Assessing factors influencing noncompliance with mass drug administration for lymphatic filariasis in urban and rural Indonesia

Abstract

Objective: To study assessed factors associated with mass drug administration (MDA) noncompliance for lymphatic filariasis in urban and rural Indonesian communities.

Methods: A cross-sectional analysis was conducted using a subset of nationally representative data from the 2023 Indonesian Health Survey (Survei Kesehatan Indonesia, SKI). Participants were classified as residing in urban (n=469 549) and rural (n=407 982) and interviewed regarding anti-filarial drugs intake over the past 5 years. Logistic regression models were constructed to identify factors associated with MDA noncompliance.

Results: A total of 877 531 individuals from 284 177 households across 514 districts in 38 provinces were included in the study. Among them, 136 526 (15.56%) took anti-filarial drugs in five years; of these, 27 113 (19.86%) never complied fully, revealing significant urban-rural disparities. In urban areas, noncompliance with MDA was associated with pre-working age group (aOR 1.58; 95% CI 1.21-2.07) and those with self-reported LF (aOR 1.47; 95% CI 1.13-1.91). Awareness of health facilities was protective against noncompliance (aOR 0.29; 95% CI 0.11-0.77). In contrast, rural noncompliance was associated with transportation cost barriers (aOR 1.55; 95% CI 1.21-1.99), children aged 2-5 years (aOR 1.43; 95% CI 1.08-1.87), mobile phone ownership (aOR 1.40; 95% CI 1.12-1.75), and self-reported LF (aOR 1.47; 95% CI 1.19-1.82).

Conclusions: Distinct demographic, socioeconomic, and accessibility factors influence MDA noncompliance in Indonesia. Targeted behavioral interventions in urban areas and improved communication and access in rural regions are essential for LF elimination.

Keywords

Lymphatic filariasis / Mass drug administration / Compliance / Indonesia

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Funding

The authors received no extramural funding for the study.

Ethical approval

The Ministry of Health conducts the 2023 Indonesia National Health Survey following the Helsinki Declaration. The National Ethics Commission approved it for Health Research, Health Polytechnic Jakarta, the Ministry of Health of the Republic of Indonesia (ethic number: LB.02.01/I/L/287/2023; date: May 10th, 2023). The study deleted all participants' identities from the dataset. Participants have provided written approval for their involvement in the research. Before the interview, the interviewer gave consent forms to all family members. The survey interviewed parents or guardians (household heads, their spouses, or an older representative of the house) and all household members who consented.

Data availability statement

The data supporting this study's findings are available from the Center for Data and Information Technology, the Ministry of Health of the Republic of Indonesia, under license and cannot be freely available. Data can be made available after approval of a written request to the center for data and information technology, Ministry of Health, Republic of Indonesia (via Homepage-Layanan Permintaan Data | Kementerian Kesehatan RI). Permission to use the data was approved by the Center for Data and information Technology, Ministry of Health of Indonesia (ref No. 24095B8D01828004).

Authors’ contribution

RW: Writing-original draft, review & editing, writing, conceptualization, methodology, formal analysis. MI: Writing-original draft, review & editing, writing, conceptualization, methodology, formal analysis, data curation. AH: Writing-review & editing, methodology, investigation, data curation. BE: Writing-original draft, review & editing, conceptualization, methodology. ANF: Writing-review & editing, methodology. NSH: Writing-review & editing, methodology. PWD: Writing-review & editing, conceptualization, methodology, formal analysis, data curation. TAG: Writing-review & editing, conceptualization, methodology, formal analysis.

Publisher’s note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Edited by Lei Y, Pan Y, Zhang Q

Acknowledgements

We thank all participants for participating in the SKI survey and DHO managers and staff for their support. Our gratitude is also given to the director of the NIHRD–the Ministry of Health of Indonesia–for allowing access to the SKI data.

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