The Acceptability of The Combined Delivery Strategy in Mass Drug Administration Distribution to Eliminate Lymphatic Filariasis in Pekalongan Municipality, Indonesia

Astridia Maharani Putri Dewanto, dr. Elsa Herdiana Murhandarwati, M.Kes., PhD.; Prof. Ari Probandari, MPH, PhD.

2023 | Tesis | S2 Ilmu Kesehatan Masyarakat

Pendahuluan:  Penguatan strategi directly observed treatment dalam implementasi distribusi Pemberian Obat Pencegahan Massal (POPM) sangat penting dilakukan setelah banyak negara belum mencapai eliminasi filariasis sejak kemoterapi preventif dikenalkan pada tahun 2000. Modifikasi metode penyaluran obat dengan mengkombinasikan strategi pos-pos dan rumah ke rumah yang diharapkan dapat memberikan kualitas POPM yang lebih baik. Studi ini mengeksplorasi aksebtabilitas strategi modifikasi penyaluran POPM dalam rangka eliminasi filariasis.

Metode: Studi dilakukan di Kota Pekalongan sebagai salah satu area endemis di Provinsi Jawa Tengah. Metode kualitatif dengan wawancara mendalam digunakan untuk eksplorasi tujuh segmen akseptabilitas yakni: affective attitude, intervention coherence, burden, perceived effectiveness, opportunity cost, self-efficacy, dan ethicality. Partisipan terdiri dari pelaku program, kader, tokoh masyarakat, dan para warga baik yang patuh maupun yang tidak patuh minum obat. Seluruh partisipan terpilih berdasarkan metode purposive samplings. Studi ini juga merekam cakupan POPM berdasarkan data sekunder. 

Hasil:  Sebagian besar pelaku program menunjukkan sikap positif terhadap implementasi modifikasi distribusi POPM dalam rangka eliminasi penyakit kaki gajah. Para partisipan juga merasakan efektivitas strategi program dengan metode distribusi modifikasi. Akan tetapi, cakupan POPM Kelurahan Jenggot (67%) yang mengimplementasikan metode modifikasi distribusi masih lebih rendah dibandingkan dengan Kelurahan Kuripan-Kertoharjo (82%). Bagaimanapun, peneliti menduga kurangnya validasi laporan cakupan POPM melalui temuan studi.

Kesimpulan: Meskipun sebagian besar partisipan menunjukkan tingkat penerimaan yang tinggi, tingkat beban yang dirasakan dapat memengaruhi kualitas program yang seharusnya mengutamakan Masyarakat untuk patuh minum obat.

Objectives: Strengthening the directly observed treatment strategy in the mass drug administration distribution has become vital after many countries have not eliminated lymphatic filariasis disease since preventive chemotherapy was introduced in 2000. Modifying the delivery method by combining the gathering point places and door-to-door strategy to distribute the antifilarial drugs is expected to result in a better quality of mass drug administration implementation. This paper explores the acceptability of a modified delivery strategy in the mass drug administration distribution to eliminate lymphatic filariasis disease.

Methods: The study was conducted in Pekalongan Municipality, one of the endemic areas in Central Java Province. Qualitative methods using in-depth interviews were employed to explore the following constructs of acceptability: affective attitude, intervention coherence, burden, perceived effectiveness, opportunity cost, self-efficacy, and ethicality. Study participants were program implementers, community health workers, community leaders, and compliant and non-compliant community members. These participants were selected through purposive samplings. Secondary data on mass drug administration coverage reported by community health workers were also recorded.

Results: Most of the program implementers showed a positive attitude in implementing modified mass drug administration distribution for lymphatic filariasis disease elimination. They also perceived the effectiveness of the program strategy, as well as the community health workers with their communities whose areas used the modified method. While the mass drug administration coverage of Jenggot village (67%) which implemented the modified method was still lower compared to Kuripan-Kertoharjo village (82%). However, we suspected a problem of validity from these findings regarding the program coverage.

Conclusions: Despite most participants tend to show high acceptability, the burden of running the program itself might affect the program’s quality, which is supposed to boost compliance in the mass drug administration program.

Kata Kunci : POPM, filariasis, penelitian kualitatif/mass drug administration, lymphatic filariasis, qualitative study