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

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 (a OR 1.58; 95% CI 1.21-2.07) and those with self-reported LF (a OR 1.47; 95% CI 1.13-1.91). Awareness of health facilities was protective against noncompliance (a OR 0.29; 95% CI 0.11-0.77). In contrast, rural noncompliance was associated with transportation cost barriers (a OR 1.55; 95% CI 1.21-1.99), children aged 2-5 years (a OR 1.43; 95% CI 1.08-1.87), mobile phone ownership (a OR 1.40; 95% CI 1.12-1.75), and self-reported LF (a OR 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.