Table 2.
| Table 2a. Determinants influencing outcome of LF elimination programs | ||||
|---|---|---|---|---|
| Factor | Positive influence* | Negative influence† | Readily changeable | Important/researchable |
| Biologic/epidemiologic/therapeutic | ||||
| Endemicity (prevalence/density) | Low | High | No | ✓ |
| Human population | Small | Large | No | |
| Endemic areas | 1) Easily accessed 2) Rural |
1) Remote 2) Urban |
No | |
| Vector density | Low | high | Yes | ✓ |
| Vector species | Anopheles (? some better than others) | Aedes or Culex | No | ✓ |
| Transmission | Seasonal | Year-round | No | ✓ |
| Parasite species | Anthropophilic Brugia | W. bancrofti | No | |
| MDA treatment regimen | DEC (diethylcarbamazine) + albendazole | Ivermectin + albendazole | +/− | ✓ |
| Ivermectin dosage in regimen | 400 mcg/kg | 150–200 mcg/kg | Yes | ✓ |
| Parasite responsiveness to treatment | Excellent | Residual mf/ag-emia | No | |
| Contiguous endemic areas | Under MDA treatment | Untreated | Yes | ✓ |
| Sympatric Loa loa | No | Yes | No | |
| Sympatric zoophilic Brugia | No | Yes | No | ✓ |
| Economic/political/social | ||||
| Economic development of endemic area | High (including housing, roads) | Low, with poor physical infrastructure | No | |
| Administrative development of endemic area | High overall performance | Low performance record | No | |
| Health system infrastructure | Good (including local health units) | Poor, with weak national MOH | No | |
| Urban population: socio-economic status | Lower (more difficult to reach, easier to treat) | Higher (easier to reach, more difficult to treat) | No | ✓ |
| Political stability, security | Good | Poor, high security risk | No | |
| Political commitment for NPELF | Strong | Minimal | Yes | |
| Compliance (people taking the drugs) | High compliance rate; no persistent non-compliance | Persistent non-compliance or poor compliance rate | Yes | ✓ |
| Evident morbidity in population | High (leads to perception of importance) | Low (inhibits recognition of importance) | No | |
| Past experience of population with LF or other MDA programs | Good results, minimal inconvenience | Poor quality drugs, adverse reactions | No | |
| Migration from other endemic areas | Minimal | Extensive | No | ✓ |
| Table 2b. Factors affecting operational effectiveness of LF elimination programs | ||||
|---|---|---|---|---|
| Factor | Positive influence | Negative influence | Readily changeable | Important/researchable |
| Global program guidelines | Detailed, comprehensive | Imprecisely defined goals, tools, strategies (compliance, # MDAs, monitoring tools, sampling strategies, stopping criteria) | Yes | |
| Mapping of LF and other NTDs | Complete | Incomplete | Yes | |
| Program management, leadership | Strong | Weak | Yes | |
| Advocacy and fund-raising | Active and effective | Poor or non-existent | Yes | |
| “Personpower” | Sufficient, well-trained, conscientious | Shortage, unskilled or untrained | Yes | |
| Drug distributors | Well trained, well informed, compensated | Poorly motivated and trained | Yes | |
| Social mobilization | Strong (IEC/COMBI), with involvement of village leaders | Inadequate | Yes | ✓ |
| Drug quality | High and consistent | Uncertain or poor | Yes | |
| Drug supply/delivery | Timely and coordinated for 2-drug delivery | Unreliable, uncoordinated | Yes | |
| MDA organization | Well timed (dates, duration) | Shifting dates, conflicting dates | Yes | |
| Drug administration | By Directly Observed Treatment | Not DOT | Yes | ✓ |
| Treatment “coverage ” (tablets distributed) | High (estimated > 70% total population) | Low | Yes | ✓ |
| Treatment of “side reactions” | Provision for rapid, effective management (medical and “political”) | Inadequate response to person and community needs | Yes | |
| Morbidity management | Strong program in place for lymphedema management and hydrocoele surgery | Minimal attention to morbidity issues | Yes | |
| Monitoring | Independent, routine; following process indicators, using good sampling strategies | Insufficient frequency or attention to detail | Yes | |
| Evaluation | Baseline mf- or ag-emia and reassessment at defined intervals or potential program end-point, using good sampling strategies | No baseline values; poor sampling strategy | Yes | ✓ |
| Adjunctive tools to eliminate LF | Vector control, twice-yearly MDA or DEC-salt supplements in place | No adjunctive measures | Yes | ✓ |
| LF’s relation to other NTD Programs | Integration or strong coordination in place | National program operates independently | Yes | ✓ |
| Community understanding | Recognizes multiple benefits of MDA (on LF, on intestinal parasites etc.) | Inadequate information on program’s full benefits to the population | Yes | ✓ |
| Partnering organizations | Multiple and coordinated | Few or uncoordinated | Yes | |
| Funding for LF program | Sufficient (best from national budget line) | Inadequate, without ensured continuity | Yes | |
| Link between national program and research community | Good collaboration; shared responsibility | Competition, distrust | Yes | |
*
Leading to greater impact or shorter duration of MDA activities.
†
Leading to lesser impact or longer duration of MDA activities.
MDA = mass drug administration; NPELF = National Program to Eliminate Lymphatic Filariasis; MOH = Ministry of Health.
MDA = mass drug administration; LF = lymphatic filariasis; NTD = neglected tropical diseases; IEC/COMBI = information education communication/communication for behavioral impact; DOT = directly observed treatment; DEC = diethylcarbamazine.