BACKGROUND Lymphatic filariasis (LF), a neglected tropical disease (NTD) and leading cause of global disability, is endemic in 32 countries in Africa with almost 350 million people requiring regular drug administration, and only 16 countries achieving target coverage. Community Drug Distributors (CDDs) are critical for the success of NTD programs, and the distribution of medicines during mass drug administration (MDA) in Africa; however they could also be a weak link. The primary aim of this study is to explore and describe perceptions of CDDs during MDA for LF in Mvita sub-county in Mombasa county and Kaloleni sub-county in Kilifi county, Kenya; and provide recommendations for the effective engagement of communities and CDDs in low-resource settings. METHODS In September 2018, we conducted six focus group discussions with community members in each sub-county, three with men aged 18-30, 31-50, and 51 years and above and three with women stratified into the same age groups. In each sub-county, we also conducted semi-structured interviews with nine community health extension workers (CHEWs), the national LF focal point, the county NTD focal points, and seven community leaders. Content analysis of the data was conducted, involving a process of reading, coding, and displaying data in order to develop a codebook. RESULTS We found that several barriers and facilitators impact the engagement between CDDs and community members during MDA. These barriers include poor communication and trust between CDDs and communities; community distrust of the federal government; low community knowledge and perceived risk of LF, poor timing of MDA, fragmented supervision of CDDs during MDA; and CDD bias when distributing medicines. We also found that CDD motivation was a critical factor in their ability to successfully meet MDA targets. It was acknowledged that directly observed treatment and adequate health education were often not executed by CDDs. The involvement of community leaders as informal supervisors of CDDs and community members improves MDA. CONCLUSIONS In order to achieve global targets around the elimination of LF, CDDs and communities must be effectively engaged by improving planning and implementation of MDA.

中文翻译：

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与淋巴丝虫病的斗争：肯尼亚沿海大规模药物管理期间对社区药物分销商的看法。

背景技术淋巴丝虫病（LF）是一种被忽视的热带病（NTD），是全球致残的主要原因，在非洲的32个国家中很普遍，有将近3.5亿人需要定期药物管理，只有16个国家实现了目标覆盖率。社区药品分销商（CDD）对于NTD计划的成功以及非洲大规模药物管理（MDA）期间药品的分销至关重要；但是它们也可能是一个薄弱环节。这项研究的主要目的是探索和描述在蒙巴萨县Mvita县和肯尼亚基利菲县Kaloleni县的LF的MDA期间对CDD的认识。并提供建议，以使社区和CDD有效地参与资源匮乏的地区。方法2018年9月，我们与每个县的社区成员进行了六次焦点小组讨论，其中三次是18-30岁，31-50岁和51岁及以上的男性，另外三次是将女性划分为同一年龄段。在每个子县，我们还与9位社区卫生推广人员（CHEW），国家LF联络点，县NTD联络点和7位社区负责人进行了半结构化访谈。进行了数据的内容分析，包括读取，编码和显示数据的过程，以开发密码本。结果我们发现在MDA期间，有几个障碍和促进者影响CDD和社区成员之间的参与。这些障碍包括CDD与社区之间的沟通和信任差。社区对联邦政府的不信任；社区知识水平低和人们发现的LF风险，MDA的时机不佳，MDA期间对CDD的监督分散；和CDD在分配药物时有偏差。我们还发现CDD动机是他们成功实现MDA目标的能力的关键因素。公认的是，疾病预防与控制中心通常不执行直接观察到的治疗和适当的健康教育。社区领导人作为CDD的非正式监督员和社区成员的参与提高了MDA。结论为了实现围绕消除LF的全球目标，必须通过改进MDA的规划和实施来有效地参与CDD和社区的参与。公认的是，疾病预防与控制中心通常不执行直接观察到的治疗和适当的健康教育。社区领导人作为CDD的非正式监督员和社区成员的参与提高了MDA。结论为了实现围绕消除LF的全球目标，必须通过改进MDA的计划和实施来有效参与CDD和社区的参与。公认的是，疾病预防与控制中心通常不执行直接观察到的治疗和适当的健康教育。社区领导人作为CDD的非正式监督员和社区成员的参与提高了MDA。结论为了实现围绕消除LF的全球目标，必须通过改进MDA的计划和实施来有效参与CDD和社区的参与。