Title : Role of health workers in the management of mass drug administration in lymphatic filariasis elimination program of Nepal: A mixed method study
Abstract:
Background: Lymphatic filariasis (LF), commonly known as elephantiasis, is a debilitating mosquito-borne disease caused by filarial parasites. The Global program to Eliminate to Lymphatic Filariasis was launched by WHO in 2000 with the aim of eliminating lymphatic filariasis as a public health problem worldwide. Health workers play a critical role in determining the quality and success of MDA programs. This study focuses on assessing health workers engagements, knowledge and attitude towards LF and MDA in order to support the strengthening of program effectiveness.
Methods: A mixed methods study was conducted among 257 health workers to assess their role in lymphatic filariasis. The quantitative approach used a cross-sectional design with a multi-stage sampling method, selecting districts, municipalities and health workers through simple random and population proportionate methods to ensure representative sampling and data were analyzed using bivariate and multivariate logistic regression to identify factors associated with knowledge, attitude and engagement. The qualitative approach employed FGD using purposive sampling until saturation, and data were analyzed using Braun and Clarke’s six step thematic analysis.
Results: Among 257 health workers in the study, 42.8% were found with optimal knowledge on Lymphatic filariasis and MDA Program. Similarly, only 45.1% health workers demonstrated favorable attitude, and 63.8% reported optimal engagement in LF-MDA activities. In multivariable logistic regression, non-Hindu health workers [AOR=2.69, 95% CI:1.04-6.9] and those working in urban setting [AOR=2.11;95 % CI=1.11-4.00] were more likely to have optimal knowledge, whereas health workers from ethnic groups other than Brahmin/Chhetri were less likely [AOR =0.46;95% CI:0.24-0.88]. Health workers with favorable attitudes were also more likely to have optimal knowledge [AOR=1.84;95%CI:1.04-3.26]. Likewise, health workers aged ≥32 years [AOR=3.31;95% CI:1.75-6.27] and those with optimal knowledge [AOR=1.85;95% CI: 1.04-3.27] were more likely to have favorable attitude [AOR =0.45;95% CI:0.11-0.84], similarly health workers with optimal engagement [AOR=0.45;95% CI:0.24-0.84] were less likely to have favorable attitude. For engagement, unmarried health workers [AOR=0.23;95% CI: 0.11-0.50] and those with favorable attitudes [AOR=0.47 ,95% CI:0.25-0.87] were less likely to have optimal involvement in LF-MDA activities.
Similarly, qualitative findings also explored health workers as strategic implementers, contextually competent resource, community mediators, compliance facilitators, and program optimizer, highlighting their end-to-end involvement in MDA delivery, coordination with stakeholders, management of community fears and rumors and adaptation to local context.
Conclusion: The findings demonstrated that health workers are the important resource for the program who are involved in planning, implementation and optimization of LF-MDA activities, who are not only working just as service providers but also as community mediators, compliance facilitators, teamwork enablers and program optimizers. Strengthening training, supervision, incentives, logistical support is critical to improve their performance, engagement and program outcomes, thereby supporting LF elimination goals in Nepal.
Keywords: Lymphatic Filariasis, Mass Drug Administration, Health Workers, Engagement, Nepal.
