Background Lymphatic filariasis (LF) causes chronic morbidity, which usually manifests as lymphedema or hydrocele. Mass drug administration (MDA) began in Kassena Nankana East Municipal (KNEM) and Nabdam, two hotspot districts in the Upper East Region in Ghana, in 2000 and 2005, respectively. This cross-sectional study evaluated the impact of 15 years of MDA on the control of LF as determined by circulating filarial antigen (CFA) and microfilariae assessment in the KNEM and the Nabdam districts. Methodology/Principal findings A total of 7,453 participants from eight sub-districts in the two hotspot districts (KNEM: N = 4604; Nabdam: N = 2849) were recruited into the study. The overall CFA prevalence as determined by the FTS was 19.6% and 12.8% in the KNEM and Nabdam districts, respectively. Manyoro, a sub-district on the border with Burkina Faso, recorded the highest CFA prevalence of 26% in the KNEM. Assessment of microfilariae and Og4C3 antigen was done from 1009 (KNEM: N = 799 (79.2%); Nabdam: N = 210 (20.8%)) randomly selected FTS-positive (N = 885) and FTS-negative (N = 124) individuals. The Og4C3 antigen was found in 22.6%/23.0% of the selected individuals (KNEM/Nabdam), whereas the night blood revealed microfilariae in only 0.7%/0.5%. Conclusions/Significance Using the WHO endorsed FTS, CFA prevalence exceeded the long-standing <2% threshold—which may need revision and validation. Surprisingly, the Og4C3 ELISA showed positive results in only about one-fifth of the FTS positive samples. However, even this result would not have met the <2% CFA criteria for LF elimination. In contrast, projections from the microfilariae results revealed a halt in LF transmission. The global elimination target was due in 2020 but has been extended to 2030 since this could not be met. Focused MDA intervention intensification on seasonal migrants and non-compliers, and implementation of alternative treatment strategies may suffice for the elimination of the disease.

Background Onchocerciasis is the world’s second leading cause of infectious blindness and a major public health problem in many parts of the world, including Ghana, with severe impact on the skin also. Mass drug administration (MDA) with ivermectin began in the Sefwi Akontombra district of the Western North Region of Ghana in 1994. The aim of this cross-sectional study was to evaluate the impact of about three decades of MDA on onchocerciasis and its clinical manifestations by investigating the current nodule and microfilaria (MF) prevalence in the Sefwi Akontombra district using established protocols. Methodology This cross-sectional study had participants examined for signs of dermal/skin onchocerciasis and palpated, and those with ≥ 1 palpable sub-cutaneous nodule had skin snips taken from the left and right iliac crests for later parasitological (microfilariae) assessment. Logistic regression models were used to identify independent predictive and risk factors significantly associated with nodule and MF prevalence. Results A total of 1980 participants from 25 communities in three sub-districts were recruited. Compliance to the MDA intervention in the district was 93.7%. The study recorded Onchocerca nodule prevalence of 35.4% (N = 701), out of which 31.5% (N = 221) were MF positives, with district community microfilariae load (CMFL) and geometric mean intensity of 0.25 MF/ss and 0.26 MF/ss respectively. Adawu, the central community among the 25 surveyed recorded the highest CMFL (0.77 MF/ss)— with 14 communities being hypoendemic and 11, mesoendemic for the onchocerciasis infection. The overall estimated district onchocerciasis MF prevalence was 11.2%, making the district hypoendemic. Of the 17 participants who presented with dermal symptoms, acute papular onchodermatitis (41.2%) was the most prevalent. Age, ivermectin intake and gender were the independent predictive factors significantly associated (p < 0.05) with onchocerciasis in the district. Conclusion Despite decades of ivermectin administration in the district, the MF prevalence in the district was > the 1% threshold required for elimination. As the focus of the Ghana Onchocerciasis Control Programme has changed from control to elimination, MDA should be intensified in areas with MF prevalence > 1%. Though the district’s CMFL was far below the 5.0 MF/ss public health problem threshold, macrofilaricidal drugs should be explored to complement the microfilaricidal ivermectin.

BackgroundOnchocerciasis is the world’s second leading cause of infectious blindness and a major public health problem in many parts of the world, including Ghana, with severe impact on the skin also. Mass drug administration (MDA) with ivermectin began in the Sefwi Akontombra district of the Western North Region of Ghana in 1994. The aim of this cross-sectional study was to evaluate the impact of about three decades of MDA on onchocerciasis and its clinical manifestations by investigating the current nodule and microfilaria (MF) prevalence in the Sefwi Akontombra district using established protocols. MethodologyThis cross-sectional study had participants examined for signs of dermal/skin onchocerciasis and palpated, and those with ≥1 palpable sub-cutaneous nodule had skin snips taken from the left and right iliac crests for later parasitological (microfilariae) assessment. Logistic regression models were used to identify independent predictive and risk factors significantly associated with nodule and MF prevalence.ResultsA total of 1980 participants from 25 communities in three sub-districts were recruited. Compliance to the MDA intervention in the district was 93.7%. The study recorded Onchocerca nodule prevalence of 35.4% (N=701), out of which 31.5% (N=221) were MF positives, with district community microfilariae load (CMFL) and geometric mean intensity of 0.25 MF/ss and 0.26 MF/ss respectively. Adawu, the central community among the 25 surveyed recorded the highest CMFL (0.77 MF/ss)— with 14 communities being hypoendemic and 11, mesoendemic for the onchocerciasis infection. The overall estimated district onchocerciasis MF prevalence was 11.2%, making the district hypoendemic. Of the 17 participants who presented with dermal symptoms, acute papular onchodermatitis (41.2%) was the most prevalent. Age, ivermectin intake and gender were the independent predictive factors significantly associated (p<0.05) with onchocerciasis in the district.ConclusionDespite decades of ivermectin administration in the district, the MF prevalence in the district was > the 1% threshold required for elimination. As the focus of the Ghana Onchocerciasis Control Programme has changed from control to elimination, MDA should be intensified in areas with MF prevalence >1%. Though the district’s CMFL was far below the 5.0 MF/ss public health problem threshold, macrofilaricidal drugs should be explored to complement the microfilaricidal ivermectin.