# A mixed-method study to improve outcome of mass drug administration in two TAS failed districts of Uttar Pradesh, India

## TL;DR

This study improves drug consumption in India's MDA campaigns by addressing community fears and awareness gaps, leading to better health outcomes for lymphatic filariasis.

## Contribution

The study introduces a community-centered intervention package that significantly improves MDA coverage and awareness in underperforming districts.

## Key findings

- Fear of side effects was the main barrier to drug consumption, followed by lack of awareness and poor micro-planning.
- The intervention package increased drug coverage by 10.1% in Varanasi and 20.7% in Chitrakoot.
- Community awareness improved by 40% in Chitrakoot, with interpersonal communication being most effective.

## Abstract

Lymphatic filariasis (LF), commonly called “elephantiasis,” is one of the leading causes of disability around the world, with approximately 863 million people across 47 countries still living under threat of LF infection. India, with 40% of the global LF burden, is the most affected country that undertakes annual mass drug administration (MDA) using double and triple drug chemoprophylaxis in 157 LF-endemic districts. Consumption of drugs during MDA campaigns remains the biggest challenge for disease elimination in the country. PATH conducted a dual-phased study titled, “A Mixed-Method Study to Improve outcome of Mass Drug Administration in Two TAS failed Districts of Uttar Pradesh, India.” The study aimed to identify the critical factors in achieving optimal drug consumption among community members during MDA campaigns (pre-intervention phase), develop an intervention package (IP) for use in the government's subsequent MDA program to improve the coverage, and assess the impact (post-intervention phase). The quantitative data collection entailed house-to-house and drug administrator surveys, while qualitative data collection included in-depth interviews and rapid ethnography. The main reason for non-consumption was found to be fear of side effects, followed by away from home, lack of awareness, and suboptimal micro-planning. Post-IP measurements showed that there was an increase in evaluated coverage of 10.1% in Varanasi and 20.7% in Chitrakoot, as well as an increase in community awareness of 40% in Chitrakoot, with interpersonal communication being the most effective method for demand generation/ community awareness. An Intervention Package (IP), developed and piloted in the two study districts, was adopted by the state government of Uttar Pradesh and used across all 50 LF-endemic districts in the state.

Lymphatic filariasis (LF), a debilitating mosquito-borne disease, continues to affect millions globally, with India bearing the highest burden. Mass Drug Administration (MDA) is a key public health strategy to eliminate LF, but many districts in Uttar Pradesh have struggled with low drug consumption rates despite repeated MDA rounds. This mixed-method study addresses that challenge by examining why people don't take the LF drugs and testing a tailored intervention package (IP) in two under performing districts, Varanasi and Chitrakoot.

Using household surveys, interviews, and ethnographic methods, the study identified critical barriers to drug uptake—fear of side effects, lack of awareness, and mistrust in health workers. Based on these insights, a targeted IP was developed and piloted. Post-intervention, both districts showed marked improvements in drug coverage and community awareness, with Chitrakoot’s awareness levels nearly doubling.

This work is important because it offers an evidence-based model for improving MDA outcomes through community-centered and system-level changes. For scientists, it contributes to implementation science in disease elimination. For broader audiences, it highlights how tailored, empathetic public health strategies—grounded in local realities—can accelerate progress against neglected tropical diseases and improve health equity in underserved populations.