Coverage and Determinants of Mass Drug Administration against Lymphatic Filariasis in Southeast Asian Regional Countries during the End-game Strategy: A Systematic Review & Meta-analysis of published articles from January 2019 to March 2025.

Abstract

Background objectives: Mass Drug Administration (MDA) is one of the important pillars of eliminating lymphatic filariasis. The present study aimed to determine the pooled coverage and compliance of the MDA and its determinants in the Southeast Asian Regional countries.

Methods: This proposal was registered in PROSPERO. The study focused on four databases (PubMed, Scopus, Embase, and Cochrane Central) and articles published between January 2019 and March 2025. The setting was taken from studies performed across the Southeast Asian Region. Stata Version 17 was used for meta-analysis of the selected studies. The overall and subgroup-wise analysis was computed using the DerSimonian-Laird method for the random-effects model in Forest plots. A funnel plot was done to find out the publication bias.

Results: Altogether, 34 articles were analysed. Of the 34 articles, 28 (82.3%) and 4 (11.8%) articles were published in India and Indonesia, respectively. The pooled coverage and compliance of MDA were found to be 80.16% (95% CI: 74.68-85.64%) and 67.25% (95% CI: 60.17-74.33%), respectively. Subgroup-wise, both coverage and compliance decreased in studies conducted in 2020 or afterwards. Side effects of the drugs, non-diseased status, suffering from some other diseases, too many drugs, bad taste of the drugs were some of the common barriers to successful MDA implementation.

Interpretation conclusion: Thus, the time has come to develop strategies to improve MDA coverage and compliance at the community level. The strategy would be bilateral, involving both providers and beneficiaries, who need to be engaged in the proper implementation of MDA administration at the grassroots level.