Persistent ‘hotspots’ of lymphatic filariasis microfilaraemia despite 14 years of mass drug administration in Ghana
May 2nd, 2017
Among the 216 districts in Ghana, 98 were declared endemic for lymphatic filariasis in 1999 after mapping. Pursuing the goal of elimination, WHO recommends annual treatment using mass drugs administration (MDA) for at least 5 years. MDA was started in the country in 2001 and reached national coverage in 2006. By 2014, 69 districts had ‘stopped-MDA’ (after passing the transmission assessment survey) while 29 others remained with persistent microfilaraemia (mf) prevalence (≥1%) despite more than 11 years of MDA and were classified as ‘hotspots’.
Methods: An ecological study was carried out to compare baseline mf prevalence and anti-microfilaria interventions between hotspot and stopped-MDA districts.
Results: Baseline mf prevalence was significantly higher in hotspots than stopped-MDA districts (p<0.001). After three years of MDA, there was a significant decrease in mf prevalence in hotspot districts, but it was still higher than in stopped-MDA districts. The number of MDA rounds was slightly higher in hotspot districts (p<0.001), but there were no differences in coverage of MDA or long-lasting-insecticide-treated nets.
Conclusions: The main difference in hotspots and stopped-MDA districts was a high baseline mf prevalence. This finding indicates that the recommended 5–6 rounds annual treatment may not achieve interruption of transmission.
Authors: Nana-Kwadwo Biritwuma, Paul Yikpoteyb,*, Benjamin K. Marfoa, Samuel Odooma, Ernest O. Mensahb, Odame Asiedua, Bright Alomatua, Edward T. Herviea, Abednego Yeboaha, Serge Adec,d, Sven G. Hinderakere, Anthony Reidf, Kudakwashe C. Takarindad, Benjamin Koudoug and Joseph B. Koroma
a Neglected Tropical Diseases Programme, Ghana; b Family Health International (FHI360), P.O. Box 4033, Accra, Ghana; c University of Parakou, Benin; dInternational Union Against Tuberculosis and Lung Disease, France; e University of Bergen, Bergen, Norway; f Operational Research Unit (LuxOR), Medical Department, Médecins Sans Frontières, Operational Centre Brussels, Luxembourg; g Liverpool School of Tropical Medicine, Filaria Programme Support Unit, Liverpool, UK
*Corresponding author: Tel: +233 209374110; E-mail: PYikpotey@fhi360.org, firstname.lastname@example.org
Received 19 December 2016; revised 29 January 2017; editorial decision 31 January 2017; accepted 1 February 2017
Trans R Soc Trop Med Hyg 2016; 110: 690–695
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