02901nas a2200241   4500000000100000008004100001260005300042653002900095653002500124653004000149653002200189653001000211100001300221700001400234700001200248700001100260700001500271245012300286856008300409300000900492520214400501022001402645       2025                            d  c12/2025bSpringer Science and Business Media LLC10aMass drug administration10aLymphatic filariasis10aCoverage Evaluation Sampling Survey10aendemic districts10aIndia1 aBiswas B1 aJahnavi G1 aGupta P1 aPaul A1 aVarshney S00aCoverage evaluation of mass drug administration for lymphatic filariasis in four endemic districts of Jharkhand, India  uhttps://link.springer.com/content/pdf/10.1186/s41043-025-01185-7_reference.pdf  a1-303 a<p><strong>Background</strong></p>

<p>Lymphatic filariasis (LF) remains endemic in several districts of Jharkhand despite repeated Mass Drug Administration (MDA) rounds. This study assessed drug coverage, compliance, and associated factors in four endemic districts: Deoghar, Dumka, Giridih, and Godda.</p>

<p><strong>Methods</strong></p>

<p>A community-based cross-sectional Coverage Evaluation Survey (CES) was conducted within six weeks of MDA. The double-drug regimen (Diethylcarbamazine and Albendazole) (DA) was administered in Deoghar and Giridih, and the triple-drug regimen (Ivermectin, Diethylcarbamazine, and Albendazole) (IDA) in Dumka and Godda. Using multistage random sampling of clusters and systematic selection of adjacent households within each cluster, 2,400 households (14,782 individuals) were surveyed. Coverage indicators were calculated per World Health Organization (WHO) guidelines.</p>

<p><strong>Results</strong></p>

<p>Overall drug coverage was 52.1%, and epidemiological drug coverage was 49.2%. Complete household-level MDA drug coverage was 45.0%, highest in Dumka (58.2%) and lowest in Giridih (28.8%). In multivariable logistic regression analysis, significant predictors of complete household-level MDA drug coverage included higher educational level (adjusted odds ratio [aOR]: 1.05), residence in Dumka (aOR: 1.63) or Godda (aOR: 1.40), tribal (aOR: 2.27) or rural area (aOR: 2.02), awareness of LF (aOR: 1.87), knowledge that LF is mosquito-borne (aOR: 1.32), prior MDA communication (aOR: 2.64), and participation in two or more previous MDA rounds (aOR: 2.30). Larger household size was negatively associated (aOR: 0.88). Among MDA participants, adverse events were significantly more common when drugs were consumed on an empty stomach (<em>p</em> &lt; 0.001).</p>

<p><strong>Conclusion</strong></p>

<p>None of the districts achieved WHO-recommended epidemiological coverage thresholds (≥ 65% for DA and ≥ 85% for IDA). Strengthening community engagement and pre-campaign communication is essential for improving MDA outcomes and accelerating LF elimination.</p>
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