Improved assessment of mass drug administration and health district management performance to eliminate lymphatic filariasis

摘要

Author summary Global elimination of lymphatic filariasis (LF) is achieved through treatment of at-risk populations with annual or bi-annual mass drug administration campaigns. In Africa campaigns need to be completed in 32 countries with 343 million people at risk. The World Health Organisation recommends verification of the campaign's administrative records using household cluster surveys at least once every 5-years. However, cluster surveys are expensive and usually completed in a few districts only or at sub-national levels. Together with National Programmes in Mozambique and the Democratic Republic of the Congo (DRC) we adapted Lot Quality Assurance Sampling (LQAS) methods to verify campaign coverage because it is relatively inexpensive in comparison to other survey approaches, provides information and facilitates actions at the Implementation Unit (IU) level, which is usually the district. LQAS signals IU whose performance is likely to need improvement because MDA coverage is below the coverage target. Our results show consistently that administrative records over-estimated campaign coverage and did not detect implementation and coverage problems due to errors in numerators and denominators, incorrect reporting, and/or incorrect aggregation of tally sheets. The LQAS verification approach prompted immediate action to remedy coverage shortfalls averting persistent LF transmission and disease, and the costs associated with failed campaigns. Our study demonstrates that a rapid probability sample to verify coverage provides district teams with information after each campaign which can be used for action, and that one coverage survey every 5-years is insufficient for infectious disease elimination in highly endemic settings where achievement of optimal coverage is essential. It also demonstrates that LQAS provides a decentralised assessment, sensitive for detecting and ameliorating programme bottlenecks and can be used to verify MDA in other countries.