LYMPHATIC FILARIASIS DRUG TREATMENT POLICIES IN EASTERN INDONESIA: WHAT TARGET CHARACTERISTICS MATTER?
Background: Lymphatic filariasis (LF) drug treatment compliance remains a challenge in Eastern Indonesia.
Aims: The study sought to determine which aspects of Eastern Indonesia's LF drug treatment compliance policies were most pertinent.
Methods: The 2018 Indonesian Basic Health Survey data was employed. The analysis units were adults (≥ 15 years) who had received LF drug treatment. LF drug treatment compliance was analyzed based on respondent characteristics (age, gender, marital status, education, occupation, wealth and comorbidities) using binary logistic regression.
Results: The proportion of adherence to LF treatment in Eastern Indonesia was 73.1%. Respondent characteristics that influenced LF treatment compliance were age group > 24 (aOR = 1.374, 95% CI: 1.305-1.447), female (aOR = 1.307, 95% CI: 1.263-1.353), all educated respondent status (aOR = 2.152, 95% CI: 2.043-2.268), and all employed respondents (aOR = 1.437, 95% CI: 1.365 - 1.512). Married respondents and those with all levels of wealth status were less likely to take LF drug treatment.
Conclusion: Policy focus on improving LF treatment compliance among the younger male, the less educated, the unemployed, and those with lower social economic status.
Keywords: compliance, Eastern Indonesia, lymphatic filariasis, public health
Introduction
The neglected tropical disease lymphatic filariasis (LF) is caused by roundworms of the family Filariodidea carried by such mosquitoes as Aedes, Culex, Mansonia, and Anopheles. LF is not a fatal disease, but it can cause permanent disability(Lourens & Ferrell, 2019);(Sungpradit & Sanprasert, 2020). In 2020, there were 72 LF endemic countries, and 863 million individuals in 47 of these countries needed prophylactic chemotherapy to prevent LF. The disease is distributed in tropical and sub-tropical regions such as Africa, the South Pacific Islands, Southeast Asia, Latin America, and the Caribbean(Sungpradit & Sanprasert, 2020). In 2000, the distribution of the highest prevalence of LF in the world was in Southeast Asia, with a 52% prevalence of LF worldwide. It was estimated that the majority of LF cases in 2018 would remain in Southeast Asia, including Indonesia, with the provinces of East Nusa Tenggara and Papua having the highest numbers of LF cases(N.I.H.R.D., 2019);(Deshpande & , 2020).
Efforts to prevent LF require the involvement of all sectors and stakeholders, with health promotion and knowledge improvement for the public being essential to LF risk reduction(Maryen et al., 2018). In addition, to break the chain of transmission, the government implements a mass drug administration (MDA) program in LF endemic areas. The procedure for MDA typically involves the distribution of medications. The use of community drug distributors, known as cadres in Indonesia, who collaborate with village health personnel to deliver LF medications, is one of the main elements of mass treatment programs in Indonesia(Titaley & , 2018). MDA coverage necessitates the population's willingness to take the drug as prescribed. Several places with limited resources have struggled to sustain MDA coverage over time(Won & , 2009);(Burgert-Brucker & , 2020). A number of prior studies have found that low MDA compliance for the elimination of LF is one of the variables determining the incidence of re-transmission of LF in locations that have completed MDA(Widjanarko et al., 2018);(Biritwum & , 2019);(Burgert-Brucker & , 2020).
Some obstacles to MDA adherence for the elimination of LF are related to individual influences and program implementation(Silumbwe & , 2017). Individual influences include fear of adverse events(Mathieu & , 2004);(Widiastuti & , 2021), education level(Kasturiratne & , 2001), occupation, knowledge(Krentel & , 2016)and wealth(Gunawardena & , 2007). One of the impacts of the program is increased participants' exposure to advertisements on the media as well as local drug distributors and health worker visits(Krentel & , 2016). Indonesia is an archipelago of approximately 260 million inhabitants(Bank, 2020). The dispersion of the population, the vast distances involved, and the geography of the region are obstacles for the population to receive expeditious treatment(Meireles & , 2020)and it is also true for Indonesia(Suharmiati et al., 2013);(Laksono et al., 2020). Based on the preceding information, this study aimed to identify the most suitable characteristics for LF drug treatment compliance policies in the eastern region of Indonesia. The findings of this research can be considered in the development of appropriate policies regarding targets related to MDA coverage to accelerate the elimination of LF in eastern Indonesia, including whether intensive socialization or involvement of key stakeholders is needed.
Method
Data Source
For this study, secondary data were taken from the 2018 Indonesian Basic Health Survey, carried out by the National Institute of Health Research and Development (NIHRD). Indonesia also conducted a community-based cross- sectional survey in 2018 as part of its Basic Health Survey. This survey's sample structure was derived from the results of the 2018 National Socio-economic Survey, which was carried out by the Central Statistics Agency in March of 2018. The 2018 Indonesian Basic Health Survey targeted 300,000 households from 30,000 census blocks, and the 2018 Indonesian Socio-economic Survey targeted 300,000 families from 30,000 census blocks.
The 2018 Indonesian Basic Health Survey adopted Probability Proportional to Size (PPS), a two-stage systematic linear sampling method. The first stage constituted implicit stratification based on the 2010 Population Census' determination of the welfare strata of each census unit. As many as 180,000 census blocks (or 25%) of the total 720,000 census blocks from the 2010 Population Census were chosen by PPS as the sampling frame from the sample survey. The survey counted census blocks in each urban/rural stratum per regency/city using the PPS method to create a census block sample list, resulting in 30,000 census blocks being surveyed. The second phase used systematic sampling to identify the ten homes in each census block with the highest implicit stratification of education completed by the head of household. Members of randomly chosen households in Indonesia were questioned for the 2018 Basic Health Survey(N.I.H.R.D., 2019).
Specifically, 295,720 houses in 34 provinces with 1,091,528 household members were surveyed for the 2018 Indonesia Basic Health Survey. A sample of data from five chosen provinces was studied. We limited our analysis to people aged 15 years and above (n = 790) living in five provinces (Papua \( \documentclass{article} \usepackage{amsmath} \begin{document} \displaystyle (n = 274) \end{document} \), West Papua \( \documentclass{article} \usepackage{amsmath} \begin{document} \displaystyle (n = 99) \end{document} \), Maluku \( \documentclass{article} \usepackage{amsmath} \begin{document} \displaystyle (n = 177) \end{document} \), North Maluku \( \documentclass{article} \usepackage{amsmath} \begin{document} \displaystyle (n = 50)
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