational and lymphedema management programs can reverse this trend.

Nearly 1.3 billion people worldwide live at risk of infection with the parasite that causes lymphatic filariasis. Infected individuals may develop long-term complications, such as grossly swollen limbs from lymphedema. Elimination of this disease of poverty requires giving drugs at least once per year to people who are at risk; of that population, 80% or more need to continue receiving medication on an annual basis for 5 or more years to stop transmission.

The authors evaluated a community-based education campaign, noted deficiencies, and designed interventions to correct them. An evaluation of the revised education program, covering over 8,000 people in ninety villages, showed markedly improved drug compliance and, for the first time, showed that lymphedema management programs, which teach leg care to patients with swollen legs, may also increase compliance with lymphatic filariasis mass drug administration programs. The increase was greatest in areas that had implemented U.S. Agency for International Development-supported programs to teach people how to care for legs swollen from infection.

This evaluation was confined to rural areas in Orissa State, so the findings do not necessarily apply to urban areas or areas outside the state. Nonetheless, lymphatic filariasis elimination programs facing difficulties in achieving the necessary level of drug compliance should consider evaluating their education campaigns using similar methods and integrating lymphedema management with lymphatic filariasis elimination efforts, the authors say.

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Financial disclosure: Funding for this work was provided by USAID (GHA-G-00-03-0005-00) to IMA World Health and by CDC (IAA GHH99-006). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manucript.

Competing interests: The authors have declared that no competing interests exist

PLEASE ADD THIS LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://dx.plos.org/10.1371/journal.pntd.0000728

Citation: Cantey PT, Rout J, Rao G, Williamson J, Fox LM (2010) Increasing Compliance with Mass Drug Administration Programs for Lymphatic Filariasis in India through Education and Lymphedema Management Programs. PLoS Negl Trop Dis 4(6): e728. doi:10.1371/journal.pntd.0000728