Table 2. Implementation challenges and opportunities for improved uptake.

Issue	Challenges	Opportunities for Improved Uptake
Community members’ refusal to take the drugs	Lack of perceived need for treatment Unaware of MDA Fear of Severe Adverse Events (SAEs) (abdominal pain, nausea and dizziness) Myths and misconceptions about LF disease Lack of hygiene in drugs handling	Awareness creation on LF, drugs used and eligibility Aggressive and repeated awareness creation about MDA Awareness creation about potential SAEs which are resilient Repeated health promotion activities Use of plastic spoons while administering the drugs
Community members’ absenteeism during MDA	Seasonal migration-for agricultural activities Occupation (working and living away from home periodically) Unaware of MDA timing	Duration and timing of MDA to be scheduled in consideration of farming season Awareness creation Repeated messaging on MDA
Lack of transparency in the CDDs selection process	Unknown CDDs Aged CDDs who had never attended school Same CDDs all years	Select CDDs who belong to the villages allocated Select youthful CDDs with some level of schooling Give others (CHVs) a chance to participate
Inadequacy of number of CDDs in comparison to the area to be covered	Limited number of CDDs, limited time to respond to community members’ questions Large area to be covered Few CDDs allocated to vast areas with sparse population	Engage more CDDs Allocate enough CDDs to large areas Allocate enough CDDs to vast areas to allow them reach all households
Inadequate training of CDDs	No training at all Inadequate training-too brief	Train CDDs adequately Call CDDs for training in good time and train adequately
Insufficiency of drugs issued to CDDs	Inadequate numbers of drugs for all community members	Issue enough drugs to cater for those absent during registration
Lack of CDDs supervision and low motivation	Little or no supervision at all Low motivation	Adequate supervision of CDDs for moral support Appreciate and motivate CDDs