Operational Evaluation of Lymphatic Filariasis Elimination Activities in Anambra State, Southeast Nigeria

Nigeria is among the countries with the highest burden of lymphatic filariasis globally, and achieving elimination requires sustained high-coverage mass drug administration with rigorous operational evaluation. This study conducted an operational evaluation of lymphatic filariasis elimination activities in Anambra State, Southeast Nigeria, covering the 2022 to 2024 programme cycle. Evaluation data were obtained from programme coverage reports, community drug distributor records, and post-campaign spot-check surveys in 12 communities across six local government areas. Focus group discussions with community drug distributors and community members were conducted to assess implementation fidelity and community acceptance. Reported coverage averaged 71.2 percent, exceeding the WHO threshold of 65 percent, but independent spot-check surveys found actual coverage at 56.8 percent in assessed communities, revealing a significant reporting gap. Side effect concerns and religious objections were the most cited reasons for non-compliance. Community drug distributor attrition over the programme period was 34.2 percent, adversely affecting continuity. The study recommends harmonised coverage verification methods, community drug distributor incentive structures, and targeted community dialogue to address side effect fears in Anambra State's filariasis elimination programme. Keywords: lymphatic filariasis, mass drug administration, programme evaluation, Anambra State, elimination.