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Boko-Collins PM, Ogouyemi-Hounto A, Adjinacou-Badou EG, Gbaguidi-Saizonou L, Dossa NI, Dare A, Ibikounle M, Zoerhoff KL, Cohn DA, Batcho W. Assessment of treatment impact on lymphatic filariasis in 13 districts of Benin: progress toward elimination in nine districts despite persistence of transmission in some areas. Parasit Vectors 2019; 12:276. [PMID: 31146779 PMCID: PMC6543600 DOI: 10.1186/s13071-019-3525-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is still a public health burden in many developing countries. In Benin, a West African country, at least 6.6 million people are at risk for LF. With the goal of eliminating LF by 2020, mass drug administration (MDA) has been scaled-up during the last decade. Currently, 23 districts are believed to have eliminated LF as a public health problem, and 25 other districts are still under treatment. In this study we report the results of the first transmission assessment survey of LF (TAS1) in 13 districts from the second group, which have received at least six rounds of MDA with albendazole and ivermectin. METHODS The 13 districts were grouped into six evaluation units (EU). In each EU, 30 schools randomly selected by survey sample builder (SSB) software were surveyed. Children aged six and seven were sampled in schools and for each child the Alere™ Filariasis Test Strip test was carried out using finger-prick blood to detect the circulating filarial antigen from Wuchereria bancrofti. RESULTS Overall, 9381 children were sampled in 191 schools from the six EU with 47.6% of the children aged six years and 52.4% aged seven years. Five EU passed the assessment, with no positive cases identified. The EU of Ouinhi which grouped the districts of Ouinhi, Cove, Za-Kpota and Zagnanado failed, with 47 positive cases. These cases were clustered in the districts of Ouinhi (n = 20), Za-Kpota (n = 11) and Zagnanado (n = 16). No cases were found in the district of Cove. CONCLUSIONS The findings of our study indicate that Benin has made important progress towards elimination in most districts evaluated. However, this study also shows that transmission of LF is ongoing in the EU of Ouinhi, part of the Zou department. The MDA strategy needs to be strengthened in order to control the human reservoir of infection in these districts.
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Affiliation(s)
- Pelagie M Boko-Collins
- National Control Program of Communicable Diseases, Ministry of Health of Benin, 01-BP-882, Cotonou, Benin.
| | | | - Elvire G Adjinacou-Badou
- National Control Program of Communicable Diseases, Ministry of Health of Benin, 01-BP-882, Cotonou, Benin
| | - Laurinda Gbaguidi-Saizonou
- National Control Program of Communicable Diseases, Ministry of Health of Benin, 01-BP-882, Cotonou, Benin
| | | | | | - Moudachirou Ibikounle
- Department of Zoology, Faculty of Sciences and Techniques, University of Abomey-Calavi, 01 BP 526, Cotonou, Benin
| | - Kathryn L Zoerhoff
- RTI International, 701 13th Street NW, Suite 750, Washington, DC, 20005, USA
| | - Daniel A Cohn
- RTI International, 701 13th Street NW, Suite 750, Washington, DC, 20005, USA
| | - Wilfrid Batcho
- National Control Program of Communicable Diseases, Ministry of Health of Benin, 01-BP-882, Cotonou, Benin
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102
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Abstract
Approximately 250 million people have been using ivermectin (IVM) annually to combat many parasitic diseases including filariasis, onchocerciasis, strongyloidiasis, scabies and pediculosis. Many clinical studies have proven its efficacy against these diseases and have reported the optimum dose and duration of treatment. Moreover, its antiparasitic range has increased to cover more parasitic infections, but it still requires further exploration, e.g. for trichinosis and myiasis. Furthermore, IVM showed high efficacy in killing vectors of disease-causing parasites such as mosquitoes, sandflies and tsetse flies. The World Health Organization (WHO) has managed many control programmes involving the use of IVM to achieve elimination of onchocerciasis and lymphatic filariasis and to reduce malaria transmission. However, IVM is not exempt from the possibility of resistance and, certainly, its intensive use has led to the emergence of resistance in some parasites. Recent research is investigating the possibility of novel drug delivery systems for IVM that increase its potential to treat a new range of diseases and to overcome the possibility of drug resistance. This review highlights the most common human uses of IVM, with special reference to the new and promising properties of IVM.
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Affiliation(s)
- Dalia S Ashour
- Medical Parasitology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
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103
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Chaumeau V, Kajeechiwa L, Fustec B, Landier J, Naw Nyo S, Nay Hsel S, Phatharakokordbun P, Kittiphanakun P, Nosten S, Thwin MM, Win Tun S, Wiladphaingern J, Cottrell G, Parker DM, Minh MC, Kwansomboon N, Metaane S, Montazeau C, Kunjanwong K, Sawasdichai S, Andolina C, Ling C, Haohankhunnatham W, Christiensen P, Wanyatip S, Konghahong K, Cerqueira D, Imwong M, Dondorp AM, Chareonviriyaphap T, White NJ, Nosten FH, Corbel V. Contribution of Asymptomatic Plasmodium Infections to the Transmission of Malaria in Kayin State, Myanmar. J Infect Dis 2019; 219:1499-1509. [PMID: 30500927 PMCID: PMC6467188 DOI: 10.1093/infdis/jiy686] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/27/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The objective of mass antimalarial drug administration (MDA) is to eliminate malaria rapidly by eliminating the asymptomatic malaria parasite reservoirs and interrupting transmission. In the Greater Mekong Subregion, where artemisinin-resistant Plasmodium falciparum is now widespread, MDA has been proposed as an elimination accelerator, but the contribution of asymptomatic infections to malaria transmission has been questioned. The impact of MDA on entomological indices has not been characterized previously. METHODS MDA was conducted in 4 villages in Kayin State (Myanmar). Malaria mosquito vectors were captured 3 months before, during, and 3 months after MDA, and their Plasmodium infections were detected by polymerase chain reaction (PCR) analysis. The relationship between the entomological inoculation rate, the malaria prevalence in humans determined by ultrasensitive PCR, and MDA was characterized by generalized estimating equation regression. RESULTS Asymptomatic P. falciparum and Plasmodium vivax infections were cleared by MDA. The P. vivax entomological inoculation rate was reduced by 12.5-fold (95% confidence interval [CI], 1.6-100-fold), but the reservoir of asymptomatic P. vivax infections was reconstituted within 3 months, presumably because of relapses. This was coincident with a 5.3-fold (95% CI, 4.8-6.0-fold) increase in the vector infection rate. CONCLUSION Asymptomatic infections are a major source of malaria transmission in Southeast Asia.
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Affiliation(s)
- Victor Chaumeau
- Centre hospitalier universitaire de Montpellier, Montpellier
- UMR 224 “Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle,” Institut de Recherche pour le Développement, Montpellier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Ladda Kajeechiwa
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Bénédicte Fustec
- UMR 224 “Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle,” Institut de Recherche pour le Développement, Montpellier
| | - Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
- Institut de Recherches pour le Développement, Aix Marseille Univ, INSERM, SESSTIM, Marseille
| | - Saw Naw Nyo
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Saw Nay Hsel
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Phabele Phatharakokordbun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Prapan Kittiphanakun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Suphak Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - May Myo Thwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Saw Win Tun
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Jacher Wiladphaingern
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Gilles Cottrell
- UMR 216 “Mère et enfant face aux infections tropicales,” Institut de Recherche pour le Développement, Université Paris Descartes, Paris, France
| | - Daniel M Parker
- Department of Population Health and Disease Prevention, University of California, Irvine
| | - Myo Chit Minh
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Nittpha Kwansomboon
- Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok, Thailand
| | - Selma Metaane
- UMR 224 “Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle,” Institut de Recherche pour le Développement, Montpellier
| | - Céline Montazeau
- UMR 224 “Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle,” Institut de Recherche pour le Développement, Montpellier
| | - Kitti Kunjanwong
- Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok, Thailand
| | - Sunisa Sawasdichai
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Chiara Andolina
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Clare Ling
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Warat Haohankhunnatham
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Peter Christiensen
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Sunaree Wanyatip
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Kamonchanok Konghahong
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
| | - Dominique Cerqueira
- Department of Entomology, Faculty of Agriculture, Kasetsart University, Bangkok, Thailand
| | - Mallika Imwong
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University
| | - Arjen M Dondorp
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University
| | | | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University
| | - François H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Vincent Corbel
- UMR 224 “Maladies Infectieuses et Vecteurs, Ecologie, Génétique, Evolution et Contrôle,” Institut de Recherche pour le Développement, Montpellier
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Chami GF, Kabatereine NB, Tukahebwa EM. Profiling the best-performing community medicine distributors for mass drug administration: a comprehensive, data-driven analysis of treatment for schistosomiasis, lymphatic filariasis, and soil-transmitted helminths in Uganda. BMC Med 2019; 17:69. [PMID: 30917824 PMCID: PMC6437990 DOI: 10.1186/s12916-019-1303-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/11/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The most prevalent neglected tropical diseases are treated through blanket drug distribution that is reliant on lay community medicine distributors (CMDs). Yet, treatment rates achieved by CMDs vary widely and it is not known which CMDs treat the most people. METHODS In Mayuge District, Uganda, we tracked 6779 individuals (aged 1+ years) in 1238 households across 31 villages. Routine, community-based mass drug administration (MDA) was implemented for schistosomiasis, lymphatic filariasis, and soil-transmitted helminths. For each CMD, the percentage of eligible individuals treated (offered and ingested medicines) with at least one drug of praziquantel, albendazole, or ivermectin was examined. CMD attributes (more than 25) were measured, ranging from altruistic tendencies to socioeconomic characteristics to MDA-specific variables. The predictors of treatment rates achieved by CMDs were selected with least absolute shrinkage and selection operators and then analyzed in ordinary least squares regression with standard errors clustered by village. The influences of participant compliance and the ordering of drugs offered also were examined for the treatment rates achieved by CMDs. RESULTS Overall, only 44.89% (3043/6779) of eligible individuals were treated with at least one drug. Treatment rates varied amongst CMDs from 0% to 84.25%. Treatment rate increases were associated (p value< 0.05) with CMDs who displayed altruistic biases towards their friends (13.88%), had friends who helped with MDA (8.43%), were male (11.96%), worked as fishermen/fishmongers (14.93%), and used protected drinking water sources (13.43%). Only 0.24% (16/6779) of all eligible individuals were noncompliant by refusing to ingest all offered drugs. Distributing praziquantel first was strongly, positively correlated (p value < 0.0001) with treatment rates for albendazole and ivermectin. CONCLUSIONS These findings profile CMDs who treat the most people during routine MDA. Criteria currently used to select CMDs-community-wide meetings, educational attainment, age, years as a CMD, etc.-were uninformative. Participant noncompliance and the provision of praziquantel before albendazole and ivermectin did not negatively impact treatment rates achieved by CMDs. Engaging CMD friend groups with MDA, selecting CMDs who practise good preventative health behaviours, and including CMDs with high-risk occupations for endemic infections may improve MDA treatment rates. Evidence-based guidelines are needed to improve the monitoring, selection, and replacement of CMDs during MDA.
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Affiliation(s)
- Goylette F Chami
- Department of Pathology, University of Cambridge, Tennis Ct. Rd., Cambridge, CB2 1QP, UK.
| | - Narcis B Kabatereine
- Vector Control Division, Bilharzia and Worm Control Programme, Uganda Ministry of Health, Kampala, Uganda
| | - Edridah M Tukahebwa
- Vector Control Division, Bilharzia and Worm Control Programme, Uganda Ministry of Health, Kampala, Uganda
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Carlingford CN, Melrose W, Mokoia G, Graves PM, Ichimori K, Capuano C, Kim SH, Aratchige P, Nosa M. Elimination of lymphatic filariasis as a public health problem in Niue under PacELF, 1999-2016. Trop Med Health 2019; 47:20. [PMID: 30923457 PMCID: PMC6420762 DOI: 10.1186/s41182-019-0141-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Lymphatic filariasis (LF) is a mosquito-borne parasitic disease which is targeted for elimination as a public health problem worldwide. Niue is a small self-governing South Pacific island nation with approximately 1600 residents that was formerly LF endemic. Here, we review the progress made towards eliminating LF in Niue since 1999. Methods This study has reviewed all the available literature relating to LF in Niue to assess surveillance efforts and the elimination of transmission. Reviewed documentation included both published and unpublished works including historical reports of LF, WHO PacELF records, and Niue Country Reports of the national LF elimination program. Findings Niue conducted mapping of baseline LF endemicity by testing the total present and consenting population for LF antigen with immunochromatographic test (ICT) in 1999, when circulating filarial antigen prevalence was 3.1% (n = 1794). Five nationwide annual mass drug administration (MDA) rounds with albendazole (400 mg) and diethylcarbamazine citrate (DEC) were undertaken from 2000 to 2004, with coverage reported from distribution records ranging from 78 to 99% of the eligible population, which excluded pregnant women and children under 2 years of age. A further whole population survey using ICT in 2001 found 1.3% positive (n = 1630). In 2004, antigen prevalence had reduced to 0.2% (n = 1285). A similar post-MDA survey in 2009 indicated antigen prevalence to be 0.5% (n = 1378). Seven positive cases were re-tested and re-treated every six months until negative. Conclusions After five rounds of MDA, Niue had reduced the LF antigen population prevalence in all ages from 3.1% to below 1% and maintained this prevalence for a further five years. Due to Niue’s small population, surveillance was done by whole population surveys. Niue’s results support the WHO recommended strategy that five to six rounds of annual MDA with effective population coverage can successfully interrupt the transmission of LF. Niue received official acknowledgement of the validation of elimination of LF as a public health problem by the WHO Director-General and WHO Western Pacific Regional Office (WPRO) Regional Director at the 67th session of the Regional Committee for the Western Pacific held in Manila in October 2016.
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Affiliation(s)
| | - Wayne Melrose
- 2College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville and Cairns, Australia
| | | | - Patricia M Graves
- 2College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville and Cairns, Australia
| | - Kazuyo Ichimori
- 4Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Corinne Capuano
- WHO Office of the Representative for the South Pacific and Division of Pacific Technical Support, Suva, Fiji
| | - Sung Hye Kim
- 6Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Padmasiri Aratchige
- 6Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
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Pi-Bansa S, Osei JHN, Frempong KK, Elhassan E, Akuoko OK, Agyemang D, Ahorlu C, Appawu MA, Koudou BG, Wilson MD, de Souza DK, Dadzie SK, Utzinger J, Boakye DA. Potential factors influencing lymphatic filariasis transmission in "hotspot" and "control" areas in Ghana: the importance of vectors. Infect Dis Poverty 2019; 8:9. [PMID: 30717788 PMCID: PMC6362603 DOI: 10.1186/s40249-019-0520-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mass drug administration (MDA) programmes for the control of lymphatic filariasis in Ghana, have been ongoing in some endemic districts for 16 years. The current study aimed to assess factors that govern the success of MDA programmes for breaking transmission of lymphatic filariasis in Ghana. METHODS The study was undertaken in two "hotspot" districts (Ahanta West and Kassena Nankana West) and two control districts (Mpohor and Bongo) in Ghana. Mosquitoes were collected and identified using morphological and molecular tools. A proportion of the cibarial armatures of each species was examined. Dissections were performed on Anopheles gambiae for filarial worm detection. A questionnaire was administered to obtain information on MDA compliance and vector control activities. Data were compared between districts to determine factors that might explain persistent transmission of lymphatic filariasis. RESULTS High numbers of mosquitoes were sampled in Ahanta West district compared to Mpohor district (F = 16.09, P = 0.002). There was no significant difference between the numbers of mosquitoes collected in Kassena Nankana West and Bongo districts (F = 2.16, P = 0.185). Mansonia species were predominant in Ahanta West district. An. coluzzii mosquitoes were prevalent in all districts. An. melas with infected and infective filarial worms was found only in Ahanta West district. No differences were found in cibarial teeth numbers and shape for mosquito species in the surveyed districts. Reported MDA coverage was high in all districts. The average use of bednet and indoor residual spraying was 82.4 and 66.2%, respectively. There was high compliance in the five preceding MDA rounds in Ahanta West and Kassena Nankana West districts, both considered hotspots of lymphatic filariasis transmission. CONCLUSIONS The study on persistent transmission of lymphatic filariasis in the two areas in Ghana present information that shows the importance of local understanding of factors affecting control and elimination of lymphatic filariasis. Unlike Kassena Nankana West district where transmission dynamics could be explained by initial infection prevalence and low vector densities, ongoing lymphatic filariasis transmission in Ahanta West district might be explained by high biting rates of An. gambiae and initial infection prevalence, coupled with high densities of An. melas and Mansonia vector species that have low or no teeth and exhibiting limitation.
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Affiliation(s)
- Sellase Pi-Bansa
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana.
| | - Joseph Harold Nyarko Osei
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana.,Department of Animal Biology and Conservation Science, University of Ghana, Legon, Ghana
| | - Kwadwo Kyeremeh Frempong
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana.,Department of Animal Biology and Conservation Science, University of Ghana, Legon, Ghana
| | | | - Osei Kweku Akuoko
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana.,African Regional Postgraduate Programme in Insect Science, University of Ghana, Legon, Ghana
| | | | - Collins Ahorlu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Maxwell Alexander Appawu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Benjamin Guibehi Koudou
- Vector Biology Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Michael David Wilson
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Dziedzom Komi de Souza
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Samuel Kweku Dadzie
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Daniel Adjei Boakye
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
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107
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Abstract
Mass drug administration (MDA) of antimalarials has re-emerged as a recommended tool for interrupting malaria transmission, but evidence from low endemicity settings is scarce. A trial in Zanzibar found that two rounds of MDA made no significant impact on malaria incidence, and many questions on the optimal mode and setting for implementing MDA remain unanswered. A more thorough understanding of local sources and drivers of transmission, and a better toolbox for evaluating interventions in near-elimination settings are essential.Please see related research article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1202-8 .
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Affiliation(s)
- Manuel W Hetzel
- Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | - Blaise Genton
- Swiss Tropical and Public Health Institute, P.O. Box, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland.,Division of Infectious Diseases and Department of Community Health, University Hospital (CHUV), Rue du Bugnon 44, 1011, Lausanne, Switzerland
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Wanzira H, Naiga S, Mulebeke R, Bukenya F, Nabukenya M, Omoding O, Echodu D, Yeka A. Community facilitators and barriers to a successful implementation of mass drug administration and indoor residual spraying for malaria prevention in Uganda: a qualitative study. Malar J 2018; 17:474. [PMID: 30558632 PMCID: PMC6298012 DOI: 10.1186/s12936-018-2624-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/11/2018] [Indexed: 11/23/2022] Open
Abstract
Background There is growing interest to add mass drug administration (MDA) to the already existing malaria prevention strategies, such as indoor residual spraying (IRS). However, successful MDA and IRS requires high population-wide coverage, emphasizing the importance of community acceptance. This study’s objectives were to identify community-level facilitators and barriers during the implementation of both MDA and IRS in communities with high malaria transmission intensity. Methods This was a qualitative study conducted in two sub-counties in Katakwi district. Kapujan sub-county residents received two rounds of IRS and MDA while Toroma sub-county residents received two rounds of IRS only. Key informant interviews and focus group discussions were conducted with key influential district and sub-county personnel and community members. Data were analysed using thematic analysis. Transcripts and interview notes from the in-depth interviews were analysed using a coding scheme developed from pre-defined topics together with themes emerging from the data. The Nvivo software program was used to aggregate the data by codes and to present study findings. Results Overall, 14 key informants were interviewed: 4 from Katakwi district and 5 each from Kapujan and Toroma sub-counties. Five focus group discussions were conducted: 4 with community members (men and women), 2 in each sub-county and one with medical staff of Toroma health centre IV. Important themes for consideration raised by the respondents include community sensitization, conducting implementation during the low activity dry season, involvement of government and local leadership, use of the competent locally composed team, community knowledge of malaria effects and consequences, combining interventions and evidence of malaria reduction from interventions. Potential barriers such as spreading of misinformation regarding interventions, the strong unpleasant smell from Actellic and inadequate duration of engagement with the community should be taken into consideration. Conclusion This study documents important community engagement strategies that need to be considered when implementing malaria MDA in combination with IRS, for malaria prevention in such settings. This information is useful for malaria programmes, especially during the design and implementation of such community level interventions.
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Affiliation(s)
| | - Susan Naiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | | | - Mariam Nabukenya
- Ministry of Health, National Malaria Control Program, Kampala, Uganda
| | | | | | - Adoke Yeka
- Makerere University School of Public Health, Kampala, Uganda
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Morris U, Msellem MI, Mkali H, Islam A, Aydin-Schmidt B, Jovel I, Shija SJ, Khamis M, Ali SM, Hodzic L, Magnusson E, Poirot E, Bennett A, Sachs MC, Tarning J, Mårtensson A, Ali AS, Björkman A. A cluster randomised controlled trial of two rounds of mass drug administration in Zanzibar, a malaria pre-elimination setting-high coverage and safety, but no significant impact on transmission. BMC Med 2018; 16:215. [PMID: 30526588 PMCID: PMC6287359 DOI: 10.1186/s12916-018-1202-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/29/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Mass drug administration (MDA) has the potential to interrupt malaria transmission and has been suggested as a tool for malaria elimination in low-endemic settings. This study aimed to determine the effectiveness and safety of two rounds of MDA in Zanzibar, a pre-elimination setting. METHODS A cluster randomised controlled trial was conducted in 16 areas considered as malaria hotspots, with an annual parasite index of > 0.8%. The areas were randomised to eight intervention and eight control clusters. The intervention included two rounds of MDA with dihydroartemisinin-piperaquine and single low-dose primaquine 4 weeks apart in May-June 2016. Primary and secondary outcomes were cumulative confirmed malaria case incidences 6 months post-MDA and parasite prevalences determined by PCR 3 months post-MDA. Additional outcomes included intervention coverage, treatment adherence, occurrence of adverse events, and cumulative incidences 3, 12, and 16 months post-MDA. RESULTS Intervention coverage was 91.0% (9959/10944) and 87.7% (9355/10666) in the first and second rounds, respectively; self-reported adherence was 82.0% (881/1136) and 93.7% (985/1196). Adverse events were reported in 11.6% (147/1268) and 3.2% (37/1143) of post-MDA survey respondents after both rounds respectively. No serious adverse event was reported. No difference in cumulative malaria case incidence was observed between the control and intervention arms 6 months post-MDA (4.2 and 3.9 per 1000 population; p = 0.94). Neither was there a difference in PCR-determined parasite prevalences 3 months post-MDA (1.4% and 1.7%; OR = 1.0, p = 0.94), although having received at least the first MDA was associated with reduced odds of malaria infection (aOR = 0.35; p = 0.02). Among confirmed malaria cases at health facilities, 26.0% and 26.3% reported recent travel outside Zanzibar in the intervention and control shehias (aOR ≥ 85; p ≤ 0.001). CONCLUSIONS MDA was implemented with high coverage, adherence, and tolerability. Despite this, no significant impact on transmission was observed. The findings suggest that two rounds of MDA in a single year may not be sufficient for a sustained impact on transmission in a pre-elimination setting, especially when the MDA impact is restricted by imported malaria. Importantly, this study adds to the limited evidence for the use of MDA in low transmission settings in sub-Saharan Africa. TRIAL REGISTRATION ClinicalTrials.gov, NCT02721186 (registration date: March 29, 2016).
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Affiliation(s)
- Ulrika Morris
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Mwinyi I. Msellem
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Humphrey Mkali
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Atiqul Islam
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Berit Aydin-Schmidt
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Irina Jovel
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Shija Joseph Shija
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Mwinyi Khamis
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Safia Mohammed Ali
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Lamija Hodzic
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Ellinor Magnusson
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Eugenie Poirot
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, USA
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, USA
| | - Michael C. Sachs
- Biostatistics Unit, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joel Tarning
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Bangkok, Thailand
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Andreas Mårtensson
- Department of Women’s and Children’s Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Abdullah S. Ali
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Anders Björkman
- Department of Microbiology, Tumor, and Cell Biology, Karolinska Institutet, Stockholm, Sweden
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Kugo M, Keter L, Maiyo A, Kinyua J, Ndemwa P, Maina G, Otieno P, Songok EM. Fortification of Carica papaya fruit seeds to school meal snacks may aid Africa mass deworming programs: a preliminary survey. Altern Ther Health Med 2018; 18:327. [PMID: 30526582 PMCID: PMC6286506 DOI: 10.1186/s12906-018-2379-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/16/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Soil transmitted helminths (STHs) are among the world's neglected tropical diseases. Morbidity due to STHs is greatest in school-age children who typically have the highest burden of infection. In 2001, WHO passed a resolution for the use of large-scale mass drug administration (MDA) to deworm vulnerable children through school based programs. Though effective, there is concern that MDA might not be sustainable over extended periods. Additionally the current MDA strategy does not consider child malnutrition, a very common malady in resource limited countries. We report a pilot evaluation of an innovation that bundles school feeding and deworming. METHODS We designed a maize (corn) flour fortified with grounded dried papaya (Carica papaya) seeds and used it to prepare porridge as per the usual school meal recipe Children from three primary schools from Nandi County in Kenya were randomized into three arms: One school received 300 ml papaya fortified porridge daily (papaya group), the second school received similar serving of plain porridge without the pawpaw ingredient (control group) and the third school received plain porridge and the conventional MDA approach of one time 400 mg dosage of albendazole (albendazole arm). Prior to the randomization, an initial baseline stool microscopy analysis was done to determine presence and intensity of intestinal worms. Core indicators of nutrition-height, weight and hemoglobin counts were also assessed. The children were monitored daily for two months and final stool sample analysis and clinical monitoring done at the end of the study. Baseline and follow-up data were analyzed and compared through SAS version 9.1 statistical package. RESULTS A total of 326 children participated in the trial. The overall prevalence of Ascaris lumbricoides was 29.4% (96), Trichuris Trichura 5.2% (17) and hookworm 1 (0.3%). Papaya seed fortified porridge reduced the Ascaris lumbricoides egg count by 63.9% after the two month period (mean 209.7epg to 75.7 p < 0.002) as compared to the albendazole arm 78.8% (129.5 epg to 27.5, p value 0.006). The control group showed an increase in egg count (42.epg to 56.3) though it was not statistically significant. Hemoglobin counts in the papaya group increased from a mean of 2 g/dL (11.5 g/dL to 13.5 g/dL, p < 0.001), as compared to the albendazole arm that increased by 1 g/dL (12.8-13.9, p < 0.001). No significant change was observed in the placebo arm (13.2 to 13.1). Interestingly the papaya group showed a significant reduction of children with Tinea capitis (ringworms) (54.4 to 34%, p < 0.002) as compared to the albendazole arm that showed an increase in ringworm infestation though not statistically significant (39.7 to 64.7% p = 0.608). CONCLUSION Papaya seed fortified porridge had a significant effect on reduction of Ascaris lumbricoides burden. It had a better nutritional outcome and effect on child fungal infections than albendazole. Its application as a routine school meal may aid current national school based nutrition and deworming programs in Africa. TRIAL REGISTRATION This study was retrospectively registered at Clinicaltrials.gov Ref. NCT02725255 on 31st March 2016.
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Jones C, Ngasala B, Derua YA, Tarimo D, Reimer L, Bockarie M, Malecela MN. Lymphatic filariasis transmission in Rufiji District, southeastern Tanzania: infection status of the human population and mosquito vectors after twelve rounds of mass drug administration. Parasit Vectors 2018; 11:588. [PMID: 30424781 PMCID: PMC6234578 DOI: 10.1186/s13071-018-3156-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/17/2018] [Indexed: 11/25/2022] Open
Abstract
Background Control of lymphatic filariasis (LF) in most of the sub-Saharan African countries is based on annual mass drug administration (MDA) using a combination of ivermectin and albendazole. Monitoring the impact of this intervention is crucial for measuring the success of the LF elimination programmes. This study assessed the status of LF infection in Rufiji district, southeastern Tanzania after twelve rounds of MDA. Methods Community members aged between 10 and 79 years were examined for Wuchereria bancrofti circulating filarial antigens (CFA) using immunochromatographic test cards (ICTs) and antigen-positive individuals were screened for microfilaraemia. All study participants were examined for clinical manifestation of LF and interviewed for drug uptake during MDA rounds. Filarial mosquito vectors were collected indoor and outdoor and examined for infection with W. bancrofti using a microscope and quantitative real-time polymerase chain reaction (qPCR) techniques. Results Out of 854 participants tested, nine (1.1%) were positive for CFA and one (0.1%) was found to be microfilaraemic. The prevalence of hydrocele and elephantiasis was 4.8% and 2.9%, respectively. Surveyed drug uptake rates were high, with 70.5% of the respondents reporting having swallowed the drugs in the 2014 MDA round (about seven months before this study). Further, 82.7% of the respondents reported having swallowed the drugs at least once since the inception of MDA programme in 2000. Of the 1054 filarial vectors caught indoors and dissected to detect W. bancrofti infection none was found to be infected. Moreover, analysis by qPCR of 1092 pools of gravid Culex quinquefasciatus collected outdoors resulted in an estimated infection rate of 0.1%. None of the filarial vectors tested with qPCR were found to be infective. Conclusion Analysis of indices of LF infection in the human population and filarial mosquito vectors indicated a substantial decline in the prevalence of LF and other transmission indices, suggesting that local transmission was extremely low if occurring at all in the study areas. We, therefore, recommend a formal transmission assessment survey (TAS) to be conducted in the study areas to make an informed decision on whether Rufiji District satisfied WHO criteria for stopping MDA.
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Affiliation(s)
- Clarer Jones
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, P. O. Box 65011, Dar es Salaam, Tanzania.
| | - Billy Ngasala
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, P. O. Box 65011, Dar es Salaam, Tanzania.,Department of Women's and Children's Health International Maternal and Child Health (IMCH), Uppsala Universitet, Uppsala, Sweden
| | - Yahya A Derua
- National Institute for Medical Research, P. O. Box 9653, Dar es Salaam, Tanzania
| | - Donath Tarimo
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, P. O. Box 65011, Dar es Salaam, Tanzania
| | - Lisa Reimer
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Moses Bockarie
- European and Development Countries Clinical Trials Partnership, Cape Town, South Africa
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Haeusler IL, Chan XHS, Guérin PJ, White NJ. The arrhythmogenic cardiotoxicity of the quinoline and structurally related antimalarial drugs: a systematic review. BMC Med 2018; 16:200. [PMID: 30400791 PMCID: PMC6220451 DOI: 10.1186/s12916-018-1188-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/09/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Several quinoline and structurally related antimalarial drugs are associated with cardiovascular side effects, particularly hypotension and electrocardiographic QT interval prolongation. A prolonged QT interval is a sensitive but not specific risk marker for the development of Torsade de Pointes-a potentially lethal polymorphic ventricular tachyarrhythmia. The increasing use of quinoline and structurally related antimalarials in mass treatments to eliminate malaria rapidly highlights the need to review their cardiovascular safety profiles. METHODS The primary objective of this systematic review was to describe the documented clinical and electrocardiographic cardiovascular side effects of quinine, mefloquine, lumefantrine, piperaquine, halofantrine, chloroquine, sulfadoxine-pyrimethamine, amodiaquine, and primaquine. Trials in healthy subjects or patients with Plasmodium falciparum or P. vivax infection were included if at least two ECGs were conducted during the trial. All trial designs were included except case reports and pooled analyses. Secondary outcomes were the methods adopted by trials for measuring and reporting the QT interval. RESULTS Data from trials published between 1982 and July 2016 were included. A total of 177 trials met the inclusion criteria. 35,448 participants received quinoline antimalarials in these trials, of which 18,436 participants underwent ECG evaluation. Subjects with co-medication use or comorbidities including cardiovascular disease were excluded from the majority of trials. Dihydroartemisinin-piperaquine was the drug most studied (5083 participants). Despite enormous use over the past 60 years, only 1076, 452, and 150 patients had ECG recordings reported in studies of chloroquine, amodiaquine, and primaquine respectively. Transiently high concentrations of quinine, quinidine, and chloroquine following parenteral administration have all been associated with hypotension, but there were no documented reports of death or syncope attributable to a cardiovascular cause, nor of electrocardiographic recordings of ventricular arrhythmia in these trials. The large volume of missing outcome information and the heterogeneity of ECG interval reporting and measurement methodology did not allow pooled quantitative analysis of QT interval changes. CONCLUSIONS No serious cardiac adverse effects were recorded in malaria clinical trials of 35,548 participants who received quinoline and structurally related antimalarials with close follow-up including 18,436 individuals who underwent ECG evaluation. While these findings provide further evidence of the rarity of serious cardiovascular events after treatment with these drugs, they also underscore the need for continued strengthening of pharmacovigilance systems for robust detection of rare drug adverse events in real-world populations. A standardised approach to measurement and reporting of ECG data in malaria trials is also needed. TRIAL REGISTRATION PROSPERO CRD42016036678.
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Affiliation(s)
- Ilsa L Haeusler
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Philippe J Guérin
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas J White
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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Nath TC, Padmawati RS, Murhandarwati EH. Barriers and gaps in utilization and coverage of mass drug administration program against soil-transmitted helminth infection in Bangladesh: An implementation research. J Infect Public Health 2018; 12:205-212. [PMID: 30385237 DOI: 10.1016/j.jiph.2018.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Bangladesh has implemented school-based mass drug administration (MDA) bi-annually since 2008 aimed to control soil-transmitted helminth (STH) infection. Despite several rounds of MDA, the government is still facing challenges to achieve the target coverage and utilization of the intervention. This study was done to explore and explain the barriers and gaps that hinder the utilization and coverage of MDA for STH. METHODS This research was a mixed method study, was conducted in two selected districts of Bangladesh. A total of 160 questionnaire surveys, 12 in-depth interviews, 8 focus group discussion, and 2 key-informant interviews were done among 238 study participants which included school-age children with relevant parents, school teachers, health workers, community leaders and MDA program managers. Descriptive statistical analysis was used to analyze the quantitative data while thematic analysis was applied for the qualitative data. RESULTS It was revealed that the participants have positive attitudes towards MDA but they pointed out the limitations in reaching all target population especially non-school going children. The level of knowledge regarding STH and MDA were found different among the study population. The evaluated coverage of MDA was also found lower than that reported. Some major barriers associated with MDA coverage found in this study were drug distribution policy, accessibility to schools, poor record keeping, follow-up, and information dissemination. Inadequate information about population dynamics and rumors about side effects of MDA drugs adversely affected the compliance of the intervention. Insufficient training of drug distributors and poor motivation among stakeholders also added to the barriers. CONCLUSION There is the need to re-strategize drug distributing methods and create effective policies to include all targeted population. Use of local channels for community sensitization, adding local distribution points, regular monitoring and follow-up and promotion of health education can possibly enhance both treatment coverage and program infrastructure.
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Affiliation(s)
- Tilak C Nath
- Special Program of Implementation Research on Tropical Diseases, Faculty of Medicine, Universitas Gadjah Mada, Indonesia; Department of Parasitology, Sylhet Agricultural University, Bangladesh.
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Ames HMR, Zuske M, King JD, Steinmann P, Bosch-Capblanch X. Community and Drug Distributor Perceptions and Experiences of Mass Drug Administration for the Elimination of Lymphatic Filariasis: A Rapid Review of Qualitative Research. Adv Parasitol 2019; 103:117-49. [PMID: 30878056 DOI: 10.1016/bs.apar.2018.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVES This article presents findings from a rapid review of qualitative research conducted to inform decision makers about community and drug distributor perceptions and experiences of mass drug administration campaigns for the elimination of lymphatic filariasis. We focused on questions related to acceptability of the mass drug administration campaigns within these groups and their thoughts around the feasibility of planning and carrying out the campaigns. METHODS We carried out a systematic search in five databases to identify potential studies. We included studies that focused on community members and drug distributors and used qualitative methods for data collection and analysis. We conducted a thematic framework analysis using the Supporting the Use of Research Evidence framework. Due to time constraints, one author conducted the screening, extraction and data analysis. FINDINGS Studies found that communities lack knowledge and information about lymphatic filariasis and the mass drug administration campaigns and that this can have an impact on how many community members choose to take medication. Health workers often had a good understanding that lymphatic filariasis was a problem in their setting, of its cause and mode of transmission and that hydrocele and elephantiasis had the same cause. However, this knowledge was not as prevalent amongst community drug distributors who often had misconceptions surrounding the topic. Furthermore, studies found that the length, timing, level of community and health system involvement, access to care for side effects, inadequate numbers of drug distributors and supervisors and motivation of drug distributors influenced participation in mass drug administration campaigns. Finally, the inadequate training of drug distributors could influence community trust in the mass drug administration program and the drug distributor themselves if there was a perception that the person was uninformed or not trained to carry out their tasks.
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Manning J, Lon C, Spring M, Wojnarski M, Somethy S, Chann S, Gosi P, Soveasna K, Sriwichai S, Kuntawunginn W, Fukuda MM, Smith PL, Rekol H, Sinoun M, So M, Lin J, Satharath P, Saunders D. Cluster-randomized trial of monthly malaria prophylaxis versus focused screening and treatment: a study protocol to define malaria elimination strategies in Cambodia. Trials 2018; 19:558. [PMID: 30326952 DOI: 10.1186/s13063-018-2931-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 09/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria remains a critical public health problem in Southeast Asia despite intensive containment efforts. The continued spread of multi-drug-resistant Plasmodium falciparum has led to calls for malaria elimination on the Thai-Cambodian border. However, the optimal approach to elimination in difficult-to-reach border populations, such as the Military, remains unclear. METHODS/DESIGN A two-arm, cluster-randomized controlled, open-label pilot study is being conducted in military personnel and their families at focal endemic areas on the Thai-Cambodian border. The primary objective is to compare the effectiveness of monthly malaria prophylaxis (MMP) with dihydroartemisinin-piperaquine and weekly primaquine for 12 weeks compared with focused screening and treating (FSAT) following current Cambodian national treatment guidelines. Eight separate military encampments, making up approximately 1000 military personnel and their families, undergo randomization to the MMP or FSAT intervention for 3 months, with an additional 3 months' follow-up. In addition, each treatment cluster of military personnel and civilians is also randomly assigned to receive either permethrin- or sham (water)-treated clothing in single-blind fashion. The primary endpoint is risk reduction for malaria infection in geographically distinct military encampments based on their treatment strategy. Monthly malaria screening in both arms is done via microscopy, PCR, and rapid diagnostic testing to compare both the accuracy and cost-effectiveness of diagnostic modalities to detect asymptomatic infection. Universal glucose-6-phosphate dehydrogenase (G6PD) deficiency screening is done at entry, comparing the results from a commercially available rapid diagnostic test, the fluorescence spot test, and quantitative testing for accuracy and cost-effectiveness. The comparative safety of the interventions chosen is also being evaluated. DISCUSSION Despite the apparent urgency, the key operational elements of proposed malaria elimination strategies in Southeast Asian mobile and migrant populations, including the Military, have yet to be rigorously tested in a well-controlled clinical study. Here, we present a protocol for the primary evaluation of two treatment paradigms - monthly malaria prophylaxis and focused screening and treatment - to achieve malaria elimination in a Cambodian military population. We will also assess the feasibility and incremental benefit of outdoor-biting vector intervention - permethrin-treated clothing. In the process, we aim to define the cost-effectiveness of the inputs required for success including a responsive information system, skilled human resource and laboratory infrastructure requirements, and quality management. Despite being a relatively low transmission area, the complexities of multi-drug-resistant malaria and the movement of vulnerable populations require an approach that is not only technically sound, but simple enough to be achievable. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02653898 . Registered on 13 January 2016.
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Truscott JE, Gurarie D, Alsallaq R, Toor J, Yoon N, Farrell SH, Turner HC, Phillips AE, Aurelio HO, Ferro J, King CH, Anderson RM. A comparison of two mathematical models of the impact of mass drug administration on the transmission and control of schistosomiasis. Epidemics 2018; 18:29-37. [PMID: 28279453 PMCID: PMC5340850 DOI: 10.1016/j.epidem.2017.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 11/24/2022] Open
Abstract
This paper compares two mathematical models describing the transmission dynamics of schistosome infection and the impact of mass drug administration. The models differ structurally in a number of ways, including the dynamics of the intermediate snail host and the treatment of adult worms within the human host. The models are validated against data taken from a mass-drug administration trial in Mozambique. The differences between the model predictions and the data are discussed in the context of the structural differences between the models.
The predictions of two mathematical models describing the transmission dynamics of schistosome infection and the impact of mass drug administration are compared. The models differ in their description of the dynamics of the parasites within the host population and in their representation of the stages of the parasite lifecycle outside of the host. Key parameters are estimated from data collected in northern Mozambique from 2011 to 2015. This type of data set is valuable for model validation as treatment prior to the study was minimal. Predictions from both models are compared with each other and with epidemiological observations. Both models have difficulty matching both the intensity and prevalence of disease in the datasets and are only partially successful at predicting the impact of treatment. The models also differ from each other in their predictions, both quantitatively and qualitatively, of the long-term impact of 10 years’ school-based mass drug administration. We trace the dynamical differences back to basic assumptions about worm aggregation, force of infection and the dynamics of the parasite in the snail population in the two models and suggest data which could discriminate between them. We also discuss limitations with the datasets used and ways in which data collection could be improved.
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Affiliation(s)
- J E Truscott
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Imperial College, Norfolk Place, St. Mary's Campus, London, UK.
| | - D Gurarie
- Department of Mathematics, Case Western Reserve University, 10900 Euclid Avenue LC: 4983, Cleveland, OH 44106, United States
| | - R Alsallaq
- Department of Mathematics, Case Western Reserve University, 10900 Euclid Avenue LC: 4983, Cleveland, OH 44106, United States
| | - J Toor
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Imperial College, Norfolk Place, St. Mary's Campus, London, UK
| | - N Yoon
- Center for Global Health and Diseases, Case Western Reserve University, 10900 Euclid Avenue LC: 4983, Cleveland, OH 44106, United States
| | - S H Farrell
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Imperial College, Norfolk Place, St. Mary's Campus, London, UK
| | - H C Turner
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Imperial College, Norfolk Place, St. Mary's Campus, London, UK
| | - A E Phillips
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College, Norfolk Place, St. Mary's Campus, London, UK
| | - H O Aurelio
- Schistosomiasis Control Initiative, Department of Infectious Disease Epidemiology, Imperial College, Norfolk Place, St. Mary's Campus, London, UK
| | - J Ferro
- Universidade Catholica de Moçambique, Beira, Mozambique
| | - C H King
- Center for Global Health and Diseases, Case Western Reserve University, 10900 Euclid Avenue LC: 4983, Cleveland, OH 44106, United States
| | - R M Anderson
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Imperial College, Norfolk Place, St. Mary's Campus, London, UK
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Coffeng LE, Truscott JE, Farrell SH, Turner HC, Sarkar R, Kang G, de Vlas SJ, Anderson RM. Comparison and validation of two mathematical models for the impact of mass drug administration on Ascaris lumbricoides and hookworm infection. Epidemics 2018; 18:38-47. [PMID: 28279454 PMCID: PMC5340859 DOI: 10.1016/j.epidem.2017.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 11/02/2022] Open
Abstract
The predictions of two mathematical models of the transmission dynamics of Ascaris lumbricoides and hookworm infection and the impact of mass drug administration (MDA) are compared, using data from India. One model has an age structured partial differential equation (PDE) deterministic framework for the distribution of parasite numbers per host and sexual mating. The second model is an individual-based stochastic model. Baseline data acquired prior to treatment are used to estimate key transmission parameters, and forward projections are made, given the known MDA population coverage. Predictions are compared with observed post-treatment epidemiological patterns. The two models could equally well predict the short-term impact of deworming on A. lumbricoides and hookworm infection levels, despite being fitted to different subsets and/or summary statistics of the data. As such, the outcomes give confidence in their use as aids to policy formulation for the use of PCT to control A. lumbricoides and hookworm infection. The models further largely agree in a qualitative sense on the added benefit of semi-annual vs. annual deworming and targeting of the entire population vs. only children, as well as the potential for interruption of transmission. Further, this study also illustrates that long-term predictions are sensitive to modelling assumptions about which age groups contribute most to transmission, which depends on human demography and age-patterns in exposure and contribution to the environmental reservoir of infection, the latter being notoriously difficult to empirically quantify.
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Affiliation(s)
- Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - James E Truscott
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, St. Mary's Campus, Imperial College London, London WC2 1 PG, United Kingdom
| | - Sam H Farrell
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, St. Mary's Campus, Imperial College London, London WC2 1 PG, United Kingdom
| | - Hugo C Turner
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, St. Mary's Campus, Imperial College London, London WC2 1 PG, United Kingdom
| | - Rajiv Sarkar
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore 632004, Tamil Nadu, India
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roy M Anderson
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, St. Mary's Campus, Imperial College London, London WC2 1 PG, United Kingdom
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Staal SL, Hogendoorn SKL, Voets SA, Tepper RC, Veenstra M, de Vos II, van Son KC, Gool JK, Paramitha AC, Aristyo K, Wildan A, Pratiwi C, van Ree R, Yazdanbakhsh M, Supali T, Djuardi Y, Labuda LA, Tahapary DL, Sartono E. Prevalence of Atopy following Mass Drug Administration with Albendazole: A Study in School Children on Flores Island, Indonesia. Int Arch Allergy Immunol 2018; 177:192-198. [PMID: 30130756 DOI: 10.1159/000490952] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/16/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND In many rural areas of tropical countries such as Indonesia, the prevalence of soil-transmitted helminths (STH) infections remains high. At the same time, the burden of allergic disorders in such rural areas is reported to be low and inversely associated with helminth infections. To reduce the morbidity and transmission of helminth infections, the world health organization recommends preventive treatment of school children by providing mass drug administration (MDA) with albendazole. Here, we had an opportunity to evaluate the prevalence of skin reactivity to allergens before and after albendazole treatment to get an indication of the possible impact of MDA on allergic sensitization. METHODS A study was conducted among 150 school children living in an area endemic for STH infections. Before and 1 year after anthelminthic treatment with albendazole, stool samples were examined for the presence of STH eggs, skin prick tests (SPT) for cockroach and house dust mites were performed, blood eosinophilia was assessed, and total immunoglobulin E (IgE) and C-reactive protein (CRP) were measured in plasma. RESULTS Anthelminthic treatment significantly reduced the prevalence of STH from 19.6 before treatment to 6% after treatment (p < 0.001). Levels of total IgE (estimate: 0.30; 95% CI 0.22-0.42, p < 0.0001), CRP (estimate: 0.60; 95% CI 0.42-0.86, p = 0.006), and eosinophil counts (estimate: 0.70; 95% CI 0.61-0.80, p < 0.001) decreased significantly. The prevalence of SPT positivity increased from 18.7 to 32.7%. Multivariate analysis adjusted for confounding factors showed an increased risk of being SPT positive to any allergen (OR 3.04; 95% CI 1.338-6.919, p = 0.008). CONCLUSIONS This study indicates that 1 year of MDA with albendazole was associated with a reduced prevalence of STH infections. This study shows that the prevalence of allergic sensitization increases after 1 year of albendazole treatment. Placebo-controlled and larger studies are needed to further substantiate a role of deworming treatment in an increased risk of allergic sensitization.
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Affiliation(s)
- Steven L Staal
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sarika K L Hogendoorn
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sophie A Voets
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rebecca C Tepper
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mirte Veenstra
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ivo I de Vos
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Koen C van Son
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jari K Gool
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Antonia C Paramitha
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Kevin Aristyo
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ardy Wildan
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Chici Pratiwi
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ronald van Ree
- Departments of Experimental Immunology and Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Maria Yazdanbakhsh
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Taniawati Supali
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yenny Djuardi
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Lucja A Labuda
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Dicky L Tahapary
- Division of Endocrinology, Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Erliyani Sartono
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
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119
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Mehta PK, Rauniyar R, Gupta BP. Microfilaria persistent foci during post MDA and the risk assessment of resurgence in India. Trop Med Health 2018; 46:25. [PMID: 30026669 PMCID: PMC6050703 DOI: 10.1186/s41182-018-0107-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 06/29/2018] [Indexed: 11/10/2022] Open
Abstract
Background Pondicherry, a union territory in India, is an endemic district for bancroftian lymphatic filariasis transmitted by Culex quinquefasciatus where eight rounds of mass drug administration (MDA) were completed in 2011 (annually once from 2004 to 2011).The objectives of this study were to conduct a focal survey to assess microfilaria and antigen (Ag) prevalence among young adults and to assess vector infection and infectivity through a focal entomological survey. Methods Mosquitoes were collected using gravid traps in Sedurapet village of Pondicherry and dissected to enumerate W. bancrofti larvae stage first larval stage (L1), second larval stage (L2), and third larval stage (L3). Microfilarias (Mf) were detected using blood smears collected from inhabitants. Results A total of 360 individuals from 67 houses were enrolled in this study of which 290 (80.6%) were surveyed for the presence of Mf. Two Mf carriers were detected yielding an overall prevalence of 0.69% and two out of 85 (2.35%) were Mf antigen positive. Of the 2875 mosquitoes collected by gravid trap, Culex quinquefasciatus (93.9%) was the predominant species, followed by Anopheles subpictus (2.3%) and Culex vishnui (3.8%). The density of Cx. quinquefasciatus was 28.1 per trap-night. A total of 2429 Cx. quinquefasciatus were dissected and microscopically examined for abdominal conditions (gravid 85%, semi-gravid 9.4%, unfed 3.8%, and fully fed 1.9%) and filarial infection. One mosquito (infection rate equal to 0.04%) was found to harbor a second stage filarial larva, and none of the mosquitoes had infective stage larva. Conclusion Our results show no reappearance of infection of lymphatic filariasis in Sedurapet village of Pondicherry after MDA, and thus, no further intervention is required in that area for possible resurgence of lymphatic filariasis. However, monitoring should be continued as part of post MDA activities until the endpoint of complete elimination is achieved. We demonstrated that xenomonitoring can be used to monitor the post MDA situation for possible risk of transmission to initiate control measures.
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Affiliation(s)
- Pramod Kumar Mehta
- 1Vector Control Research Centre, Medical Complex, Indira Nagar, Pondicherry, India.,Present address: Central Regional Health Directorate Office, Ministry of Health and Population, Kathmandu, Nepal
| | - Ramanuj Rauniyar
- Kathmandu Research Institute for Biological Sciences, Kathmandu, Nepal
| | - Birendra Prasad Gupta
- Kathmandu Research Institute for Biological Sciences, Kathmandu, Nepal.,Central Diagnostic Laboratory and Research Center Pvt. Ltd, Kathmandu, Nepal
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120
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Koroma JB, Sesay S, Conteh A, Paye J, Bah M, Sonnie M, Hodges MH, Zhang Y. Progress on elimination of lymphatic filariasis in Sierra Leone. Parasit Vectors 2018; 11:334. [PMID: 29866207 PMCID: PMC5987388 DOI: 10.1186/s13071-018-2915-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background A baseline survey in 2007–2008 found lymphatic filariasis (LF) to be endemic in Sierra Leone in all 14 districts and co-endemic with onchocerciasis in 12 districts. Mass drug administration (MDA) with ivermectin started in 2006 for onchocerciasis and was modified to add albendazole in 2008 to include LF treatment. In 2011, after three effective MDAs, a significant reduction in microfilaraemia (mf) prevalence and density was reported at the midterm assessment. After five MDAs, in 2013, mf prevalence and density were again measured as part of a pre-transmission assessment survey (pre-TAS) conducted per WHO guidelines. Methods For the pre-TAS survey, districts were paired to represent populations of one million for impact assessment. One sentinel site selected from baseline and one spot check site purposefully selected based upon local knowledge of patients with LF were surveyed per pair (two districts). At each site, 300 people over five years of age provided mid-night blood samples and mf prevalence and density were determined using thick blood film microscopy. Results are compared with baseline and midterm data. Results At pre-TAS the overall mf prevalence was 0.54% (95% CI: 0.36–0.81%), compared to 0.30% (95% CI: 0.19–0.47) at midterm and 2.6% (95% CI: 2.3–3.0%) at baseline. There was a higher, but non-significant, mf prevalence among males vs females. Eight districts (four pairs) had a prevalence of mf < 1% at all sites. Two pairs (four districts) had a prevalence of mf > 1% at one of the two sites: Koinadugu 0.98% (95% CI: 0.34–2.85%) and Bombali 2.67% (95% CI: 1.41–5.00%), and Kailahun 1.56% (95% CI: 0.72–3.36%) and Kenema 0% (95% CI: 0.00–1.21%). Conclusions Compared to baseline, there was a significant reduction of LF mf prevalence and density in the 12 districts co-endemic for LF and onchocerciasis after five annual LF MDAs. No statistically significant difference was seen in either measure compared to midterm. Eight of the 12 districts qualified for TAS. The other four districts that failed to qualify for TAS had historically high LF baseline prevalence and density and had regular cross-border movement of populations. These four districts needed to conduct two additional rounds of LF MDA before repeating the pre-TAS. The results showed that Sierra Leone continued to make progress towards the elimination of LF as a public health problem.
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Affiliation(s)
- Joseph B Koroma
- Family Health International 360, Ghana Country Office, Accra, Ghana
| | - Santigie Sesay
- National Neglected Tropical Disease Control Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Abdul Conteh
- National Neglected Tropical Disease Control Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Jusufu Paye
- Helen Keller International, Freetown, Sierra Leone
| | - Mohamed Bah
- Helen Keller International, Freetown, Sierra Leone
| | | | | | - Yaobi Zhang
- Helen Keller International, Regional Office for Africa, Dakar, Senegal.
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121
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Jenson A, Roter DL, Mkocha H, Munoz B, West S. Patient-centered communication of community treatment assistants in Tanzania predicts coverage of future mass drug administration for trachoma. Patient Educ Couns 2018; 101:1075-1081. [PMID: 29329726 DOI: 10.1016/j.pec.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 12/27/2017] [Accepted: 01/05/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Prevention of Trachoma, the leading cause of infectious blindness, requires community treatment assistants (CTAs) to perform mass drug administration (MDA) of azithromycin. Previous research has shown that female CTAs have higher MDA coverage, but no studies have focused on the content of conversation. We hypothesize that female CTAs had more patient-centered communication and higher MDA coverage. METHODS In 2011, CTAs from 23 distribution sites undergoing MDA as part of the Partnership for Rapid Elimination of Trachoma were selected. CTA - villager interactions were audio recorded. Audio was analyzed using an adaptation of the Roter Interaction Analysis System. The outcome of interest was the proportion of adults receiving MDA in 2011 who returned in 2012. RESULTS 58 CTAs and 3122 interactions were included. Sites with female CTAs had significantly higher patient-centeredness ratio (0.548 vs 0.400) when compared to sites with male CTAs. Sites with more patient-centered interactions had higher proportion of patients return (p = 0.009). CONCLUSION Female CTAs had higher proportion of patient-centered communication. Patient centered communication was associated with higher rates of return for MDA. PRACTICE IMPLICATIONS Greater patient-centered connection with health care providers affects participation in public health efforts, even when those providers are lay health workers.
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Affiliation(s)
- Alexander Jenson
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore MD, United States.
| | - Debra L Roter
- The Johns Hopkins Bloomberg School of Public Health, Baltimore MD, United States
| | | | - Beatriz Munoz
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore MD, United States
| | - Sheila West
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore MD, United States
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122
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Aye NN, Lin Z, Lon KN, Linn NYY, Nwe TW, Mon KM, Ramaiah K, Betts H, Kelly-Hope LA. Mapping and modelling the impact of mass drug adminstration on filariasis prevalence in Myanmar. Infect Dis Poverty 2018; 7:56. [PMID: 29855355 PMCID: PMC5984392 DOI: 10.1186/s40249-018-0420-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 04/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is endemic in Myanmar and targeted for elimination. To highlight the National Programme to Eliminate Lymphatic Filariasis (NPELF) progress between 2000 and 2014, this paper describes the geographical distribution of LF, the scale-up and impact of mass drug administration (MDA) implementation, and the first evidence of the decline in transmission in five districts. METHODS The LF distribution was determined by mapping historical and baseline prevalence data collected by NPELF. Data on the MDA implementation, reported coverage rates and sentinel site surveillance were summarized. A statistical model was developed from the available prevalence data to predict prevalence at township level by year of measurement. Transmission assessment survey (TAS) methods, measuring antigenemia (Ag) prevalence in children, were used to determine whether prevalence was below a level where recrudescence is unlikely to occur. RESULTS The highest baseline LF prevalence was found in the Central Valley region. The MDA implementation activities scaled up to cover 45 districts, representing the majority of the endemic population, with drug coverage rates ranging from 60.0% to 98.5%. Challenges related to drug supply and local conflict were reported, and interrupted MDA in some districts. Overall, significant reductions in LF prevalence were found, especially after the first 2 to 3 rounds of MDA, which was supported by the corresponding model. The TAS activities in five districts found only two Ag positive children, resulting in all districts passing the critical threshold. CONCLUSION Overall, the Myanmar NPELF has made positive steps forward in the elimination of LF despite several challenges, however, it needs to maintain momentum, drawing on international stakeholder support, to aim towards the national and global goals of elimination.
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Affiliation(s)
- Ni Ni Aye
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Zaw Lin
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Khin Nan Lon
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Nay Yi Yi Linn
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Thet Wai Nwe
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | - Khin Mon Mon
- Ministry of Health and Sports, Department of Public Health, Nay Pyi Taw, Myanmar
| | | | - Hannah Betts
- Department of Parasitology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Louise A. Kelly-Hope
- Department of Parasitology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK
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Cooper AJ, Hollingsworth TD. The impact of seasonality on the dynamics and control of Ascaris lumbricoides infections. J Theor Biol 2018; 453:96-107. [PMID: 29800536 PMCID: PMC6013298 DOI: 10.1016/j.jtbi.2018.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 05/09/2018] [Accepted: 05/21/2018] [Indexed: 11/24/2022]
Abstract
Intestinal nematode infections affect a huge proportion of the world's population. Increasingly these infections, particularly amongst the poorest communities, are controlled through mass drug treatment programs. Seasonal variations of climate and behaviour in these regions can be significant, but their impact on the dynamics of infection and implications for the effectiveness of any mass drug treatment program (a pulsed reduction in worm burden in hosts) is not clearly understood. Here the effect of seasonality on the dynamics of the soil-based helminth, Ascaris lumbricoides, is investigated using a reformulated version of the Anderson-May model for macro-parasitic infections. Explicit analytical expressions are obtained for the stable oscillatory solution over the annual cycle, which provides a means of relating times of peak numbers of eggs, larvae and mature worms to seasonal variations. Numerical and analytical techniques are then used to consider the impact of seasonality on the optimal timing of drug treatment. Our results show that there is a relatively large window for the timing of optimal treatment, and the impact of repeated annual mass drug treatments can be substantially improved if they are timed to coincide with the months when the number of eggs and larvae are at their lowest - minimising reinfection. In terms of a more measurable quantity, in our example this corresponds to the months when the seasonal temperature is highest. Multiple annual treatments at (or close to) the optimal time each year are predicted to achieve local elimination in the community, whereas treatment at other times has a more limited impact. A key finding is that even for pronounced seasonality, perturbations in mean worm burden, and hence seasonal variation in observed egg output, may be small, potentially explaining why seasonal effects have been overlooked. Taken together these results suggest that seasonality of soil-transmitted helminths requires further experimental, field and mathematical study if the impact for mass drug administration programs is to be exploited.
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Affiliation(s)
- A J Cooper
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry CV4 7AL, UK.
| | - T Déirdre Hollingsworth
- Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, University of Warwick, Coventry CV4 7AL, UK; Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford OX1 2JD, UK
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Bundy DAP, Appleby LJ, Bradley M, Croke K, Hollingsworth TD, Pullan R, Turner HC, de Silva N. 100 Years of Mass Deworming Programmes: A Policy Perspective From the World Bank's Disease Control Priorities Analyses. Adv Parasitol 2018; 100:127-54. [PMID: 29753337 DOI: 10.1016/bs.apar.2018.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
For more than 100 years, countries have used mass drug administration as a public health response to soil-transmitted helminth infection. The series of analyses published as Disease Control Priorities is the World Bank's vehicle for exploring the cost-effectiveness and value for money of public health interventions. The first edition was published in 1993 as a technical supplement to the World Bank's World Development Report Investing in Health where deworming was used as an illustrative example of value for money in treating diseases with relatively low morbidity but high prevalence. Over the second (2006) and now third (2017) editions deworming has been an increasingly persuasive example to use for this argument. The latest analyses recognize the negative impact of intestinal worm infection on human capital in poor communities and document a continuing decline in worm infection as a result of the combination of high levels of mass treatment and ongoing economic development trends in poor communities.
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Dorkenoo MA, Bronzan R, Yehadji D, Tchalim M, Yakpa K, Etassoli S, Adjeloh P, Maman I, Sodahlon Y. Surveillance for lymphatic filariasis after stopping mass drug administration in endemic districts of Togo, 2010-2015. Parasit Vectors 2018; 11:244. [PMID: 29661231 PMCID: PMC5902853 DOI: 10.1186/s13071-018-2843-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/09/2018] [Indexed: 11/22/2022] Open
Abstract
Background Togo is a country previously endemic for lymphatic filariasis (LF). In 2010, following nine years of mass drug administration (MDA) for LF, the country established a post-treatment surveillance (PTS) system. We present here the results of these PTS activities, carried out from 2010 to 2015, as well as the findings of follow-up investigations in 2016 to confirm the absence of infection in previously infected individuals. Methods The routine surveillance established in 2010 consisted of a network of 47 laboratories, which searched for Wuchereria bancrofti microfilaria on nocturnal blood smears collected for malaria diagnosis and an additional network of 20 peripheral health facilities, which collected dried blood spots and tested them for Og4C3 antigen. Two transmission assessment surveys (TAS) were also undertaken, as recommended by WHO, in 2012 and 2015. Any positive case identified through any surveillance activity was immediately retested by nocturnal smear and confirmed cases were immediately investigated by screening family members and neighboring household members. In 2016, 32 of the 40 positive cases detected during TAS or laboratory and health facility network activities were traced and whether confirmed positive by nocturnal smear or not were tested again simultaneously by filariasis test strip (FTS), Og4C3 and a nocturnal blood smear to rule out any active infection. Results From 2010 to 2015, the laboratory network identified one microfilaria-positive individual (0.0% of 26,584 persons tested) and the peripheral health facility network detected 19 Og4C3-positive individuals (0.28% of 6788 persons tested). All 19 Og4C3 cases were negative for microfilaremia by nocturnal blood smear. In the 2012 and 2015 TAS, thirteen and six ICT/FTS positive cases, respectively, were identified, which were significantly below the critical cut-off (18–20 cases) across all evaluation units. Three of the six ICT/FTS-positive cases from the 2015 TAS were positive by nocturnal smear; immediate investigation identified one additional microfilaria-positive individual. Epidemiological investigation revealed that four of the five cases of microfilaremia were imported from another country in the region. In 2016, 32 of the 40 positive cases detected by at least one test during all surveillance activities were traced: four (12.5%) individuals were still positive by FTS but all 32 individuals were negative for microfilaremia and Og4C3 antigen. Conclusion The results of post-treatment surveillance in Togo have demonstrated that W. bancrofti filariasis is no longer of public health concern in Togo, more than six years after stopping MDA. Every possible effort should be made to maintain surveillance in order to promptly detect any resurgence and preserve this achievement.
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Affiliation(s)
- Monique Ameyo Dorkenoo
- Faculté des Sciences de la santé, Université de Lomé, BP 1515, Lomé, Togo. .,Programme National d'Elimination de la Filariose Lymphatique, Ministère de la Santé et de la Protection Sociale, Angle avenue Sarakawa et Avenue du 24 Janvier, BP 336, Lomé, Togo.
| | - Rachel Bronzan
- Health and Development International (HDI), Newburyport, MA, USA
| | - Degninou Yehadji
- Programme National d'Elimination de la Filariose Lymphatique, Ministère de la Santé et de la Protection Sociale, Angle avenue Sarakawa et Avenue du 24 Janvier, BP 336, Lomé, Togo
| | - Mawèke Tchalim
- Programme National d'Elimination de la Filariose Lymphatique, Ministère de la Santé et de la Protection Sociale, Angle avenue Sarakawa et Avenue du 24 Janvier, BP 336, Lomé, Togo
| | - Kossi Yakpa
- Programme National de Lutte contre le Paludisme, BP 518, Lomé, Togo
| | - Santrao Etassoli
- Programme National d'Elimination de la Filariose Lymphatique, Ministère de la Santé et de la Protection Sociale, Angle avenue Sarakawa et Avenue du 24 Janvier, BP 336, Lomé, Togo
| | | | - Issaka Maman
- Laboratoire de référence, Institut National d'Hygiène, BP 1396, Lomé, Togo
| | - Yao Sodahlon
- Mectizan Donation Program, 325 Swanton Way, Decatur, GA, 30030, USA
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Elliott RC, Smith DL, Echodu D. Medical and entomological malarial interventions, a comparison and synergy of two control measures using a Ross/Macdonald model variant and openmalaria simulation. Math Biosci 2018; 300:187-200. [PMID: 29655551 PMCID: PMC6013649 DOI: 10.1016/j.mbs.2018.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 12/04/2017] [Accepted: 04/10/2018] [Indexed: 01/23/2023]
Abstract
An adaptation of the classical Ross–Macdonald model for vector disease transmission to incorporate time-dependent medical and entomological control measures. Modeling both mass drug administration and indoor residual spraying campaigns, the synchronous deployment of both yields a synergy where the impact of a joint intervention exceeds that of isolated campaigns. Openmalaria simulations, separately run, indicate comparable intervention impacts to the Ross/Macdonald model variant. The vector reservoir of parasitemia is found to be labile, and this dictates the impacts of the medical and entomological interventions. A scaling-law level of analysis is performed that estimates the rebound of infections in a community after interventions expire, and not only do higher transmission environments bounce back to prevalent infections faster, communities with stronger interventions are shown to have a slower relapse to parasitemia.
Using an established Ross/Macdonald model variant for mosquito-born parasite transmission, we extend the formalism to simply incorporate time-dependent control measures. In particular, two interventions are considered, mass drug administration (MDA) and indoor residual spraying (IRS), whose individual intensities during their respective campaigns are set to the same intervention-reduced reproductive number R0. The impacts of these interventions, measured as each campaign’s ability over time to reduce infections in a community, are found based on the transmission setting, coverage, and their associated durations. These impacts are compared for both interventions and their joint deployment. Synchronous campaigns of IRS deployed with MDA have a cooperative, synergistic effect whose impact exceeds that when the campaigns are deployed in isolation. Simulations with openmalaria, with its more complex model of transmission, are separately performed and show a similar impact enhancement with these interventions. A new, associated analysis yields simple scaling relationships that estimate the dynamical resurgence time, post-intervention, to infection proliferation in a community.
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Affiliation(s)
- R C Elliott
- Micron School of Materials Science and Engineering, Boise State University, Engineering Building Suite 338, Boise, ID 83725, USA; Pilgrim Africa, 115 N 85th St #202, Seattle, WA 98103, USA.
| | - D L Smith
- Institute of Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave., Suite 600, Seattle, WA 98121, USA.
| | - D Echodu
- Pilgrim Africa, 115 N 85th St #202, Seattle, WA 98103, USA.
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127
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Win KM, Tripathy JP, Maung TM, Oo T, Thi A, Lon KN, Lin Z. Rapid progress towards elimination of lymphatic filariasis in endemic regions of Myanmar as a result of 16 years of anti-filarial activities (2001-2016). Trop Med Health 2018; 46:14. [PMID: 29720887 PMCID: PMC5916724 DOI: 10.1186/s41182-018-0093-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background As Myanmar progresses towards lymphatic filariasis (LF) elimination, it is important to know how well the anti-filarial activities have performed. The present study was conducted to study the implementation of the key anti-filarial activities and their impact on key indicators of LF transmission. Methods A secondary analysis of aggregate program data on the anti-filarial activities was conducted in four endemic state/regions of Myanmar receiving at least six mass drug administration (MDA) rounds during 2001-2016. Results MDA coverage has been expanded to cover all the endemic implementation units (IUs), i.e., 45 by 2015 and 6 IUs out of them have already stopped MDA. The reported coverage of MDA ranges from 87 to 100% whereas surveyed coverage ranges from 78 to 100% among the eligible population. The prevalence of microfilaria has significantly declined especially in Magway from 4.7 to 0.2% and Sagaing region from 7.9 to 1.3% during 2001-2016. Around 2.5% of estimated cases of hydrocele were reported to the program during 2009-2014. Conclusion Myanmar has achieved significant success in interrupting LF transmission through several MDA rounds with high coverage. However, morbidity reporting and management, being in its initial phase requires an active surveillance system for identifying and managing people with LF-associated morbidities under the program.
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Affiliation(s)
- Kyawt Mon Win
- Vector Borne Diseases Control Program, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Jaya Prasad Tripathy
- 2International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Regional Office, New Delhi, India
| | - Thae Maung Maung
- 3Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Tin Oo
- 3Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Aung Thi
- Vector Borne Diseases Control Program, Ministry of Health and Sports, Naypyitaw, Myanmar
| | - Khin Nan Lon
- 4Yangon Regional Public Health Department, Department of Public Health, Ministry of Health and Sports, Yangon, Myanmar
| | - Zaw Lin
- Vector Borne Diseases Control Program, Ministry of Health and Sports, Naypyitaw, Myanmar
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128
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Koroma JB, Sesay S, Conteh A, Koudou B, Paye J, Bah M, Sonnie M, Hodges MH, Zhang Y, Bockarie MJ. Impact of five annual rounds of mass drug administration with ivermectin on onchocerciasis in Sierra Leone. Infect Dis Poverty 2018; 7:30. [PMID: 29628019 PMCID: PMC5890354 DOI: 10.1186/s40249-018-0410-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 03/20/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Onchocerciasis is endemic in 12 of the 14 health districts of Sierra Leone. Good treatment coverage of community-directed treatment with ivermectin was achieved between 2005 and 2009 after the 11-year civil conflict. Sentinel site surveys were conducted in 2010 to evaluate the impact of five annual rounds of ivermectin distribution. METHODS In total, 39 sentinel villages from hyper- and meso-endemic areas across the 12 endemic districts were surveyed using skin snips in 2010. Results were analyzed and compared with the baseline data from the same 39 villages. RESULTS The average microfilaridermia (MF) prevalence across 39 sentinel villages was 53.10% at baseline. The MF prevalence was higher in older age groups, with the lowest in the age group of 1-9 years (11.00%) and the highest in the age group of 40-49 years (82.31%). Overall mean MF density among the positives was 28.87 microfilariae (mf)/snip, increasing with age with the lowest in the age group of 1-9 years and the highest in the age group of 40-49 years. Males had higher MF prevalence and density than females. In 2010 after five rounds of mass drug administration, the overall MF prevalence decreased by 60.26% from 53.10% to 21.10%; the overall mean MF density among the positives decreased by 71.29% from 28.87 mf/snip to 8.29 mf/snip; and the overall mean MF density among all persons examined decreased by 88.58% from 15.33 mf/snip to 1.75 mf/snip. Ten of 12 endemic districts had > 50% reduction in MF prevalence. Eleven of 12 districts had ≥50% reduction in mean MF density among the positives. CONCLUSIONS A significant reduction of onchocerciasis MF prevalence and mean density was recorded in all 12 districts of Sierra Leone after five annual MDAs with effective treatment coverage. The results suggested that the onchocerciasis elimination programme in Sierra Leone was on course to reach the objective of eliminating onchocerciasis in the country by the year 2025. Annual MDA with ivermectin should continue in all 12 districts and further evaluations are needed across the country to assist the NTDP with programme decision making.
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Affiliation(s)
- Joseph B. Koroma
- Family Health International (FHI) 360, Ghana Country Office, Accra, Ghana
| | - Santigie Sesay
- National Neglected Tropical Disease Control Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Abdul Conteh
- National Neglected Tropical Disease Control Programme, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Benjamin Koudou
- Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jusufu Paye
- Helen Keller International, Freetown, Sierra Leone
| | - Mohamed Bah
- Helen Keller International, Freetown, Sierra Leone
| | | | | | - Yaobi Zhang
- Helen Keller International, Regional Office for Africa, Dakar, Senegal
| | - Moses J. Bockarie
- European & Developing Countries Clinical Trials Partnership (EDCTP), Medical Research Council, Cape Town, South Africa
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129
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Biritwum NK, Yikpotey P, Marfo BK, Odoom S, Mensah EO, Asiedu O, Alomatu B, Hervie ET, Yeboah A, Ade S, Hinderaker SG, Reid A, Takarinda KC, Koudou B, Koroma JB. Persistent 'hotspots' of lymphatic filariasis microfilaraemia despite 14 years of mass drug administration in Ghana. Trans R Soc Trop Med Hyg 2018; 110:690-695. [PMID: 28938053 DOI: 10.1093/trstmh/trx007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/01/2017] [Indexed: 11/12/2022] Open
Abstract
Background 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.
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Affiliation(s)
| | - Paul Yikpotey
- Family Health International (FHI360), P.O. Box 4033, Accra, Ghana
| | | | | | - Ernest O Mensah
- Family Health International (FHI360), P.O. Box 4033, Accra, Ghana
| | | | | | | | | | - Serge Ade
- University of Parakou, Benin.,International Union Against Tuberculosis and Lung Disease, France
| | | | - Anthony Reid
- Operational Research Unit (LuxOR), Medical Department, Médecins Sans Frontières, Operational Centre Brussels, Luxembourg
| | | | - Benjamin Koudou
- Liverpool School of Tropical Medicine, Filaria Programme Support Unit, Liverpool, UK
| | - Joseph B Koroma
- Family Health International (FHI360), P.O. Box 4033, Accra, Ghana
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130
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Farrell SH, Anderson RM. Helminth lifespan interacts with non-compliance in reducing the effectiveness of anthelmintic treatment. Parasit Vectors 2018; 11:66. [PMID: 29382359 PMCID: PMC5791166 DOI: 10.1186/s13071-018-2670-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/23/2018] [Indexed: 11/19/2022] Open
Abstract
Background The success of mass drug administration programmes targeting the soil-transmitted helminths and schistosome parasites is in part dependent on compliance to treatment at sequential rounds of mass drug administration (MDA). The impact of MDA is vulnerable to systematic non-compliance, defined as a portion of the eligible population remaining untreated over successive treatment rounds. The impact of systematic non-compliance on helminth transmission dynamics - and thereby on the number of treatment rounds required to interrupt transmission - is dependent on the parasitic helminth being targeted by MDA. Results Here, we investigate the impact of adult parasite lifespan in the human host and other factors that determine the magnitude of the basic reproductive number R0, on the number of additional treatment rounds required in a target population, using mathematical models of Ascaris lumbricoides and Schistosoma mansoni transmission incorporating systematic non-compliance. Our analysis indicates a strong interaction between helminth lifespan and the impact of systematic non-compliance on parasite elimination, and confirms differences in its impact between Ascaris and the schistosome parasites in a streamlined model structure. Conclusions Our analysis suggests that achieving reductions in the level of systematic non-compliance may be of particular benefit in mass drug administration programmes treating the longer-lived helminth parasites, and highlights the need for improved data collection in understanding the impact of compliance.
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Affiliation(s)
- Sam H Farrell
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, W2 1PG, UK.
| | - Roy M Anderson
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, W2 1PG, UK
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131
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Tian-Bi YNT, Ouattara M, Knopp S, Coulibaly JT, Hürlimann E, Webster B, Allan F, Rollinson D, Meïté A, Diakité NR, Konan CK, N'Goran EK, Utzinger J. Interrupting seasonal transmission of Schistosoma haematobium and control of soil-transmitted helminthiasis in northern and central Côte d'Ivoire: a SCORE study protocol. BMC Public Health 2018; 18:186. [PMID: 29378542 PMCID: PMC5789673 DOI: 10.1186/s12889-018-5044-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/08/2018] [Indexed: 12/19/2022] Open
Abstract
Background To achieve a world free of schistosomiasis, the objective is to scale up control and elimination efforts in all endemic countries. Where interruption of transmission is considered feasible, countries are encouraged to implement a comprehensive intervention package, including preventive chemotherapy, information, education and communication (IEC), water, sanitation and hygiene (WASH), and snail control. In northern and central Côte d’Ivoire, transmission of Schistosoma haematobium is seasonal and elimination might be achieved. In a cluster-randomised trial, we will assess different treatment schemes to interrupt S. haematobium transmission and control soil-transmitted helminthiasis over a 3-year period. We will compare the impact of (i) arm A: annual mass drug administration (MDA) with praziquantel and albendazole before the peak schistosomiasis transmission season; (ii) arm B: annual MDA after the peak schistosomiasis transmission season; (iii) arm C: two yearly treatments before and after peak schistosomiasis transmission; and (iv) arm D: annual MDA before peak schistosomiasis transmission, coupled with chemical snail control using niclosamide. Methods/design The prevalence and intensity of S. haematobium and soil-transmitted helminth infections will be assessed using urine filtration and Kato-Katz thick smears, respectively, in six administrative regions in northern and central parts of Côte d’Ivoire. Once a year, urine and stool samples will be collected and examined from 50 children aged 5–8 years, 100 children aged 9–12 years and 50 adults aged 20–55 years in each of 60 selected villages. Changes in S. haematobium and soil-transmitted helminth prevalence and intensity will be assessed between years and stratified by intervention arm. In the 15 villages randomly assigned to intervention arm D, intermediate host snails will be collected three times per year, before niclosamide is applied to the selected freshwater bodies. The snail abundance and infection rates over time will allow drawing inference on the force of transmission. Discussion This cluster-randomised intervention trial will elucidate whether in an area with seasonal transmission, the four different treatment schemes can interrupt S. haematobium transmission and control soil-transmitted helminthiasis. Lessons learned will help to guide schistosomiasis control and elimination programmes elsewhere in Africa. Trial registration ISRCTNISRCTN10926858. Registered 21 December 2016. Retrospectively registered.
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Affiliation(s)
- Yves-Nathan T Tian-Bi
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 22 BP 770, Abidjan, 22, Côte d'Ivoire. .,Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan, 01, Côte d'Ivoire.
| | - Mamadou Ouattara
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 22 BP 770, Abidjan, 22, Côte d'Ivoire.,Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan, 01, Côte d'Ivoire
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Jean T Coulibaly
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 22 BP 770, Abidjan, 22, Côte d'Ivoire.,Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan, 01, Côte d'Ivoire.,Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Eveline Hürlimann
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003, Basel, Switzerland
| | - Bonnie Webster
- Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History Museum, Cromwell Road, London, SW7 5BD, United Kingdom
| | - Fiona Allan
- Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History Museum, Cromwell Road, London, SW7 5BD, United Kingdom
| | - David Rollinson
- Wolfson Wellcome Biomedical Laboratories, Department of Life Sciences, Natural History Museum, Cromwell Road, London, SW7 5BD, United Kingdom
| | - Aboulaye Meïté
- Programme National de Lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive, Ministère de la Santé et de l'Hygiène Publique, 06 BP 6394, Abidjan, 06, Côte d'Ivoire
| | - Nana R Diakité
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 22 BP 770, Abidjan, 22, Côte d'Ivoire.,Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan, 01, Côte d'Ivoire
| | - Cyrille K Konan
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 22 BP 770, Abidjan, 22, Côte d'Ivoire.,Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan, 01, Côte d'Ivoire
| | - Eliézer K N'Goran
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, 22 BP 770, Abidjan, 22, Côte d'Ivoire.,Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, 01 BP 1303, Abidjan, 01, Côte d'Ivoire
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland. .,University of Basel, P.O. Box, CH-4003, Basel, Switzerland.
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132
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Peto TJ, Debackere M, Etienne W, Vernaeve L, Tripura R, Falq G, Davoeung C, Nguon C, Rekol H, von Seidlein L, Dondorp AM, Sanann N, Cheah PY, De Smet M, Pell C, Kindermans JM. Community participation during two mass anti-malarial administrations in Cambodia: lessons from a joint workshop. Malar J 2018; 17:53. [PMID: 29374462 PMCID: PMC5787251 DOI: 10.1186/s12936-018-2202-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 01/20/2018] [Indexed: 11/16/2022] Open
Abstract
Two mass drug administrations (MDA) against falciparum malaria were conducted in 2015–16, one as operational research in northern Cambodia, and the other as a clinical trial in western Cambodia. During an April 2017 workshop in Phnom Penh the field teams from Médecins Sans Frontières and the Mahidol-Oxford Tropical Medicine Research Unit discussed lessons for future MDAs.
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Affiliation(s)
- Thomas J Peto
- Mahidol-Oxford University Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | | | | | | | - Rupam Tripura
- Mahidol-Oxford University Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Chea Nguon
- Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Huy Rekol
- Centre for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Lorenz von Seidlein
- Mahidol-Oxford University Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Arjen M Dondorp
- Mahidol-Oxford University Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nou Sanann
- Mahidol-Oxford University Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phaik Yeong Cheah
- Mahidol-Oxford University Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Christopher Pell
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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133
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Adhikari B, Phommasone K, Kommarasy P, Soundala X, Souvanthong P, Pongvongsa T, Henriques G, Newton PN, White NJ, Day NPJ, Dondorp AM, von Seidlein L, Mayxay M, Cheah PY, Pell C. Why do people participate in mass anti-malarial administration? Findings from a qualitative study in Nong District, Savannakhet Province, Lao PDR (Laos). Malar J 2018; 17:15. [PMID: 29316932 PMCID: PMC5761145 DOI: 10.1186/s12936-017-2158-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/23/2017] [Indexed: 01/01/2023] Open
Abstract
Background As a part of targeted malaria elimination (TME) in the Greater Mekong Sub-region (GMS), mass drug administration (MDA) with anti-malarials was conducted in four villages in Nong District, Savannakhet Province, Lao PDR (Laos). A high proportion of the target population participated in the MDA, with over 87% agreeing to take the anti-malarial. Drawing on qualitative data collected alongside the MDA, this article explores the factors that led to this high population coverage. Methods Qualitative data collection methods included observations, which were recorded in field notes, focus group discussions (FGDs), and semi-structured interviews (SSIs). Data were collected on local context, MDA-related knowledge, attitudes and perceptions. FGDs and SSIs were audio-recorded, transcribed and translated to English. All transcriptions and field notes underwent qualitative content analysis using QSR NVivo. Results Respondents recognized malaria as a health concern and described the need for a malaria control program. The risk of malaria including asymptomatic infection was explained in terms of participants’ work in forest and fields, and poor hygiene. During the MDA rounds, there was an improvement in knowledge on the concept of asymptomatic malaria, the rationale of MDA and the blood test. In all four villages, poverty affected access to healthcare and the provision of free care by TME was highly appreciated. TME was jointly undertaken by research staff and local volunteers. Authorities were involved in all TME activities. Lao Theung communities were cohesive and community members tended to follow each other’s behaviour closely including participation in MDA. Factors such as understanding the concept and rationale of the study, free health care, collaboration with the village volunteers, support from authorities and cohesive communities contributed in building trust and high population coverage in MDA. Conclusion Future malaria control programmes can become successful in achieving the high coverage in MDAs drawing from the success of TME in Laos. A high population coverage in TME was a combination of various factors that included the community engagement to promote the concept and rationale of MDA for asymptomatic malaria in addition to their baseline understanding of malaria as a health concern, provision of free primary health care, partnering of the research with local volunteers and authorities, building social relationship with community members and the cohesive nature of the communities boosted the trust and participation in MDA. Electronic supplementary material The online version of this article (10.1186/s12936-017-2158-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK.,Kellogg College, University of Oxford, Oxford, UK
| | - Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Laos
| | - Palingnaphone Kommarasy
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Laos
| | - Xayaphone Soundala
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Laos
| | - Phonesavanh Souvanthong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Laos
| | - Tiengkham Pongvongsa
- Savannakhet Provincial Health Department, Savannakhet, Savannakhet Province, Laos
| | - Gisela Henriques
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Paul N Newton
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Laos
| | - Nicholas J White
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK
| | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK
| | - Arjen M Dondorp
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK
| | - Lorenz von Seidlein
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK
| | - Mayfong Mayxay
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Vientiane, Laos.,Faculty of Postgraduate Studies, University of Health Sciences, Vientiane, Laos
| | - Phaik Yeong Cheah
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. .,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Churchill Hospital, Oxford, UK. .,The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Christopher Pell
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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134
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Akinsolu FT, de Paiva VN, Souza SS, Varga O. Patent landscape of neglected tropical diseases: an analysis of worldwide patent families. Global Health 2017; 13:82. [PMID: 29137663 PMCID: PMC5686799 DOI: 10.1186/s12992-017-0306-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 10/24/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND "Neglected Tropical Diseases" (NTDs) affect millions of people in Africa, Asia and South America. The two primary ways of strategic interventions are "preventive chemotherapy and transmission control" (PCT), and "innovative and intensified disease management" (IDM). In the last 5 years, phenomenal progress has been achieved. However, it is crucial to intensify research effort into NTDs, because of the emerging drug resistance. According to the World Health Organization (WHO), the term NTDs covers 17 diseases, namely buruli ulcer, Chagas disease, dengue, dracunculiasis, echinococcosis, trematodiasis, human African trypanosomiasis, leishmaniasis, leprosy, lymphatic filariasis, onchocerciasis, rabies, schistosomiasis, soil-transmitted helminthes, taeniasis, trachoma, and yaws. The aim of this study is to map out research and development (R&D) landscape through patent analysis of these identified NTDs. To achieve this, analysis and evaluation have been conducted on patenting trends, current legal status of patent families, priority countries by earliest priority years and their assignee types, technological fields of patent families over time, and original and current patent assignees. MAIN BODY Patent families were extracted from Patseer, an international database of patents from over 100 patent issuing authorities worldwide. Evaluation of the patents was carried out using the combination of different search terms related to each identified NTD. In this paper, a total number of 12,350 patent families were analyzed. The main countries with sources of inventions were identified to be the United States (US) and China. The main technological fields covered by NTDs patent landscape are pharmaceuticals, biotechnology, organic fine chemistry, analysis of biological materials, basic materials chemistry, and medical technology. Governmental institutions and universities are the primary original assignees. Among the NTDs, leishmaniasis, dengue, and rabies received the highest number of patent families, while human African trypanosomiasis (sleeping sickness), taeniasis, and dracunciliasis received the least. The overall trend of patent families shows an increase between 1985 and 2008, and followed by at least 6 years of stagnation. CONCLUSION The filing pattern of patent families analyzed undoubtedly reveals slow progress on research and development of NTDs. Involving new players, such as non-governmental organizations may help to mitigate and reduce the burden of NTDs.
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Affiliation(s)
- Folahanmi Tomiwa Akinsolu
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | | | | | - Orsolya Varga
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
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135
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Corstjens PLAM, Hoekstra PT, de Dood CJ, van Dam GJ. Utilizing the ultrasensitive Schistosoma up-converting phosphor lateral flow circulating anodic antigen (UCP-LF CAA) assay for sample pooling-strategies. Infect Dis Poverty 2017; 6:155. [PMID: 29089064 PMCID: PMC5664425 DOI: 10.1186/s40249-017-0368-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 10/09/2017] [Indexed: 01/08/2023] Open
Abstract
Background Methodological applications of the high sensitivity genus-specific Schistosoma CAA strip test, allowing detection of single worm active infections (ultimate sensitivity), are discussed for efficient utilization in sample pooling strategies. Besides relevant cost reduction, pooling of samples rather than individual testing can provide valuable data for large scale mapping, surveillance, and monitoring. Method The laboratory-based CAA strip test utilizes luminescent quantitative up-converting phosphor (UCP) reporter particles and a rapid user-friendly lateral flow (LF) assay format. The test includes a sample preparation step that permits virtually unlimited sample concentration with urine, reaching ultimate sensitivity (single worm detection) at 100% specificity. This facilitates testing large urine pools from many individuals with minimal loss of sensitivity and specificity. The test determines the average CAA level of the individuals in the pool thus indicating overall worm burden and prevalence. When requiring test results at the individual level, smaller pools need to be analysed with the pool-size based on expected prevalence or when unknown, on the average CAA level of a larger group; CAA negative pools do not require individual test results and thus reduce the number of tests. Results Straightforward pooling strategies indicate that at sub-population level the CAA strip test is an efficient assay for general mapping, identification of hotspots, determination of stratified infection levels, and accurate monitoring of mass drug administrations (MDA). At the individual level, the number of tests can be reduced i.e. in low endemic settings as the pool size can be increased as opposed to prevalence decrease. Conclusions At the sub-population level, average CAA concentrations determined in urine pools can be an appropriate measure indicating worm burden. Pooling strategies allowing this type of large scale testing are feasible with the various CAA strip test formats and do not affect sensitivity and specificity. It allows cost efficient stratified testing and monitoring of worm burden at the sub-population level, ideally for large-scale surveillance generating hard data for performance of MDA programs and strategic planning when moving towards transmission-stop and elimination.
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Affiliation(s)
- Paul L A M Corstjens
- Department of Molecular Cell Biology, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands.
| | - Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
| | - Claudia J de Dood
- Department of Molecular Cell Biology, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
| | - Govert J van Dam
- Department of Parasitology, Leiden University Medical Center, P.O. Box 9600, 2300, RC, Leiden, The Netherlands
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Ash A, Okello A, Khamlome B, Inthavong P, Allen J, Thompson RA. Controlling Taenia solium and soil transmitted helminths in a northern Lao PDR village: Impact of a triple dose albendazole regime. Acta Trop 2017; 174:171-178. [PMID: 26001973 DOI: 10.1016/j.actatropica.2015.05.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/11/2015] [Accepted: 05/16/2015] [Indexed: 10/23/2022]
Abstract
Taenia solium taeniasis-cysticercosis and soil-transmitted helminths (STHs) are parasitic Neglected Tropical Diseases endemic throughout Southeast Asia. Within Lao PDR, a remote northern hill tribe village had previously been identified as a hyper endemic focus for T. solium. To reduce this observed prevalence, a One Health intervention covering both pigs and humans was implemented, which included two Mass drug administrations (MDA1 and MDA2) for village residents using a triple dose albendazole 400mg treatment regime. In addition to the effect on T. solium levels, the dual impact of this anthelmintic regime on STHs within the community was also monitored. Faecal samples were collected pre and post MDA1 and MDA2 and analysed for the presence of Taenia species and the STHs Ascaris lumbricoides, Trichuris trichiura and hookworm species. The McMaster technique was used to measure the changes in both prevalence and intensity of infection. Molecular characterisation of Taenia and hookworm species was conducted to detect zoonotic species. The level of taeniasis within the sampled population decreased by 79.4% after MDA1, remained steady during the five month inter-treatment interval and decreased again by 100% after MDA2. The prevalence of STHs decreased by 65.5% and 62.8% after MDA1 and MDA2 respectively; however an increase to 62.1% of pre MDA1 levels was detected during the inter-treatment interval. Individually, hookworm prevalence decreased by 83.4% (MDA1) and 84.5% (MDA2), A. lumbricoides by 95.6% and 93.5% and T. trichiura by 69.2% and 61%. The intensity of infection within the sampled population also decreased, with egg reduction rates of 94.4% and 97.8% for hookworm, 99.4% and 99.3% for A. lumbricoides and 77.2% and 88.5% for T. trichiura. Molecular characterisation identified a T. solium tapeworm carrier from 21.6% (13/60) of households in the village. T. saginata was identified in 5% (3/60) of households. The zoonotic hookworm A. ceylanicum was detected in the resident dog population. These results suggest that the triple dose albendazole 400mg treatment regime achieved a significant reduction in the level of taeniasis whilst simultaneously reducing the STH burden within the village. The increased STH prevalence detected between MDAs reflects the need for behavioural changes and a sustained chemotherapy programme, which may also need to include the resident dog population.
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137
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Michael E, Singh BK, Mayala BK, Smith ME, Hampton S, Nabrzyski J. Continental-scale, data-driven predictive assessment of eliminating the vector-borne disease, lymphatic filariasis, in sub-Saharan Africa by 2020. BMC Med 2017; 15:176. [PMID: 28950862 PMCID: PMC5615442 DOI: 10.1186/s12916-017-0933-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 08/16/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There are growing demands for predicting the prospects of achieving the global elimination of neglected tropical diseases as a result of the institution of large-scale nation-wide intervention programs by the WHO-set target year of 2020. Such predictions will be uncertain due to the impacts that spatial heterogeneity and scaling effects will have on parasite transmission processes, which will introduce significant aggregation errors into any attempt aiming to predict the outcomes of interventions at the broader spatial levels relevant to policy making. We describe a modeling platform that addresses this problem of upscaling from local settings to facilitate predictions at regional levels by the discovery and use of locality-specific transmission models, and we illustrate the utility of using this approach to evaluate the prospects for eliminating the vector-borne disease, lymphatic filariasis (LF), in sub-Saharan Africa by the WHO target year of 2020 using currently applied or newly proposed intervention strategies. METHODS AND RESULTS: We show how a computational platform that couples site-specific data discovery with model fitting and calibration can allow both learning of local LF transmission models and simulations of the impact of interventions that take a fuller account of the fine-scale heterogeneous transmission of this parasitic disease within endemic countries. We highlight how such a spatially hierarchical modeling tool that incorporates actual data regarding the roll-out of national drug treatment programs and spatial variability in infection patterns into the modeling process can produce more realistic predictions of timelines to LF elimination at coarse spatial scales, ranging from district to country to continental levels. Our results show that when locally applicable extinction thresholds are used, only three countries are likely to meet the goal of LF elimination by 2020 using currently applied mass drug treatments, and that switching to more intensive drug regimens, increasing the frequency of treatments, or switching to new triple drug regimens will be required if LF elimination is to be accelerated in Africa. The proportion of countries that would meet the goal of eliminating LF by 2020 may, however, reach up to 24/36 if the WHO 1% microfilaremia prevalence threshold is used and sequential mass drug deliveries are applied in countries. CONCLUSIONS We have developed and applied a data-driven spatially hierarchical computational platform that uses the discovery of locally applicable transmission models in order to predict the prospects for eliminating the macroparasitic disease, LF, at the coarser country level in sub-Saharan Africa. We show that fine-scale spatial heterogeneity in local parasite transmission and extinction dynamics, as well as the exact nature of intervention roll-outs in countries, will impact the timelines to achieving national LF elimination on this continent.
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Affiliation(s)
- Edwin Michael
- Department of Biological Sciences, University of Notre Dame, Galvin Life Science Center, Notre Dame, IN, 46556, USA.
| | - Brajendra K Singh
- Department of Biological Sciences, University of Notre Dame, Galvin Life Science Center, Notre Dame, IN, 46556, USA
| | - Benjamin K Mayala
- Department of Biological Sciences, University of Notre Dame, Galvin Life Science Center, Notre Dame, IN, 46556, USA
| | - Morgan E Smith
- Department of Biological Sciences, University of Notre Dame, Galvin Life Science Center, Notre Dame, IN, 46556, USA
| | - Scott Hampton
- Center for Research Computing, University of Notre Dame, Notre Dame, IN, 46556, USA
| | - Jaroslaw Nabrzyski
- Center for Research Computing, University of Notre Dame, Notre Dame, IN, 46556, USA
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138
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Cha S, Hong ST, Lee YH, Lee KH, Cho DS, Lee J, Chai JY, Elhag MS, Khaled SGA, Elnimeiri MKM, Siddig NAA, Abdelrazig H, Awadelkareem S, Elshafie ATE, Ismail HAHA, Amin M. Nationwide cross-sectional survey of schistosomiasis and soil-transmitted helminthiasis in Sudan: study protocol. BMC Public Health 2017; 17:703. [PMID: 28899362 PMCID: PMC5596840 DOI: 10.1186/s12889-017-4719-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 09/06/2017] [Indexed: 11/12/2022] Open
Abstract
Background Schistosomiasis and soil-transmitted helminthiasis (STHs) are target neglected tropical diseases (NTDs) of preventive chemotherapy, but the control and elimination of these diseases have been impeded due to resource constraints. Few reports have described study protocol to draw on when conducting a nationwide survey. We present a detailed methodological description of the integrated mapping of schistosomiasis and STHs on the basis of our experiences, hoping that this protocol can be applied to future surveys in similar settings. In addition to determining the ecological zones requiring mass drug administration interventions, we aim to provide precise estimates of the prevalence of these diseases. Methods A school–based cross-sectional design will be applied for the nationwide survey across Sudan. The survey is designed to cover all districts in every state. We have divided each district into 3 different ecological zones depending on proximity to bodies of water. We will employ a probability-proportional-to-size sampling method for schools and systematic sampling for student selection to provide adequate data regarding the prevalence for schistosomiasis and STHs in Sudan at the state level. A total of 108,660 students will be selected from 1811 schools across Sudan. After the survey is completed, 391 ecological zones will be mapped out. To carry out the survey, 655 staff members were recruited. The feces and urine samples are microscopically examined by the Kato-Katz method and the sediment smears for helminth eggs respectively. For quality control, a minimum of 10% of the slides will be rechecked by the federal supervisors in each state and also 5% of the smears are validated again within one day by independent supervisors. Discussion This nationwide mapping is expected to generate important epidemiological information and indicators about schistosomiasis and STHs that will be useful for monitoring and evaluating the control program. The mapping data will also be used for overviewing the status and policy formulation and updates to the control strategies. This paper, which describes a feasible and practical study protocol, is to be shared with the global health community, especially those who are planning to perform nationwide mapping of NTDs by feces or urine sampling. Electronic supplementary material The online version of this article (10.1186/s12889-017-4719-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seungman Cha
- Korea Association of Health Promotion, Gangseo-gu, Seoul, 07653, South Korea.,Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Sung-Tae Hong
- Department of Parasitology and Tropical Medicine Seoul National University College of Medicine, Daehak-ro, Seoul, 03080, South Korea.
| | - Young-Ha Lee
- Department of Infection Biology, Chungnam National University School of Medicine, Daejeon, 35015, South Korea
| | - Keon Hoon Lee
- Korea Association of Health Promotion, Gangseo-gu, Seoul, 07653, South Korea
| | - Dae Seong Cho
- Korea Association of Health Promotion, Gangseo-gu, Seoul, 07653, South Korea
| | - Jinmoo Lee
- Korea Association of Health Promotion, Gangseo-gu, Seoul, 07653, South Korea
| | - Jong-Yil Chai
- Korea Association of Health Promotion, Gangseo-gu, Seoul, 07653, South Korea
| | - Mousab Siddig Elhag
- Community Interventions Division, Communicable and Non-Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Soheir Gabralla Ahmad Khaled
- Community Interventions Division, Communicable and Non-Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | | | | | - Hana Abdelrazig
- Community Interventions Division, Communicable and Non-Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Sarah Awadelkareem
- Community Interventions Division, Communicable and Non-Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Azza Tag Eldin Elshafie
- Laboratory Coordination Unit, Case Management Department, Communicable & Non Communicable Diseases Control Directorate Federal Ministry of Health, Khartoum, Sudan
| | - Hassan Ahmed Hassan Ahmed Ismail
- Community Interventions Division and NTDs, Directorate for Communicable and Non-Communicable Diseases, General Directorate for Primary Health Care, Federal Ministry of Health, Khartoum, Sudan
| | - Mutamad Amin
- Research and Grants Unit, Ahfad University for Women, Omdurman, Khartoum, Sudan
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139
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Bretscher MT, Griffin JT, Ghani AC, Okell LC. Modelling the benefits of long-acting or transmission-blocking drugs for reducing Plasmodium falciparum transmission by case management or by mass treatment. Malar J 2017; 16:341. [PMID: 28814310 PMCID: PMC5559805 DOI: 10.1186/s12936-017-1988-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/09/2017] [Indexed: 11/16/2022] Open
Abstract
Background Anti-malarial drugs are an important tool for malaria control and elimination. Alongside their direct benefit in the treatment of disease, drug use has a community-level effect, clearing the reservoir of infection and reducing onward transmission of the parasite. Different compounds potentially have different impacts on transmission—with some providing periods of prolonged chemoprophylaxis whilst others have greater transmission-blocking potential. The aim was to quantify the relative benefit of such properties for transmission reduction to inform target product profiles in the drug development process and choice of first-line anti-malarial treatment in different endemic settings. Methods A mathematical model of Plasmodium falciparum epidemiology was used to estimate the transmission reduction that can be achieved by using drugs of varying chemoprophylactic (protection for 3, 30 or 60 days) or transmission-blocking activity (blocking 79, 92 or 100% of total onward transmission). Simulations were conducted at low, medium or high transmission intensity (slide-prevalence in 2–10 year olds being 1, 10 or 40%, respectively), with drugs administered either via case management or mass drug administration (MDA). Results Transmission reductions depend strongly on deployment strategy, treatment coverage and endemicity level. Transmission-blocking was most effective at low endemicity, whereas chemoprophylaxis was most useful at high endemicity levels. Increasing the duration of protection as much as possible was beneficial. Increasing transmission-blocking activity from the level of ACT to a 100% transmission-blocking drug (close to the effect estimated for ACT combined with primaquine) produced moderate impact but was not as effective as increasing the duration of protection in medium-to-high transmission settings (slide prevalence 10–40%). Combining both good transmission-blocking activity (e.g. as achieved by ACT or ACT + primaquine) and a long duration of protection (30 days or more, such as provided by piperaquine or mefloquine) within a drug regimen can substantially increase impact compared with drug regimens with only one of these properties in medium to high transmission areas (slide-prevalence in 2–10 year olds ~10 to 40%). These results applied whether the anti-malarials were used for case management or for MDA. Discussion These results emphasise the importance of increasing access to treatment for routine case management, and the potential value of choosing first-line anti-malarial treatment policies according to local malaria epidemiology to maximise impact on transmission. There is no indication that the optimal drug choice should differ between delivery via case management or MDA. Electronic supplementary material The online version of this article (doi:10.1186/s12936-017-1988-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael T Bretscher
- Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analysis & Modelling, Imperial College, London, UK.,F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Jamie T Griffin
- School of Mathematical Sciences, Queen Mary University of London, London, UK
| | - Azra C Ghani
- Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analysis & Modelling, Imperial College, London, UK
| | - Lucy C Okell
- Department of Infectious Disease Epidemiology, MRC Centre for Outbreak Analysis & Modelling, Imperial College, London, UK.
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Odongo-Aginya EI, Olia A, Luwa KJ, Nagayasu E, Auma AM, Egitat G, Mwesigwa G, Ogino Y, Kimura E, Horii T. Wuchereria bancrofti infection at four primary schools and surrounding communities with no previous blood surveys in northern Uganda: the prevalence after mass drug administrations and a report on suspected non-filarial endemic elephantiasis. Trop Med Health 2017; 45:20. [PMID: 28814926 PMCID: PMC5556395 DOI: 10.1186/s41182-017-0060-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A prevalence study of Wuchereria bancrofti infection was carried out in 2014 at 4 study sites in northern Uganda using antigen and microfilaria tests. Each study site consists of a primary school and surrounding communities. These sites are inside the filariasis endemic area and have been covered by mass drug administration under the national elimination programme. However, no prevalence study had been conducted there before the present study. Without information on past and present endemicity levels, our study was meant to be an independent third-party investigation to know the latest filariasis situation. RESULTS A total of 982 people including 570 schoolchildren (7-19 years) and 412 community people (7-25 years) were examined, all of them for filarial antigen and 695 for microfilariae. The study revealed that all subjects were negative by both methods. CONCLUSIONS It was considered that annual mass drug administrations together with anti-malarial activities such as indoor residual spraying had contributed to the reduction of the filarial infection. However, based on the past data obtained near our study sites, we cannot exclude the possibility that filarial prevalence rates in our study sites were very low or even zero originally. During the study, we encountered several patients with lower leg edema and pachydermic (elephant skin-like), mossy skin lesion of the foot. Judging from clinical features and bare-footed life-style of people in the area, non-filarial elephantiasis, possibly podoconiosis, was suspected. This elephantiasis has been reported in areas where filariasis is not endemic.
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Affiliation(s)
| | - Alex Olia
- Department of Microbiology and Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
| | - Kilama Justin Luwa
- Department of Biology, Faculty of Science, Gulu University, P.O.Box 166, Gulu, Uganda
| | - Eiji Nagayasu
- Division of Parasitology, Department of Infectious Diseases, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692 Japan
| | - Anna Mary Auma
- Vector Control Division, Ministry of Health, P.O.Box 1661, Kampala, Uganda
| | - Geoffrey Egitat
- Vector Control Division, Ministry of Health, P.O.Box 1661, Kampala, Uganda
| | - Gerald Mwesigwa
- Vector Control Division, Ministry of Health, P.O.Box 1661, Kampala, Uganda
| | - Yoshitaka Ogino
- Department of Parasitology, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505 Japan.,Department of Haematology and Respiratory Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505 Japan
| | - Eisaku Kimura
- Department of Molecular Protozoology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka 565-0871 Japan
| | - Toshihiro Horii
- Department of Molecular Protozoology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka 565-0871 Japan
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141
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Ali AS, Thawer NG, Khatib B, Amier HH, Shija J, Msellem M, Al-Mafazy AW, Garimo IA, Mkali H, Ramsan MM, Kafuko JM, Paxton LA, Reithinger R, Ngondi JM. Artemisinin combination therapy mass drug administration in a setting of low malaria endemicity: programmatic coverage and adherence during an observational study in Zanzibar. Malar J 2017; 16:332. [PMID: 28807035 PMCID: PMC5557321 DOI: 10.1186/s12936-017-1982-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/07/2017] [Indexed: 11/30/2022] Open
Abstract
Background Mass drug administration (MDA) appears to be effective in reducing the risk of malaria parasitaemia. This study reports on programmatic coverage and compliance of MDA using artemisinin-based combination therapy (ACT) in four shehias (smallest administration unit) that had been identified as hotspots through Zanzibar’s malaria case notification surveillance system. Methods Mass drug administration was done in four shehias selected on the basis of: being an established malaria hot spot; having had mass screening and treatment (MSaT) 2–6 weeks previously; and exceeding the epidemic alert threshold of 5 cases within a week even after MSaT. Communities were sensitized and MDA was conducted using a house-to-house approach. All household members, except pregnant women and children aged less than 2 months, were provided with ACT medicine. Two weeks after the MDA campaign, a survey was undertaken to investigate completion of ACT doses. Results A total of 8816 [97.1% of eligible; 95% confidence interval (CI) 96.8–97.5] people received ACT. During post MDA surveys, 2009 people were interviewed: 90.2% reported having completed MDA doses; 1.9% started treatment but did not complete dosage; 4.7% did not take treatment; 2.0% were absent during MDA and 1.2% were ineligible (i.e. infants <2 months and pregnant women). Main reasons for failure to complete treatment were experience of side-effects and forgetting to take subsequent doses. Failure to take treatment was mainly due to fear of side-effects, reluctance due to lack of malaria symptoms and caregivers forgetting to give medication to children. Conclusion Mass drug administration for malaria was well accepted by communities at high risk of malaria in Zanzibar, with high participation and completion rates. Further work to investigate the potential of MDA in accelerating Zanzibar’s efforts towards malaria elimination should be pursued.
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Affiliation(s)
- Abdullah S Ali
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | | | - Bakar Khatib
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Haji H Amier
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Joseph Shija
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | - Mwinyi Msellem
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, Tanzania
| | | | | | | | | | - Jessica M Kafuko
- President's Malaria Initiative/United States Agency for International Development, Abuja, Nigeria
| | - Lynn A Paxton
- President's Malaria Initiative/Centers for Disease Control and Prevention, Dar es Salaam, Tanzania
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Kshirsagar NA, Gogtay NJ, Garg BS, Deshmukh PR, Rajgor DD, Kadam VS, Thakur PA, Gupta A, Ingole NS, Lazdins-Helds JK. Efficacy and tolerability of treatment with single doses of diethylcarbamazine (DEC) and DEC plus albendazole (ABZ) for three consecutive years in lymphatic filariasis: a field study in India. Parasitol Res 2017; 116:2683-2694. [PMID: 28785847 DOI: 10.1007/s00436-017-5577-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/28/2017] [Indexed: 11/29/2022]
Abstract
Lymphatic filariasis (LF) affects 73 countries, causes morbidity and impedes socioeconomic development. We had found no difference in safety and micro (Mf) and macro filarial action of single-dose diethylcarbamazine (DEC) and DEC + albendazole (ABZ) in an F01 study done in India (year 2000). There was a programmatic need to evaluate safety and efficacy of multiple annual treatments (F02). Subjects (155) from the F01 study, meeting inclusion-exclusion criteria, were enrolled in F02 and treated with further two annual doses of DEC or DEC + ABZ. Efficacy was evaluated for Mf positivity by peripheral smear (PS) and nucleopore (NP) filter, circulating filarial antigen (CFA) and filarial dance sign (FDS) positivity and Mf count at yearly follow-up. Safety was assessed for 5 days after drug administration. Total of 139 subjects evaluated for efficacy (69 DEC and 70 DEC + ABZ group). Mf positivity prevalence declined progressively by 95% (PS), 66% (NP), and 95% (PS) and 86% (NP); CFA positivity prevalence declined by 15% and 9%; FDS by 100% each; Mf count declined by 75.5 and 76.9% with three annual treatment of DEC and DEC + ABZ, respectively. Addition of ABZ did not show any advantage over DEC given as three annual rounds for LF. DEC and DEC + ABZ were well tolerated. There was no correlation between result of CFA and FDS, (both claimed to be indicative of adult worm). Analysis of published studies and our data indicate that macrofilaricidal effect of DEC/DEC + ABZ may be seen in children and not adults, with three or more annual dosing.
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Affiliation(s)
- Nilima A Kshirsagar
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, New MS Building, 1st Floor, Parel, Mumbai, 400012, India. .,National Chair Clinical Pharmacology, ICMR Govt. of India, National Institute for Research in Reproductive Health (NIRRH), J. M. Street, Parel, Mumbai, 400012, India.
| | - N J Gogtay
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, New MS Building, 1st Floor, Parel, Mumbai, 400012, India
| | - B S Garg
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, 442102, India
| | - P R Deshmukh
- Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, 442102, India
| | - D D Rajgor
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, New MS Building, 1st Floor, Parel, Mumbai, 400012, India
| | - V S Kadam
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, New MS Building, 1st Floor, Parel, Mumbai, 400012, India
| | - P A Thakur
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, New MS Building, 1st Floor, Parel, Mumbai, 400012, India
| | - A Gupta
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, New MS Building, 1st Floor, Parel, Mumbai, 400012, India
| | - N S Ingole
- Department of Pathology, Mahatma Gandhi Institute of Medical Sciences, Wardha, 442102, India
| | - J K Lazdins-Helds
- World Health Organization (WHO), Special Program for Research and Training in Tropical Diseases, Product Research and Development, 20 Avenue Appia, Geneva 27, 1211, Geneva, CH, Switzerland
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143
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Dunn JC, Bettis AA, Wyine NY, Lwin AMM, Lwin ST, Su KK, Sein MM, Tun A, Maung NS, Anderson RM. A cross-sectional survey of soil-transmitted helminthiases in two Myanmar villages receiving mass drug administration: epidemiology of infection with a focus on adults. Parasit Vectors 2017; 10:374. [PMID: 28778217 PMCID: PMC5543579 DOI: 10.1186/s13071-017-2306-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Soil-transmitted helminths (STH) are still highly prevalent in southeast Asia. The country of Myanmar has had ongoing mass drug administration (MDA) programmes since 2003 in an attempt to control STH and reduce STH-related morbidities. Whilst the MDA programmes have reported high nationwide coverage, there have been no epidemiological surveys that included measurements from adults. This paper details three cross-sectional surveys that took place over the course of a year in two villages endemic for STH and receiving MDA in lower Myanmar. RESULTS At baseline, 27.81% of participants were infected with at least one type of STH. The most prevalent STH was Trichuris trichiura (18.12%) followed by hookworm (8.71%) and Ascaris lumbricoides (5.34%). Most infections were of low intensity, measured by eggs per gram of faeces (EPG). Gender stratification revealed that A. lumbricoides prevalence was significantly higher in females, whereas hookworm prevalence was significantly higher in males. The distribution of EPG in the study sample was highly overdispersed, suggesting that most people release few eggs whereas a few people release many eggs. Adults harbour a major proportion of the overall STH burden; 65.15% of STH infections were harboured by adults. CONCLUSIONS STH infection remains at medium prevalence in the study villages despite past and recent MDA. Recorded prevalence of STH in school-aged children has not substantially decreased since the last monitoring and evaluation activities in Myanmar in 2013. Analyses suggest that adults are a major contributor to the total STH prevalence and EPG burden, probably perpetuating transmission.
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Affiliation(s)
- Julia C. Dunn
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, W2 1PG, London, UK
- London Centre for Neglected Tropical Disease Research, London, UK
| | - Alison A. Bettis
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, W2 1PG, London, UK
- London Centre for Neglected Tropical Disease Research, London, UK
| | - Nay Yee Wyine
- London Centre for Neglected Tropical Disease Research, London, UK
| | - Aye Moe Moe Lwin
- University of Public Health, Myorma Kyaung Street, Yangon, 11131 Myanmar
| | - Soe Thiha Lwin
- Defence Services Medical Academy, Pyay Road, Mingaladon, Yangon, 11021 Myanmar
| | - Khine Khine Su
- Defence Services Medical Academy, Pyay Road, Mingaladon, Yangon, 11021 Myanmar
| | - Myint Myint Sein
- University of Public Health, Myorma Kyaung Street, Yangon, 11131 Myanmar
| | - Aung Tun
- Ministry of Health and Sports, Nyapyitaw, Myanmar
| | - Nay Soe Maung
- University of Public Health, Myorma Kyaung Street, Yangon, 11131 Myanmar
| | - Roy M. Anderson
- Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, W2 1PG, London, UK
- London Centre for Neglected Tropical Disease Research, London, UK
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144
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Abstract
Helminth infections, including soil-transmitted helminths and schistosomiasis, remain one of the most common infections in the world with over 1 billion people infected. These infections cause significant morbidity, particularly in young children, that may last a lifetime, including growth and cognitive stunting. There is an urgent need for the control and elimination of helminth infections from areas of poverty to reduce morbidity in children. Mass drug administration programs were adopted by the World Health Assembly in 2001 and have evolved to provide coverage with multiple anthelmintic medications in a single rapid impact package and more extensive coverage within a community.
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Affiliation(s)
- Jill E Weatherhead
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Feigin Research Building, 1102 Bates Avenue, Suite 550, Houston, TX 77030, USA; National School of Tropical Medicine, Baylor College of Medicine, One Baylor Plaza, MS: BCM-113, Houston, TX 77030, USA.
| | - Peter J Hotez
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Feigin Research Building, 1102 Bates Avenue, Suite 550, Houston, TX 77030, USA; National School of Tropical Medicine, Baylor College of Medicine, One Baylor Plaza, MS: BCM-113, Houston, TX 77030, USA; Department of Molecular Virology and Microbiology, Baylor College of Medicine, One Baylor Plaza, MS: BCM-385, Houston, TX 77030, USA; Sabin Vaccine Institute and Texas Children's Hospital (TCH), Center for Vaccine Development, Feigin Research Building, 1102 Bates Avenue, Suite 550, Houston, TX 77030, USA
| | - Rojelio Mejia
- Department of Pediatrics, Section of Tropical Medicine, Baylor College of Medicine, Feigin Research Building, 1102 Bates Avenue, Suite 550, Houston, TX 77030, USA; National School of Tropical Medicine, Baylor College of Medicine, One Baylor Plaza, MS: BCM-113, Houston, TX 77030, USA.
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145
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Truscott JE, Werkman M, Wright JE, Farrell SH, Sarkar R, Ásbjörnsdóttir K, Anderson RM. Identifying optimal threshold statistics for elimination of hookworm using a stochastic simulation model. Parasit Vectors 2017; 10:321. [PMID: 28666452 PMCID: PMC5493114 DOI: 10.1186/s13071-017-2256-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/12/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is an increased focus on whether mass drug administration (MDA) programmes alone can interrupt the transmission of soil-transmitted helminths (STH). Mathematical models can be used to model these interventions and are increasingly being implemented to inform investigators about expected trial outcome and the choice of optimum study design. One key factor is the choice of threshold for detecting elimination. However, there are currently no thresholds defined for STH regarding breaking transmission. METHODS We develop a simulation of an elimination study, based on the DeWorm3 project, using an individual-based stochastic disease transmission model in conjunction with models of MDA, sampling, diagnostics and the construction of study clusters. The simulation is then used to analyse the relationship between the study end-point elimination threshold and whether elimination is achieved in the long term within the model. We analyse the quality of a range of statistics in terms of the positive predictive values (PPV) and how they depend on a range of covariates, including threshold values, baseline prevalence, measurement time point and how clusters are constructed. RESULTS End-point infection prevalence performs well in discriminating between villages that achieve interruption of transmission and those that do not, although the quality of the threshold is sensitive to baseline prevalence and threshold value. Optimal post-treatment prevalence threshold value for determining elimination is in the range 2% or less when the baseline prevalence range is broad. For multiple clusters of communities, both the probability of elimination and the ability of thresholds to detect it are strongly dependent on the size of the cluster and the size distribution of the constituent communities. Number of communities in a cluster is a key indicator of probability of elimination and PPV. Extending the time, post-study endpoint, at which the threshold statistic is measured improves PPV value in discriminating between eliminating clusters and those that bounce back. CONCLUSIONS The probability of elimination and PPV are very sensitive to baseline prevalence for individual communities. However, most studies and programmes are constructed on the basis of clusters. Since elimination occurs within smaller population sub-units, the construction of clusters introduces new sensitivities for elimination threshold values to cluster size and the underlying population structure. Study simulation offers an opportunity to investigate key sources of sensitivity for elimination studies and programme designs in advance and to tailor interventions to prevailing local or national conditions.
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Affiliation(s)
- James E Truscott
- London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, St. Mary's Campus, Imperial College London, W2 1PG, London, UK. .,The DeWorm3 Project, The Natural History Museum of London, London, SW7 5BD, UK.
| | - Marleen Werkman
- London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, St. Mary's Campus, Imperial College London, W2 1PG, London, UK.,The DeWorm3 Project, The Natural History Museum of London, London, SW7 5BD, UK
| | - James E Wright
- London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, St. Mary's Campus, Imperial College London, W2 1PG, London, UK.,The DeWorm3 Project, The Natural History Museum of London, London, SW7 5BD, UK
| | - Sam H Farrell
- London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, St. Mary's Campus, Imperial College London, W2 1PG, London, UK
| | - Rajiv Sarkar
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, 632004, India
| | - Kristjana Ásbjörnsdóttir
- The DeWorm3 Project, The Natural History Museum of London, London, SW7 5BD, UK.,Department of Global Health, University of Washington, Seattle, USA
| | - Roy M Anderson
- London Centre for Neglected Tropical Disease Research (LCNTDR), Department of Infectious Disease Epidemiology, St. Mary's Campus, Imperial College London, W2 1PG, London, UK.,The DeWorm3 Project, The Natural History Museum of London, London, SW7 5BD, UK
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146
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Musuva RM, Matey E, Masaku J, Odhiambo G, Mwende F, Thuita I, Kihara J, Njomo D. Lessons from implementing mass drug administration for soil transmitted helminths among pre-school aged children during school based deworming program at the Kenyan coast. BMC Public Health 2017; 17:575. [PMID: 28615011 PMCID: PMC5471907 DOI: 10.1186/s12889-017-4481-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 06/01/2017] [Indexed: 12/14/2022] Open
Abstract
Background The 2012 London declaration which committed to “sustaining, expanding and extending drug access programmes to ensure the necessary supply of drugs and other interventions to help control soil-transmitted helminths (STH) by 2020” has seen many countries in Africa roll out mass drug administration (MDA) especially among school age children. In Kenya, however, during the National school-based deworming exercise, pre-school aged children (PSAC) have to access treatment at primary schools as the pre-school teachers are not trained to carry out deworming. With studies being conducted on the effectiveness of MDAs, the experiences of key education stakeholders which could improve the programme by giving best practices, and challenges experienced have not been documented. Methods This was a cross-sectional qualitative study using Focus group discussions (FGDs) and Key informant interviews (KIIs). It was conducted in 4 sub-counties with high STH prevalence at the Kenyan coast (Matuga, Malindi, Lunga Lunga and Msambweni) to understand best practices for implementing MDA among PSAC.FGDs categorized by gender were conducted among local community members, whereas KIIs involved pre-school teachers, primary school teachers, community health extension workers (CHEWs) and opinion leaders. Participants were purposefully selected with the saturation model determining the number of interviews and focus groups. Voice data collected was transcribed verbatim then coded and analyzed using ATLAS.Ti version 6. Results Majority of the primary school teachers and CHEWs reported that they were satisfied with the method of mobilization used and the training tools. This was however not echoed by the pre-school teachers, parents and chiefs who complained of being left out of the process. Best practices mentioned included timely drug delivery, support from pre-school teachers, and management of side effects. Overcrowding during the drug administration day, complexity of the forms (for instance the ‘S form’) and long distance between schools were mentioned as challenges. Conclusion There is need to utilize better sensitization methods to include the local administration as well as the parents for better uptake of the drugs. Extending deworming training to pre-school teachers will enhance the national deworming programme. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4481-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosemary M Musuva
- Center for Global Health Research (CGHR), Kenya Medical Research Institute, P. O. Box 1578-40100, Kisumu, Kenya.
| | - Elizabeth Matey
- Center for Microbiology Research, Kenya Medical Research Institute, P. O. Box 54840 - 00200, Nairobi, Kenya
| | - Janet Masaku
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute, P. O. Box 54840 - 00200, Nairobi, Kenya
| | - Gladys Odhiambo
- Center for Global Health Research (CGHR), Kenya Medical Research Institute, P. O. Box 1578-40100, Kisumu, Kenya
| | - Faith Mwende
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute, P. O. Box 54840 - 00200, Nairobi, Kenya
| | - Isaac Thuita
- Ministry of Education, Directorate of Basic Education, Early Childhood Education Section, P. O. Box- 30040-00100, Nairobi, Kenya
| | - Jimmy Kihara
- Ministry of Health, Division of Vector Borne Diseases, P. O. Box-20750-00202, Nairobi, Kenya
| | - Doris Njomo
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute, P. O. Box 54840 - 00200, Nairobi, Kenya
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147
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Allen T, Taleo F, Graves PM, Wood P, Taleo G, Baker MC, Bradley M, Ichimori K. Impact of the Lymphatic Filariasis Control Program towards elimination of filariasis in Vanuatu, 1997-2006. Trop Med Health 2017; 45:8. [PMID: 28579911 PMCID: PMC5452608 DOI: 10.1186/s41182-017-0047-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/22/2017] [Indexed: 11/26/2022] Open
Abstract
Background Lymphatic filariasis (LF) occurs when filarial parasites are transmitted to humans through mosquitoes. The filarial worms affect the lymphatic system which leads to abnormal enlargement of body parts, chronic pain, disability, and social discrimination. In 1999, a commitment was made to eliminate LF from the Pacific Region by 2010. The Pacific Program to Eliminate LF began, with Vanuatu being one of the 16 endemic countries included in this program. Methods In 1997/1998 a LF prevalence baseline survey was conducted to determine the need for mass drug administration (MDA) in Vanuatu. In 1999, the Vanuatu Lymphatic Filariasis Control Program was established, and nationwide MDA was implemented from 2000 to 2004. LF prevalence was collected during the MDA through sentinel site and spot check surveys, and after 5 years of MDA. MDA implementation methods included health worker training, social mobilization, and culturally appropriate health promotion strategies. Results LF prevalence at baseline was 4.79%; after MDA this declined to 0.16% in 2005/2006. Average MDA coverage ranged from 75.5–81.5% across 5 years. All three evaluation units surveyed in 2005/2006 were below the 1% threshold required to stop MDA. Conclusions The LF Control Program between 1997 and 2006 was successful in reducing LF prevalence to <1%. High MDA coverage was a critical component of this success. This period of the Vanuatu LF Control Program played an important role in helping to eliminate LF in Vanuatu.
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Affiliation(s)
- Tammy Allen
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland Australia
| | - Fasihah Taleo
- Vanuatu Ministry of Health, Government of the Republic of Vanuatu, Port Vila, Vanuatu
| | - Patricia M Graves
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland Australia
| | - Peter Wood
- James Cook University, Cairns, Queensland Australia
| | - George Taleo
- Vanuatu Ministry of Health, Government of the Republic of Vanuatu, Port Vila, Vanuatu
| | | | - Mark Bradley
- Global Health Program, GlaxoSmithKline (GSK), Brentford, UK
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Silumbwe A, Zulu JM, Halwindi H, Jacobs C, Zgambo J, Dambe R, Chola M, Chongwe G, Michelo C. A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa. BMC Public Health 2017; 17:484. [PMID: 28532397 PMCID: PMC5441010 DOI: 10.1186/s12889-017-4414-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 05/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding factors surrounding the implementation process of mass drug administration for lymphatic filariasis (MDA for LF) elimination programmes is critical for successful implementation of similar interventions. The sub-Saharan Africa (SSA) region records the second highest prevalence of the disease and subsequently several countries have initiated and implemented MDA for LF. Systematic reviews have largely focused on factors that affect coverage and compliance, with less attention on the implementation of MDA for LF activities. This review therefore seeks to document facilitators and barriers to implementation of MDA for LF in sub-Saharan Africa. METHODS A systematic search of databases PubMed, Science Direct and Google Scholar was conducted. English peer-reviewed publications focusing on implementation of MDA for LF from 2000 to 2016 were considered for analysis. Using thematic analysis, we synthesized the final 18 articles to identify key facilitators and barriers to MDA for LF programme implementation. RESULTS The main factors facilitating implementation of MDA for LF programmes were awareness creation through innovative community health education programmes, creation of partnerships and collaborations, integration with existing programmes, creation of morbidity management programmes, motivation of community drug distributors (CDDs) through incentives and training, and management of adverse effects. Barriers to implementation included the lack of geographical demarcations and unregistered migrations into rapidly urbanizing areas, major disease outbreaks like the Ebola virus disease in West Africa, delayed drug deliveries at both country and community levels, inappropriate drug delivery strategies, limited number of drug distributors and the large number of households allocated for drug distribution. CONCLUSION Mass drug administration for lymphatic filariasis elimination programmes should design their implementation strategies differently based on specific contextual factors to improve implementation outcomes. Successfully achieving this requires undertaking formative research on the possible constraining and inhibiting factors, and incorporating the findings in the design and implementation of MDA for LF.
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Affiliation(s)
- Adam Silumbwe
- Department of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
| | - Joseph Mumba Zulu
- Department of Health Promotion and Education, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia
| | - Hikabasa Halwindi
- Department of Environmental Health, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia
| | - Choolwe Jacobs
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia
| | - Jessy Zgambo
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia
| | - Rosalia Dambe
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia
| | - Mumbi Chola
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia
| | - Gershom Chongwe
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia
| | - Charles Michelo
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia
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Pell C, Tripura R, Nguon C, Cheah P, Davoeung C, Heng C, Dara L, Sareth M, Dondorp A, von Seidlein L, Peto TJ. Mass anti-malarial administration in western Cambodia: a qualitative study of factors affecting coverage. Malar J 2017; 16:206. [PMID: 28526019 PMCID: PMC5438518 DOI: 10.1186/s12936-017-1854-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/09/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mass anti-malarial administration has been proposed as a key component of the Plasmodium falciparum malaria elimination strategy in the Greater Mekong sub-Region. Its effectiveness depends on high levels of coverage in the target population. This article explores the factors that influenced mass anti-malarial administration coverage within a clinical trial in Battambang Province, western Cambodia. METHODS Qualitative data were collected through semi-structured interviews and focus group discussions with villagers, in-depth interviews with study staff, trial drop-outs and refusers, and observations in the communities. Interviews were audio-recorded, transcribed and translated from Khmer to English for qualitative content analysis using QSR NVivo. RESULTS Malaria was an important health concern and villagers reported a demand for malaria treatment. This was in spite of a fall in incidence over the previous decade and a lack of familiarity with asymptomatic malaria. Participants generally understood the overall study aim and were familiar with study activities. Comprehension of the study rationale was however limited. After the first mass anti-malarial administration, seasonal health complaints that participants attributed to the anti-malarial as "side effects" contributed to a decrease of coverage in round two. Staff therefore adapted the community engagement approach, bringing to prominence local leaders in village meetings. This contributed to a subsequent increase in coverage. CONCLUSION Future mass anti-malarial administration must consider seasonal disease patterns and the importance of local leaders taking prominent roles in community engagement. Further research is needed to investigate coverage in scenarios that more closely resemble implementation i.e. without participation incentives, blood sampling and free healthcare.
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Affiliation(s)
- Christopher Pell
- Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Rupam Tripura
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Chea Nguon
- National Center for Parasitology, Entomology and Malaria Control, Phnom Penh, Cambodia
| | - Phaikyeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Chan Davoeung
- Battambang Provincial Health Department, Krong Battambang, Cambodia
| | - Chhouen Heng
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Lim Dara
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Ma Sareth
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Arjen Dondorp
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Lorenz von Seidlein
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Thomas J. Peto
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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150
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Jones C, Ngasalla B, Derua YA, Tarimo D, Malecela MN. Lymphatic filariasis elimination efforts in Rufiji, southeastern Tanzania: decline in circulating filarial antigen prevalence in young school children after twelve rounds of mass drug administration and utilization of long-lasting insecticide-treated nets. Int J Infect Dis 2017; 61:38-43. [PMID: 28527817 PMCID: PMC5521953 DOI: 10.1016/j.ijid.2017.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 11/24/2022] Open
Abstract
Interventions based on mass drug administration and insecticide-treated nets led to a marked decline in Wuchereria bancrofti circulating filarial antigen (CFA) in young school children. The official reported treatment coverage was relatively higher than the surveyed coverage. There has been an increase in ownership and utilization of insecticide-treated nets in the study areas.
Background Lymphatic filariasis (LF) is a parasitic infection transmitted by mosquito vectors, and in Sub-Saharan Africa it is caused by the nematode Wuchereria bancrofti. The disease has been targeted for global elimination with the annual mass drug administration (MDA) strategy. Vector control is known to play an important complementary role to MDA in reducing the transmission of LF. The effects of an MDA and insecticide-treated net intervention implemented in an endemic area of southeastern Tanzania are reported here. Methods A cross-sectional study assessing W. bancrofti circulating filarial antigen (CFA) was conducted in five primary schools in five different villages. Standard one pupils aged 6–9 years were screened for CFA using immunochromatographic test cards (ICT), with a total of 413 screened in 2012 and 659 in 2015. Just after CFA testing, the children were interviewed on their participation in the MDA campaign. Moreover, 246 heads of households in 2012 and 868 in 2015 were interviewed on their participation in MDA and utilization of long-lasting insecticide-treated nets (LLINs). Results The prevalence of CFA for the 413 children tested in 2012 was 14.3%, while it was 0.0% for the 659 children tested in 2015. The Tanzanian National Lymphatic Filariasis Elimination Programme reported annual treatment coverage for Rufiji District ranging from 54.3% to 94.0% during the years 2002–2014. The surveyed treatment was 51.6% in 2011 and 57.4% in 2014. With regard to LLINs, possession and utilization increased from 63.4% and 59.2%, respectively, in 2012, to 92.5% and 75.4%, respectively, in 2015. Conclusions The findings suggest that 12 rounds of MDA complemented with vector control through the use of insecticide-treated nets resulted in a marked reduction in W. bancrofti CFA in young school children.
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Affiliation(s)
- Clarer Jones
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, United Nations Road, PO Box 65001, Dar es Salaam, Tanzania.
| | - Billy Ngasalla
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, United Nations Road, PO Box 65001, Dar es Salaam, Tanzania.
| | - Yahya A Derua
- National Institute for Medical Research, PO Box 9653, Dar es Salaam, Tanzania.
| | - Donath Tarimo
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, United Nations Road, PO Box 65001, Dar es Salaam, Tanzania.
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