Communities of practice
LF elimination is possible in the poorest of countries
1 Aug 2011
Lymphatic filariasis can be eliminated with limited resources. That’s the lesson of Togo, the first sub-Saharan African country to stop mass drug administration (MDA) after concluding that transmission of the mosquito-borne disease had been interrupted.
As reported in yesterday’s Morbidity and Mortality Weekly Report (MMWR) published by the Centers for Disease Control and Prevention (CDC) in Atlanta, USA, Togo’s Ministry of Health began in 2000 with a mapping of the prevalence of LF using the Rapid Assessment of the Geographical Distribution of Filariasis methodology developed by TDR (1). Sixty-one villages in 35 districts were included in the baseline mapping, and of the some 5,009 persons tested, 89 had a positive ICT, indicating LF infection.
From 2001 to 2009, Togo’s Ministry of Health and NGO partners administered six to nine MDAs in each of 7 LF-endemic districts (defined as districts where ≥1% of ICTs were positive). The MoH reported approximately 80% drug coverage in each district, and surveys conducted in 2004 validated those reports.
Togo, one of the continent’s poorest countries, suffered repeated political crises and suspensions of foreign aid for development throughout the late 1990s and early 2000s. Yet despite its financial woes, Togo pressed on with LF elimination, relying on a network of community health workers to distribute antiparasitic drugs (Ivermectin and albendazole tablets donated by Merck) house-to-house.
The impact of MDAs was assessed annually from 2005 to 2009. By 2009, no microfilaremia was detected in persons sampled in sentinel or spot-check sites of five of the seven districts and additional MDA campaigns were carried out in the other two districts. Post-MDA surveillance is ongoing and will continue in 40 laboratories and 18 dispensaries geographically dispersed throughout the country.
According to the CDC, the Togo experience “stresses the need for improved protocols and serologic tests for determining when MDAs can be stopped, for post-MDA surveillance, and for certifying elimination in countries in the African Region where LF is endemic.”
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