Progress towards lymphatic filariasis elimination in Ghana from 2000-2016: analysis of microfilaria prevalence data from 430 communities

Abstract

42 Background 43 Ghana started its national programme to eliminate lymphatic filariasis (LF) in 2000, with mass 44 drug administration (MDA) with ivermectin and albendazole as main strategy. We review the 45 progress towards elimination that was made by 2016 for all endemic districts of Ghana and analyze 46 mf prevalence from sentinel and spot-check sites in endemic districts. 47 48 Methods 49We reviewed district level data on the history of MDA and outcomes of transmission assessment 50 surveys (TAS). We further collated and analyzed microfilaria (mf) prevalence data from sentinel 51 and spot-check sites. [2001][2002][2003][2004][2005][2006] in all 98 endemic districts; by the end of 2016, 81 had stopped 55 MDA after passing TAS and after an average of 11 rounds of treatment (range 8 -14 rounds). The 56 median reported coverage for the communities was 77-80%. Mf prevalence survey data were 57 available for 430 communities from 78/98 endemic districts. Baseline mf prevalence data were 58 available for 53 communities, with an average mf prevalence of 8.7% (0 -45.7%). Repeated 59 measurements were available for 78 communities, showing a steep decrease in mean mf 60 prevalence in the first few years of MDA, followed by a gradual further decline. In the 2013 and 61 2014 surveys, 7 and 10 communities respectively were identified with mf prevalence still above 62 1% (maximum 5.6%). Two stopped MDA in 2015 and 2016 respectively, while the rest of the 15 63 communities above threshold are all within 13/17 districts where MDA is still ongoing. 3 64 65 Conclusions 66 The MDA programme of the Ghana Health Services has reduced mf prevalence in sentinel sites 67 below the 1% threshold in 81/98 endemic districts in Ghana, yet 15 communities within 13 districts 68 (MDA ongoing) had higher prevalence than this threshold during the surveys in 2013 and 2014. 69 These districts may need to intensify interventions to achieve the WHO 2020 target. 70 71 4 72 Author summary 73 Lymphatic filariasis (LF) control in Ghana has relied on ivermectin and albendazole since the year 74 2000 when the Ghana Filariasis Elimination Programme started. We analyzed trends in 75 microfilaraemia prevalence during MDA, reported coverage, and transmission assessment survey 76 using data obtained from the Ghana Health Services (GHS). The median reported treatment 77 coverage varied between 77-80% over the years. Our results show that the treatment in Ghana 78 made a significant impact in reducing infections <1% in majority of sentinel sites in endemic 79 districts (81/98) by 2016. In the remaining 17 districts, extra efforts may be needed to achieve the 80 same goal. Some of the challenges could be low coverage in some communities, high baseline 81 endemicity, programme logistical challenges etc. The required average rounds of MDA needed for 82 elimination was 11, higher than that proposed by the Global Filariasis Elimination Programme. 83 This article is relevant to LF control programmes in assessing the impact of MDA. It is important 84 for programmes to...

Perceptions of the roles, impact, challenges and needs of community drug distributors in the control and elimination of neglected tropical diseases in difficult-to-access communities in Ghana

“…Furthermore, FGDs with participants in the LF endemic communities revealed that MDA visits by CDDs was not consistent, with some occurring once in a year. In Ghana, MDA usually takes place 1-2 weeks between March and June at different endemic communities [34]. Even then, these programs could be halted for a number of reasons.…”

An Early Indication of the Rebound of W. Bancrofti Infection in Zanzibar

“…Whilst the present study investigated community members with a wide age range (2-86yrs). There are mixed perceptions on whether conducting a school-based or community-based TAS but other authors have drawn attention on possibility of leaving out non-school attendants some of whom might have not received the drugs (Biritwum et al, 2019). For examples in American Samoa, high prevalence of lariasis was observed in community-based assessment (6.2%) than in school-based survey (0.7%) (Sheel et al, 2018).…”

“…Despite the earlier reports which suggested termination of drug distribution following 5-6 rounds (WHO, 2011), in fact the exact number of treatments to implement such decision was unclear. For example some endemic countries have implemented up to 14 rounds of MDA (Biritwum et al, 2019). The prematurely termination of drug distribution has in part, contributed to rebounce of infection in some endemic countries (Boyd et al, 2010).…”

Community views on mass drug administration for filariasis: a qualitative evidence synthesis

“…Programme design and delivery for included studies(Continued) CDD: community drug distributor; MDA: mass drug administration; PHC: primary Health Centre. For some studies, further information was provided by a:Biritwum 2019; b: Njomo 2012a; c: NVBDCP 2018; d: Kisoka 2016; e: Oscar 2014. …”