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

Abstract

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.

Spatial Variation in Risk Factors of Lymphatic Filariasis in Hotspot Zones in Ghana

“…In all, 430 communities were surveyed for LF infections as part of a transmission assessment survey in Ghana. Details of this dataset is described by Biritwum et al (2019). Spatial locations of these communities were extracted from multiple sources including Google Earth Pro, Open Street Map, directory of cities and towns (world database) and database of the Ghana National Identi cation Authority card registration projects.…”

“…Data on mf cases in Ghana was obtained from published article in peer-reviewed journals (Biritwum et al, 2019: Gyapong et al, 2002. The data spanning 2000 to 2014 contained information on the year samples were collected, number of years of MDA, number of people examined, and number of mf positive recorded for each study community.…”

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).…”

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“…years of annual MDA, such as in Nigeria, Tanzania and Ghana [18][19][20]. In Ghana, after up to 14 rounds of MDA, the transmission of LF still persists in districts with relatively high baseline prevalence [21]. Modelling of LF MDA showed that baseline prevalence is one of the most important factors on impact, along with the number of rounds of MDA [22].…”