The Global Program to Eliminate Lymphatic Filariasis (GPELF) advocates for the treatment of entire endemic communities, in order to achieve its elimination targets. LF is predominantly a rural disease, and achieving the required treatment coverage in these areas is much easier compared to urban areas that are more complex. In Ghana, parts of the Greater Accra Region with Accra as the capital city are also endemic for LF. Mass Drug Administration (MDA) in Accra started in 2006. However, after four years of treatment, the coverage has always been far below the 65% epidemiologic coverage for interrupting transmission. As such, there was a need to identify the reasons for poor treatment coverage and design specific strategies to improve the delivery of MDA. This study therefore set out to identify the opportunities and barriers for implementing MDA in urban settings, and to develop appropriate strategies for MDA in these settings. An experimental, exploratory study was undertaken in three districts in the Greater Accra region. The study identified various types of non-rural settings, the social structures, stakeholders and resources that could be employed for MDA. Qualitative assessment such as in-depth interviews (IDIs) and focus group discussions (FGDs) with community leaders, community members, health providers, NGOs and other stakeholders in the community was undertaken. The study was carried out in three phases: pre-intervention, intervention and post-intervention phases, to assess the profile of the urban areas and identify reasons for poor treatment coverage using both qualitative and quantitative research methods. The outcomes from the study revealed that, knowledge, attitudes and practices of community members to MDA improved slightly from the pre-intervention phase to the post-intervention phase, in the districts where the interventions were readily implemented by health workers. Many factors such as adequate leadership, funding, planning and community involvement, were identified as being important in improving implementation and coverage of MDA in the study districts. Implementing MDA in urban areas therefore needs to be given significant consideration and planning, if the required coverage rates are to be achieved. This paper, presents the recommendations and strategies for undertaking MDA in urban areas. Funding: This study was supported under Grant Number 43922, administered by the Task Force for Global Health (http://www.taskforce.org/), to NKB. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript Author summaryThe control of lymphatic filariasis depends on the treatment of entire endemic communities, ensuring that a greater proportion of the population is treated. In urban areas, this can be very difficult to achieve. In Ghana, parts of the Greater Accra Region, where the capital city is located, are also endemic for lymphatic filariasis. Treatment in these areas started in 2006, but the proportion of people treated has ...

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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.

Background Ghana started its national programme to eliminate lymphatic filariasis (LF) in 2000, with mass drug administration (MDA) with ivermectin and albendazole as main strategy. We review the progress towards elimination that was made by 2016 for all endemic districts of Ghana and analyze microfilaria (mf) prevalence from sentinel and spot-check sites in endemic districts. Methods We reviewed district level data on the history of MDA and outcomes of transmission assessment surveys (TAS). We further collated and analyzed mf prevalence data from sentinel and spot-check sites. Results MDA was initiated in 2001–2006 in all 98 endemic districts; by the end of 2016, 81 had stopped MDA after passing TAS and after an average of 11 rounds of treatment (range 8–14 rounds). The median reported coverage for the communities was 77–80%. Mf prevalence survey data were available for 430 communities from 78/98 endemic districts. Baseline mf prevalence data were available for 53 communities, with an average mf prevalence of 8.7% (0–45.7%). Repeated measurements were available for 78 communities, showing a steep decrease in mean mf prevalence in the first few years of MDA, followed by a gradual further decline. In the 2013 and 2014 surveys, 7 and 10 communities respectively were identified with mf prevalence still above 1% (maximum 5.6%). Fifteen of the communities above threshold are all within districts where MDA was still ongoing by 2016. Conclusions The MDA programme of the Ghana Health Services has reduced mf prevalence in sentinel sites below the 1% threshold in 81/98 endemic districts in Ghana, yet 15 communities within 13 districts (MDA ongoing by 2016) had higher prevalence than this threshold during the surveys in 2013 and 2014. These districts may need to intensify interventions to achieve the WHO 2020 target.

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...

A hydrocoele surgery facility assessment tool (HSFAT) was developed to assess the readiness of hydrocoele surgery services in health facilities prior to implementation of hydrocoele surgical campaigns for the elimination of lymphatic filariasis (LF). A first version of the tool was piloted in Bangladesh, Malawi and Nepal in 2019, then, following feedback from country programme managers, a second version of the tool was rolled out across countries implementing hydrocoele surgery in the Accelerating the Control of Neglected Tropical Diseases (Ascend) West and Central Africa Programme, including Benin, Burkina Faso, Ghana, Guinea, Niger and Nigeria. The HSFAT assessed facilities across 10 domains: background information, essential amenities, emergency patient transfer, laboratory capacity, surgical procedures and trained staff, infection prevention, non-disposable basic equipment, disposable basic equipment, essential medicines and current hydrocoele practices. The HSFAT results highlight key areas for improvement in different countries and can be used to develop a quality improvement plan, which may include actions with agreed deadlines to improve the readiness and quality of hydrocoele surgery services provided by the health facility, prior to implementation of surgical campaigns and assist country programmes to achieve the dossier requirements set out by the World Health Organization for the elimination of LF.

Background The Upper West region of Ghana is mostly made up of rural communities and is highly endemic for lymphatic filariasis (LF), with a significant burden of disability due to lymphedema and hydrocele. The aim of this paper is to describe an enhanced, evidence-based cascading training program for integrated lymphedema management in this region, and to present some initial outcomes. Main text A baseline evaluation in the Upper West Region was carried out in 2019. A cascaded training program was designed and implemented, followed by a roll-out of self-care activities in all 72 sub-districts of the Upper West Region. A post implementation evaluation in 2020 showed that patients practiced self-care more frequently and with more correct techniques than before the training program; they were supported in this by health staff and family members. Conclusions Self-care for lymphedema is feasible and a program of short workshops in this cascaded training program led to significant improvements. Efforts to maintain momentum and sustain what has been achieved so far, will include regular training and supervision to improve coverage, the provision of adequate resources for limb care at home, and the maintenance of district registers of lymphedema cases, which must be updated regularly.

Background: Many countries in Africa are making progress towards reducing the incidence of Neglected Tropical Diseases (NTDs) and possibly eliminating them completely. Through the accepted global strategy of Mass Drug Administration (MDA), the COUNTDOWN project1 has made significant attempts through a partnership with the Ghana Health Service to reduce the incidence and impact of NTDs particularly Schistosomiasis (SCH), Soil Transmitted Helminths (STH), Onchocerciasis (OV), and Lymphatic Filariasis (LF) in Ghana. However, elimination can be achieved only when the key players including the community members comply with the programme guidelines and requirements by participating in MDA campaigns against NTDs. The objective of the paper is to examine the factors influencing community members’ participation in MDA programs that seeks to bring the services of NTDs prevention to the doorstep of individuals. Methods: We used a population-based survey data of 1,034 people from 296 households collected in the Assin North Municipality in the Central Region of Ghana. First, chi-square test was used to test the association of socio-economic factors and participation in MDAs. Subsequently, we ran a multilevel logistic regression model to estimate the association of factors that influence non-participation in MDA by community members. Results: Nearly a quarter of respondents had once suffered from STH (22.5%) and a small fraction from bilharzia (7.4), river blindness (1.1%), and nobody suffered from LF. Although almost all respondents (97%) had ever heard of MDA campaign, 22% of respondents missed or did not participate in a MDA program. Factors that were found to correlate with non-participation in MDA programs are marital status and previously receiving tablets from a MDA campaign. Conclusion: Results showed that MDA participation by community members is relatively high and thus Ghana’s efforts at eliminating NTDs through MDA is on course. However, continues public education is required to maintain high participation and possibly improve upon it. 1The project looks at the parasitological, epidemiological as well as the socio-economic factors that influence the acceptance, effectiveness, efficiency and equity impact of scale-up from a health systems approach