A review of factors that influence individual compliance with mass drug administration for elimination of lymphatic filariasis.

BACKGROUND: The success of programs to eliminate lymphatic filariasis (LF) depends in large part on their ability to achieve and sustain high levels of compliance with mass drug administration (MDA). This paper reports results from a comprehensive review of factors that affect compliance with MDA. METHODOLOGY/PRINCIPAL FINDINGS: Papers published between 2000 and 2012 were considered, and 79 publications were included in the final dataset for analysis after two rounds of selection. While results varied in different settings, some common features were associated with successful programs and with compliance by individuals. Training and motivation of drug distributors is critically important, because these people directly interact with target populations, and their actions can affect MDA compliance decisions by families and individuals. Other important programmatic issues include thorough preparation of personnel, supplies, and logistics for implementation and preparation of the population for MDA. Demographic factors (age, sex, income level, and area of residence) are often associated with compliance by individuals, but compliance decisions are also affected by perceptions of the potential benefits of participation versus the risk of adverse events. Trust and information can sometimes offset fear of the unknown. While no single formula can ensure success MDA in all settings, five key ingredients were identified: engender trust, tailor programs to local conditions, take actions to minimize the impact of adverse events, promote the broader benefits of the MDA program, and directly address the issue of systematic non-compliance, which harms communities by prolonging their exposure to LF. CONCLUSIONS/SIGNIFICANCE: This review has identified factors that promote coverage and compliance with MDA for LF elimination across countries. This information may be helpful for explaining results that do not meet expectations and for developing remedies for ailing MDA programs. Our review has also identified gaps in understanding and suggested priority areas for further research

The role of gender relations in uptake of mass drug administration for lymphatic filariasis in Alor District, Indonesia.

BACKGROUND: The Global Programme to Eliminate Lymphatic Filariasis has set 2020 as a target to eliminate lymphatic filariasis (LF) as a public health problem through mass drug administration (MDA) to all eligible people living in endemic areas. To obtain a better understanding of compliance with LF treatment, a qualitative study using 43 in-depth interviews was carried out in Alor District, Indonesia to explore factors that motivate uptake of LF treatment, including the social and behavioural differences between compliant and non-compliant individuals. In this paper, we report on the findings specific to the role of family and gender relations and how they affect compliance. RESULTS: The sample comprised 21 men and 22 women; 24 complied with treatment while 19 did not. Gender relations emerged as a key theme in access, uptake and compliance with MDA. The view that the husband, as head of household, had the power, control, and in some cases the responsibility to influence whether his wife took the medication was common among both men and women. Gender also affected priorities for health care provision in the household as well as overall decision making regarding health in the household. Four models of responsibility for health decision making emerged: (i) responsibility resting primarily with the husband; (ii) responsibility resting primarily with the wife; (iii) responsibility shared equally by both husband and wife; and (iv) responsibility autonomously assumed by each individual for his or her own self, regardless of the course of action of the other spouse. CONCLUSIONS: (i) Gender relations and social hierarchy influence compliance with LF treatment because they inherently affect decisions taken within the household regarding health; (ii) health care interventions need to take account of the complexity of gender roles; (iii) the fact that women's power tends to be implicit and not overtly recognised in the household or the community has important implications for health care interventions; (iv) campaigns and other preventive interventions need to take account of the diversity of patterns of health care decision-making and responsibility in specific communities so that social mobilisation messages can be tailored appropriately

Quantum Optimization Problems

Krentel [J. Comput. System. Sci., 36, pp.490--509] presented a framework for an NP optimization problem that searches an optimal value among exponentially-many outcomes of polynomial-time computations. This paper expands his framework to a quantum optimization problem using polynomial-time quantum computations and introduces the notion of an ``universal'' quantum optimization problem similar to a classical ``complete'' optimization problem. We exhibit a canonical quantum optimization problem that is universal for the class of polynomial-time quantum optimization problems. We show in a certain relativized world that all quantum optimization problems cannot be approximated closely by quantum polynomial-time computations. We also study the complexity of quantum optimization problems in connection to well-known complexity classes.Comment: date change

Case 1 : Vanishing Volunteers: The Use of Implementation Research to Improve Support for Community Drug Distributors in Cote d\u27Ivoire

To be implemented successfully, most large-scale public health interventions, such as mass drug administration (MDA) campaigns for the elimination of lymphatic filariasis, require a large extent of human health resources. For several reasons, health workers and volunteer community drug distributors (CDDs) sometimes feel overwhelmed and unsupported in their work, which can cause them to give up their essential roles. In lower middle-income countries such as Côte d’Ivoire, where volunteers tasked with the distribution of antifilarial medications are already in short supply, losing valuable human health resources can ultimately cause MDA programs to fail. As such, it is crucial for implementers to recognize and address any issues with their health intervention plan that may lead to increased attrition among their workforce. Dr. Emmanuel Koffi, one of the neglected tropical disease program managers at Côte d’Ivoire’s Ministry of Health and Public Hygiene, recognizes that research is needed to investigate the factors contributing to increased stress and attrition rates among his volunteer CDDs. The steps that he should take to conduct an effective research project, however, remain uncertain. After reaching out to Dr. Myriam Kouamé at the University of Abidjan, Emmanuel has decided that applying an implementation research strategy may be best for this project. Having little experience with this type of research, he has enlisted Myriam’s assistance to develop a research plan that will help him identify how he can better support his volunteers. Emmanuel knows that time is short—the 2020 deadline to eliminate lymphatic filariasis in Côte d’Ivoire is fast approaching, and he must act quickly to ensure that the CDDs are well supported if they are to achieve this elimination goal

The Complexity of Finding Reset Words in Finite Automata

We study several problems related to finding reset words in deterministic finite automata. In particular, we establish that the problem of deciding whether a shortest reset word has length k is complete for the complexity class DP. This result answers a question posed by Volkov. For the search problems of finding a shortest reset word and the length of a shortest reset word, we establish membership in the complexity classes FP^NP and FP^NP[log], respectively. Moreover, we show that both these problems are hard for FP^NP[log]. Finally, we observe that computing a reset word of a given length is FNP-complete.Comment: 16 pages, revised versio

Improving coverage and compliance in mass drug administration for the elimination of LF in two 'Endgame' districts in Indonesia using micronarrative surveys

Author Summary This research describes the process used to assist two districts endemic for lymphatic filariasis (LF) in Indonesia to better understand the reasons why their LF elimination programs have had suboptimal results. A novel survey design was used to collect stories about people's direct experiences with mass drug administration (MDA) for LF. These questionnaires also explored the reasons community members took or did not take the LF drugs. Following MDA in 2013, two baseline surveys in endemic communities provided insight into the district MDA programs. Together with district health officials, feasible recommendations were provided before the next MDA round in 2014. Uptake of these recommendations by the districts was high, although no additional funding was made available for programmatic changes. As a result, both districts reported significant improvements in their MDA coverage and compliance rates after the endline surveys were completed in 2015. This demonstrated the utility of the survey tool and process to impact change and improvement in MDA programs

Laparoscopic Supracervical Hysterectomy with In-Bag Morcellation in Very Large Uterus

Laparoscopic supracervical hysterectomy (LASH) is a safe and fast minimally invasive approach in hysterectomy. In order to extract the uterine body from the abdominal cavity, one condition for LASH is the morcellation of the tissue. The intra-abdominal dissemination of benign and occult malignant uterine cells is a possible risk of this method, which can be avoided by the use of special bags for laparoscopic in-bag morcellation. We present a case of laparoscopic supracervical hysterectomy with in-bag morcellation in a uterus of more than 1400 g. and describe that this minimal-access surgery is safe and feasible even in very large uteri. This case report is registered in Research Registry under the UIN researchregistry1810