03179nas a2200301   4500000000100000008004100001653002900042653002500071653001900096653003000115653000900145653002300154100001500177700001200192700001500204700001300219700001300232700001200245700001200257700001400269700001400283245013700297856003200434300000800466490000700474520238200481022001402863       2017                            d10aMass drug administration10aLymphatic filariasis10aImplementation10aBarriers and facilitators10aNTDs10aSub-Saharan Africa1 aSilumbwe A1 aZulu JM1 aHalwindi H1 aJacobs C1 aZgambo J1 aDambe R1 aChola M1 aChongwe G1 aMichelo C00aA systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa.  uhttp://tinyurl.com/yb2aycgb  a4840 v173 a<p><strong>BACKGROUND: </strong>Understanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa.</p>

<p><strong>METHODS: </strong>A systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation.</p>

<p><strong>RESULTS: </strong>The main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution.</p>

<p><strong>CONCLUSION: </strong>Mass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to improve implementation outcomes. Successfully achieving this requires undertaking formative research on the possible constraining and inhibiting factors, and incorporating the findings in the design and implementation of MDA for LF.</p>
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