Coverage evaluation of mass drug administration for lymphatic filariasis in four endemic districts of Jharkhand, India

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. 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. 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 (p < 0.001). 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.