Assessing morbidity management and disability prevention for lymphatic filariasis in India

BACKGROUND Evidence on the implementation of morbidity management and disability prevention (MMDP) remains limited in India. OBJECTIVES To assess characteristics of persons with lymphatic filariasis (PwLF) registered for MMDP services from 2023 to 2025 and factors associated with regular receipt of services, the quality of MMDP services at designated health facilities, and barriers and facilitators to MMDP services in Gorakhpur district. METHODOLOGY An explanatory mixed-methods study. The quantitative component involved cohort review of routine programme data from 16 public health facilities and cross-sectional quality assessment of 10 health facilities using WHO Direct Inspection Protocol. The qualitative component involved interviews and focus group discussions with beneficiaries, programme staff, and frontline workers. RESULTS Out of the 946 registered PwLF, 811 were eligible to receive annual MMDP services, of which only 172 (21.4%) regularly received it. Patients with stage III or higher lymphoedema were twice as likely to regularly receive the annual services. All facilities assessed provided either suboptimal or poor-quality services, with gaps in availability of guidelines, supplies, and staff knowledge. Key barriers included supply interruptions, stigma, travel costs, and staff workload while community health workers facilitated follow-up. CONCLUSION MMDP services continuity and quality remain suboptimal, requiring strengthened supply chains, provider capacity, and community-based follow-up.