1
|
Mogaji HO, Okoh HI, Lawal AM, Ojo KH, Marcus AJ, Aaron NO, Adeleye DR, Olamiju FO, Ekpo UF. A Post-Lockdown Assessment of Albendazole Treatment Coverage in Mass Drug Administration Campaigns Implemented Before and During COVID-19 Pandemic in Ekiti, Southwest Nigeria. Int J Public Health 2023; 68:1605510. [PMID: 36846154 PMCID: PMC9948738 DOI: 10.3389/ijph.2023.1605510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
Objective: This study assessed the coverage of albendazole (ALB) in mass drug administration (MDA) programs implemented before (2019) and during the (2020 and 2021) COVID-19 pandemic in Ekiti State, Nigeria. Methods: Standardized questionnaires were administered to 1,127 children across three peri-urban communities to ascertain if they received and swallowed ALB across the years. Reasons, why ALB was not received, were documented and analyzed in SPSS. 20.0. Results: In 2019, the medicine reach was between 42.2%-57.8%, however, during the pandemic, the reach significantly reduced to 12.3%-18.6%, and increased to 28.5%-35.2% in 2021 (p < 0.000). About 19.6%-27.2% of the participants have missed 1 MDA, while 26.9%-37.8% and 22.4%-32.8% have missed 2 and 3 MDAs, respectively. The majority who did not receive ALB (60.8%-75%) claimed drug distributors never came, while about 14.9%-20.3% mentioned they did not hear about MDA. However, individual compliance towards swallowing was above 94% across the study years (p < 0.00). Conclusion: These results highlight the need to explore the perceptions of those who have consistently missed MDAs, and also understand the health-system-related issues including those imposed by the pandemic affecting MDA.
Collapse
Affiliation(s)
- Hammed O. Mogaji
- Parasitology and Epidemiology Unit, Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Oye, Nigeria,*Correspondence: Hammed O. Mogaji,
| | - Hilary I. Okoh
- Parasitology and Epidemiology Unit, Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Oye, Nigeria
| | - Abiodun M. Lawal
- Clinical Psychology Unit, Department of Psychology, Federal University Oye-Ekiti, Oye, Nigeria
| | - Kayode H. Ojo
- Neglected Tropical Diseases Unit, Ekiti State Primary Healthcare and Development Agency, Ado Ekiti, Nigeria
| | | | - Nwana O. Aaron
- Parasitology and Epidemiology Unit, Department of Animal and Environmental Biology, Federal University Oye-Ekiti, Oye, Nigeria
| | - Damilola R. Adeleye
- Clinical Psychology Unit, Department of Psychology, Federal University Oye-Ekiti, Oye, Nigeria
| | | | - Uwem F. Ekpo
- Parasitology and Epidemiology Unit, Department of Pure and Applied Zoology, Federal University of Agriculture, Abeokuta, Abeokuta, Nigeria,Bioscience Research Programme, Institute of Food Security, Environmental Resource and Agricultural Research (IFSERAR), Federal University of Agriculture, Abeokuta, Nigeria
| |
Collapse
|
2
|
Naing C, Htet NH, Aung HH, Whittaker MA. Community engagement in health services research on elimination of lymphatic filariasis: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001226. [PMID: 36963022 PMCID: PMC10021320 DOI: 10.1371/journal.pgph.0001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023]
Abstract
This study aimed to contextualize the extent, nature, and quality of community engagement in health services research on eliminating lymphatic filariasis in low-and middle-income countries of Southeast Asia and Pacific Region. We performed a systematic review, and the results were reported according to the PRISMA-S checklist. Relevant studies were searched in health-related electronic databases, and selected according to the inclusion criteria. Sixteen studies with various study designs were identified. The majority (68%) were conducted in India. Lay people, community leaders, and volunteers were the most common groups of community members (12/16,75%). Overall, the majority (13/16, 81%) were at the 'moderate level' of engagement in research context mainly by 'collaboration' in 'developing methodology' 'collaboration' in data collection and 'collaboration' for 'dissemination of findings. The common barriers to the community engagement were lack of involvement of participating bodies and technology-related issues. In conclusion, the insufficient description of the community engagement process in the studies limits a deeper understanding and analysis of the issue. Future well-designed prospective studies with attention to the description of mechanisms of engagement, facilitating the whole process and reporting the community level outcome are recommended.
Collapse
Affiliation(s)
- Cho Naing
- Division of Tropical Health and Medicine, James Cook University, Queensland, Australia
| | - Norah Htet Htet
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Htar Htar Aung
- School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Maxine A Whittaker
- Division of Tropical Health and Medicine, James Cook University, Queensland, Australia
| |
Collapse
|
3
|
Ncube MV, Kabuyaya M, Chimbari MJ. Patient journey and resources mapping to implement a praziquantel mass drug administration program for children aged 5 years and below in resource-limited settings. Syst Rev 2022; 11:227. [PMID: 36271455 PMCID: PMC9585827 DOI: 10.1186/s13643-022-02087-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/28/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The early childhood development of millions of children in some low- and medium-income countries may be compromised by schistosomiasis infections contracted at the age of 5 years and below. Currently, there are no standard guidelines for treating schistosomiasis in children that are 5 years and younger using praziquantel (PZQ), the only drug that the World Health Organization (WHO) recommends for treating schistosomiasis. The review is on processes and resources involved in the treatment of schistosomiasis in children aged 5 years and below. METHODS An electronic search for peer-reviewed articles published in the period from January 2011 to August 2021 was done in the Academic Search Complete, CINAHL with Full Text, Health Source: Nursing/Academic Edition, and MEDLINE databases via EBSCOHost and Google Scholar databases. The search targeted journals that described the treatment of schistosomiasis in children 5 years and below using praziquantel. RESULTS Thirteen studies met the inclusion criteria. The patient journey for treating schistosomiasis in children aged 5 years old and below using PZQ included the following activities: enrolment of the children into the treatment program; clinical examination; diagnosis; taking anthropometric measurements; feeding the children, making the PZQ palatable to the children; administration of PZQ; and monitoring of side effects. There was also a variation in the resources used to treat children aged 5 and below for schistosomiasis. CONCLUSIONS A PZQ mass drug administration program for children aged 5 years old and below in endemic areas should exclude the diagnosis of schistosomiasis before treatment. The resources required in the treatment process should be affordable, and should not require skills and maintenance resources that are beyond those that are available at the primary healthcare level.
Collapse
Affiliation(s)
- Mhlengi Vella Ncube
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. .,Medical Affairs Institute, Johannesburg, South Africa.
| | - Muhubiri Kabuyaya
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Moses John Chimbari
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
4
|
Abdul Halim AFN, Ahmad D, Miaw Yn JL, Masdor NA, Ramly N, Othman R, Kandayah T, Hassan MR, Dapari R. Factors Associated with the Acceptability of Mass Drug Administration for Filariasis: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12971. [PMID: 36232271 PMCID: PMC9566436 DOI: 10.3390/ijerph191912971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
Mass drug administration (MDA) has been implemented as a tool to eliminate lymphatic filariasis. Acceptability among susceptible populations is crucial to achieving MDA effective coverage. This systematic review aims to present and systematically determine the factors associated with the acceptability of MDA. Articles related to factors associated with acceptability were collected electronically from three different databases (Scopus, Web of Science, and PubMed). Four pairs of independent reviewers screened the titles and abstracts of the collected data, stored in EndnoteX7, against the inclusion criteria. Afterwards, the included articles have been critically appraised to assess the quality of the studies using the Mixed Method Appraisal Tool (MMAT). Of the 68 articles identified, 11 were included in the final review. Knowledge, awareness, attitude and perceptions, communications, delivery and accessibility of MDA, gender, and age are the factors associated with MDA acceptability. Community acceptance remains a challenge in the implementation of MDA. To expand MDA coverage in all endemic countries, there is a strong need to address the factors influencing community acceptance of MDA.
Collapse
Affiliation(s)
| | - Dzulfitree Ahmad
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Jane Ling Miaw Yn
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Noor Azreen Masdor
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Nurfatehar Ramly
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Rahayu Othman
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Thinakaran Kandayah
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Rahmat Dapari
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia
| |
Collapse
|
5
|
Osei FA, Newton S, Nyanor I, Osei-Yeboah E, Amuzu EX, Mensah NK, Nyarko OO, Amanor E, Boadi S, Asare O, Odoom SF, Furu P, Owusu-Dabo E, Meyrowitsch DW. Mass drug administration targeting Onchocerca volvulus in Owabi catchment area in Ashanti Region, Ghana: Determinants of drug coverage and drug uptake. Parasite Epidemiol Control 2022; 16:e00235. [PMID: 35024476 PMCID: PMC8733227 DOI: 10.1016/j.parepi.2021.e00235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Achieving high Mass Drug Administration (MDA) coverage and drug uptake are pivotal in the efforts to eradicate onchocerciasis. The present study investigated the extent and predictors of ivermectin MDA coverage and uptake from the individual and healthcare providers' perspectives. The extent of ivermectin distribution and uptake, and the predictors of distribution and uptake were investigated in endemic communities in the Ashanti Region of Ghana. Methods A cross-sectional survey was conducted from August to October 2019 in communities within the Atwima Nwabiagya North District. A total of 2008 respondents were interviewed. Data was collected with REDCap mobile App which had an electronic version of the structured questionnaire. Descriptive data was presented in frequency tables, and bivariate and multivariate logistics regression analysis were performed to measure the associations between exposure variables and outcome variables which were received and uptake of MDA drugs. Results A total of 1284 (63.9%) respondents did not receive ivermectin during the 2019 MDA programme and more than half of them were not aware of the drug distribution (53.3%). The most common reasons for not ingesting the drug were fear of side effects (47.7%) and not trusting the drug distributors (20.0%). Respondents in the age group 48–57 years (AOR = 1.37; 95%CI: 1.01–2.67), Persons in the high wealth index (AOR = 1.40; 95%CI: 1.11–1.77), Being aware of the MDA programme (AOR = 6.67: 95%CI: 4.76–9.35), MDA being beneficial (AOR = 2.12; 95%CI: 1.54–2.92) participating in previous MDA (AOR = 5.44; 95%CI: 4.25–6.98) and having stayed in the communities for 10 years and above significantly increased the odds of receiving MDA drugs. Previous uptake of MDA drugs (AOR = 10.58; 95%CI: 5.78–19.38) and perception of the MDA drug as beneficial (AOR = 5.25; 95%CI: 2.55–10.82) increased the likelihood of ingesting drugs when received. Conclusion The main health system challenge was limited awareness creation regarding MDA. This seems to affect the optimal utilization of the ivermectin MDA intervention. MDA programmes against onchocerciasis eradication should be designed taking into account specific contextual factors to improve implementation outcomes.
Collapse
Affiliation(s)
- Francis Adjei Osei
- Department of Global Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sam Newton
- Department of Global Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | | | | | | | - Ophebia Asare
- Department of Global Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Peter Furu
- Department of Public Health, Global Health Section, University of Copenhagen, Denmark
| | - Ellis Owusu-Dabo
- Department of Global Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Dan Wolf Meyrowitsch
- Department of Public Health, Global Health Section, University of Copenhagen, Denmark
| |
Collapse
|
6
|
Agboraw E, Sosu F, Dean L, Siakeh A, Thomson R, Kollie K, Worrall E. Factors influencing mass drug administration adherence and community drug distributor opportunity costs in Liberia: a mixed-methods approach. Parasit Vectors 2021; 14:557. [PMID: 34711278 PMCID: PMC8555123 DOI: 10.1186/s13071-021-05058-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Preventive chemotherapy delivered via mass drug administration (MDA) is essential for the control of neglected tropical diseases (NTDs), including lymphatic filariasis (LF), schistosomiasis and onchocerciasis. Successful MDA relies heavily on community drug distributor (CDD) volunteers as the interface between households and the health system. This study sought to document and analyse demand-side (households) and supply-side (health system) factors that affect MDA delivery in Liberia. Methods Working in two purposively selected counties, we conducted a household MDA access and adherence survey; a CDD survey to obtain information on direct and opportunity costs associated with MDA work; an observational survey of CDDs; and key informant surveys (KIS) with community-level health workers. Data from the CDD survey and Liberian minimum wage rates were used to calculate the opportunity cost of CDD participation per MDA round. The observational data were used to calculate the time spent on individual household-level tasks and CDD time costs per house visited. KIS data on the organisation and management of the MDA in the communities, and researcher reflections of open-ended survey responses were thematically analysed to identify key demand- and supply-side challenges. Results More respondents were aware of MDA than NTD in both counties. In Bong, 39% (103/261) of respondents reported taking the MDA tablet in the last round, with “not being informed” as the most important reason for non-adherence. In Maryland, 56% (147/263) reported taking MDA with “being absent” at the time of distribution being important for non-adherence. The mean cost per CDD of participating in the MDA round was −$11.90 (median $5.04, range −$169.62 to $30.00), and the mean time per household visited was 17.14 min which equates to a mean opportunity cost of $0.03 to $0.05 per household visited. Thematic analysis identified challenges, including shortages of and delays in medicine availability; CDD frustration over costs; reporting challenges; and household concerns about drug side effects. Conclusions Improved adherence to MDA and subsequent elimination of NTDs in Liberia would be supported by an improved medicine supply chain, financial compensation for CDDs, improved training, healthcare workforce strengthening, greater community involvement, capacity building, and community awareness. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-05058-w.
Collapse
Affiliation(s)
- Efundem Agboraw
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Street, Liverpool, L3 5 QA, UK.
| | - Fred Sosu
- University of Liberia, Pacific Institute for Research and Evaluation (UL-PIRE), Capitol Hill, Monrovia, Liberia
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Street, Liverpool, L3 5 QA, UK
| | - Alice Siakeh
- University of Liberia, Pacific Institute for Research and Evaluation (UL-PIRE), Capitol Hill, Monrovia, Liberia
| | - Rachael Thomson
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Street, Liverpool, L3 5 QA, UK
| | - Karsor Kollie
- Ministry of Health, SKD Boulevard, Monrovia, Liberia
| | - Eve Worrall
- Department of Vector Biology, Liverpool School of Tropical Medicine, Pembroke Street, Liverpool, L3 5 QA, UK
| |
Collapse
|
7
|
Kaliappan S, Ramanujam K, Manuel M, Farzana J, Janagaraj V, Laxmanan S, Muliyil J, Sarkar R, Kang G, Walson J, Ajjampur S. Soil-transmitted helminth infections after mass drug administration for lymphatic filariasis in rural southern India. Trop Med Int Health 2021; 27:81-91. [PMID: 34704320 DOI: 10.1111/tmi.13697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Targeted deworming is the current strategy for control of morbidity associated with soil-transmitted helminths (STH) among at-risk populations: preschool-aged children, school-aged children and women of childbearing age. We report the prevalence and intensity of STH in a district after lymphatic filariasis (LF) mass drug administration (MDA) in southern India where albendazole was co-administered from 2001. METHODS Children aged 2 to 15 years and adults (defined as ≥15 years) in a rural administrative block of Tamil Nadu were recruited using a probability proportional to size method. Stool samples were screened and eggs per gram (EPG) determined by Kato-Katz method. Multilevel logistic regression (MLR) and multilevel negative binomial regression (MNBR) analyses were used to identify factors associated with infection and intensity, respectively. RESULTS Of 862 participants who provided samples, 60 (7.0%; 95% confidence interval (CI): 5.3-8.7) were positive for STH with a predominance of hookworm infections (n = 57, 6.6%; 95% CI: 5.0-8.3). Increasing age (odds ratio (OR): 1.09; 95% CI: 1.04-1.15) and regular usage of the toilet (OR: 0.32; 95% CI: 0.12-0.88) were independently associated with hookworm infection and age was significantly associated with increasing intensity of hookworm infection (infection intensity ratio (IIR): 1.28; 95% CI: 1.19-1.37). A brief review of STH prevalence in endemic settings before and after the stoppage of LF MDA indicated that, in most settings, a substantial reduction in STH prevalence is seen. CONCLUSION Community-wide MDA in all age groups in these post-LF MDA districts with low prevalence and light intensity infections could result in transmission interruption of STH.
Collapse
Affiliation(s)
- Saravanakumar Kaliappan
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Tamil Nadu, India
| | - Karthikeyan Ramanujam
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Tamil Nadu, India
| | - Malathi Manuel
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Tamil Nadu, India
| | - Jasmine Farzana
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Tamil Nadu, India
| | - Venkateshprabhu Janagaraj
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Tamil Nadu, India
| | - Selvi Laxmanan
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Tamil Nadu, India
| | - Jayaprakash Muliyil
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Tamil Nadu, India
| | - Rajiv Sarkar
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Tamil Nadu, India
| | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Tamil Nadu, India
| | - Judd Walson
- Departments of Global Health, Medicine (Infectious Disease), Paediatrics & Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sitara Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Tamil Nadu, India
| |
Collapse
|
8
|
Sangare M, Berthe A, Dolo H, Diabaté AF, Konipo FDN, Soumaoro L, Doumbia SS, Coulibaly ME, Diarra L, Sanogo Y, Atsou KM, Diallo AA, Coulibaly SY, Keita M, Doumbia S, Coulibaly YI. Evaluation of mass drug administration for schistosomiasis and soil-transmitted helminths in school-aged children in Bankass, Mali. Int J Infect Dis 2021; 112:196-201. [PMID: 34481965 DOI: 10.1016/j.ijid.2021.08.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In 2004, Mali implemented mass drug administration (MDA) aimed at controlling schistosomiasis and soil-transmitted helminths. Despite several rounds of MDA, the health district of Bankass reported low coverage (64.8%) for praziquantel and albendazole in 2017, meaning that this district was still facing challenges in accomplishing the targeted 75% coverage. This study aimed to explore the barriers and gaps that hindered MDA implementation in Bankass. METHODS A cross-sectional study was performed. Questionnaires were administrated to all school-aged children in randomly selected villages. Technical directors of community health centers and community drug distributors in the selected villages were included in the interviews. RESULTS A total of 2128 children and 52 health workers were interviewed. Coverage rates were 93.51% (1990/2128) for praziquantel and 95.25% (2027/2128) for albendazole. Among the untreated children, 31.63% (31/98) reported being unaware of the campaign and 26.53% (26/98) were unable to reach the distribution points. Most of the health workers suggested increasing incentives. CONCLUSION The data showed satisfactory coverage >90%, in contrast with lower rates initially reported by the district health information system. These results raise concerns about the reliability of programmatic data and highlight the importance of population-based surveys for the evaluation of control interventions.
Collapse
Affiliation(s)
- Moussa Sangare
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali.
| | - Adama Berthe
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Housseini Dolo
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Abdoul Fatao Diabaté
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Fatoumata Dite Nènè Konipo
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Lamine Soumaoro
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Salif Seriba Doumbia
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Michel Emmanuel Coulibaly
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Lamine Diarra
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Yacouba Sanogo
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Kueshivi Midodji Atsou
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Abdallah Amadou Diallo
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Siaka Yamoussa Coulibaly
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | | | - Seydou Doumbia
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali
| | - Yaya Ibrahim Coulibaly
- International Center for Excellence in Research Mali (ICER-Mali), University of Sciences, Techniques, and Technologies of Bamako (USTTB), Bamako, Mali; Dermatology Hospital of Bamako, Bamako, Mali
| |
Collapse
|
9
|
Ludwick T, Morgan A, Kane S, Kelaher M, McPake B. The distinctive roles of urban community health workers in low- and middle-income countries: a scoping review of the literature. Health Policy Plan 2021; 35:1039-1052. [PMID: 32494801 DOI: 10.1093/heapol/czaa049] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 12/12/2022] Open
Abstract
Addressing urban health challenges in low- and middle-income countries (LMICs) has been hampered by lack of evidence on effective mechanisms for delivering health services to the poor. The urban disadvantaged experience poor health outcomes (often worse than rural counterparts) and face service barriers. While community health workers (CHWs) have been extensively employed in rural communities to address inequities, little attention has been given to understanding the roles of CHWs in urban contexts. This study is the first to systematically examine urban CHW roles in LMICs. It aims to understand their roles vis-à-vis other health providers and raise considerations for informing future scope of practice and service delivery models. We developed a framework that presents seven key roles performed by urban CHWs and position these roles against a continuum of technical to political functions. Our scoping review included publications from four databases (MEDLINE, EMBASE, CINAHL and Social Sciences Citation Index) and two CHW resource hubs. We included all peer-reviewed, CHW studies situated in urban/peri-urban, LMIC contexts. We identify roles (un)commonly performed by urban CHWs, present the range of evidence available on CHW effectiveness in performing each role and identify considerations for informing future roles. Of 856 articles, 160 met the inclusion criteria. Programmes spanned 34 LMICs. Studies most commonly reported evidence on CHWs roles related to health education, outreach and elements of direct service provision. We found little overlap in roles between CHWs and other providers, with some exceptions. Reported roles were biased towards home visiting and individual-capacity building, and not well-oriented to reach men/youth/working women, support community empowerment or link with social services. Urban-specific adaptations to roles, such as peer outreach to high-risk, stigmatized communities, were limited. Innovation in urban CHW roles and a better understanding of the unique opportunities presented by urban settings is needed to fully capitalize on their potential.
Collapse
Affiliation(s)
- Teralynn Ludwick
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, 333 Exhibition Street, Carlton, Melbourne, VIC, 3004, Australia
| | - Alison Morgan
- Maternal Sexual and Reproductive Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sumit Kane
- Maternal Sexual and Reproductive Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| |
Collapse
|
10
|
Evaluating context-specific evidence-based quality improvement intervention on lymphatic filariasis mass drug administration in Northern Ghana using the RE-AIM framework. Trop Med Health 2021; 49:16. [PMID: 33602322 PMCID: PMC7890643 DOI: 10.1186/s41182-021-00305-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Over a decade of implementing a global strategy to eliminate lymphatic filariasis in Ghana through mass drug administration, the disease is still being transmitted in 11 districts out of an initial 98 endemic districts identified in 2000. A context-specific evidence-based quality improvement intervention was implemented in the Bole District of Northern Ghana after an initial needs assessment to improve the lymphatic filariasis mass drug administration towards eliminating the disease. Therefore, this study aimed to evaluate the process and impact of the lymphatic filariasis context-specific evidence-based quality improvement intervention in the Bole District of Northern Ghana. Method A cross-sectional mixed methods study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the context-specific evidence-based quality improvement intervention was employed. Quantitative secondary data was extracted from the neglected tropical diseases database. A community survey was conducted with 446 randomly selected participants. Qualitative data were collected from 42 purposively selected health workers, chiefs/opinion leaders and community drug distributors in the study area. Results The evaluation findings showed an improvement in social mobilisation and sensitisation, knowledge about lymphatic filariasis and mass drug administration process, willingness to ingest the medication and adherence to the direct observation treatment strategy. We observed an increase in coverage ranging from 0.1 to 12.3% after implementing the intervention at the sub-district level and reducing self-reported adverse drug reaction. The level of reach, effectiveness and adoption at the district, sub-district and individual participants’ level suggest that the context-specific evidence-based quality improvement intervention is feasible to implement in lymphatic filariasis hotspot districts based on initial context-specific needs assessment. Conclusion The study provided the groundwork for future application of the RE-AIM framework to evaluate the implementation of context-specific evidence-based quality improvement intervention to improve lymphatic filariasis mass drug administration towards eliminating the disease as a public health problem.
Collapse
|
11
|
Njomo DW, Kibe LW, Kimani BW, Okoyo C, Omondi WP, Sultani HM. Addressing barriers of community participation and access to mass drug administration for lymphatic filariasis elimination in Coastal Kenya using a participatory approach. PLoS Negl Trop Dis 2020; 14:e0008499. [PMID: 32936792 PMCID: PMC7494106 DOI: 10.1371/journal.pntd.0008499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 06/18/2020] [Indexed: 11/29/2022] Open
Abstract
Since the prioritization of Lymphatic Filariasis (LF) elimination in 1997, progress has been made in reducing disease transmission and burden. Validation of elimination through Transmission Assessment Surveys (TAS) in implementation units (IUs) that have received at least 5 rounds of mass drug administration (MDA) and achieved minimum threshold of 65% treatment coverage is required. There are IUs that do not qualify for TAS due to achievement of low treatment coverage. This study sought to identify barriers of community participation and access to MDA, develop and test strategies to be recommended for improved uptake. Two wards in Kaloleni sub-county, Kilifi county with an average treatment coverage of 56% in 2015, 50.5% in 2016 were purposively sampled and a quasi-experimental study conducted. Through systematic random sampling, 350 (pre-intervention) and 338 (post-intervention) household heads were selected and interviewed for quantitative data. For qualitative data, 16 Focus Group Discussions (FGDs) with purposively selected community groups were conducted. Participatory meetings were held with county stakeholders to agree on strategies for improved community participation in MDA. The quantitative data were analyzed using STATA version 14.1, statistical significance assessed by chi square test and qualitative data by QSR NVIVO version 10. The identified strategies were tested in experimental sites during the 2018 MDA and the usual MDA strategies applied in control sites. The results showed an increase in community participation and access to MDA in both sites 80.6% (pre-intervention), 82.9% (post-intervention). The proportion of participants who considered the treatment as necessary significantly (p = 0.001) increased to 96.2% from 88.3% and significantly dropped for those with drug swallowing problems associated with: size (p<0.001), number (p<0.027) and taste (p = 0.001). The implemented strategies may have contributed to increased participation and access to MDA and should be applied for improved treatment uptake. Health education on disease aetiology and importance of drug uptake in all rounds is key to program's success.
Collapse
Affiliation(s)
- Doris W. Njomo
- Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Lydiah W. Kibe
- Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Bridget W. Kimani
- Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Collins Okoyo
- Eastern & Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Wyckliff P. Omondi
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
| | - Hadley M. Sultani
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
| |
Collapse
|
12
|
Astale T, Sata E, Zerihun M, Nute AW, Stewart AEP, Chanyalew M, Melak B, Ayele Z, Gessese D, Ayenew G, Gashaw B, Tadesse Z, Callahan EK, Nash SD. Self-Reported Side Effects following Mass Administration of Azithromycin to Eliminate Trachoma in Amhara, Ethiopia: Results from a Region-Wide Population-Based Survey. Am J Trop Med Hyg 2020; 100:696-699. [PMID: 30675840 PMCID: PMC6402909 DOI: 10.4269/ajtmh.18-0781] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A region-wide population-based post–mass drug administration (MDA) coverage survey was conducted 3 weeks following the 2016 trachoma MDA in Amhara, Ethiopia. The prevalence of self-reported side effects was assessed among those who self-reported receiving azithromycin. A total of 16,773 individuals from 5,129 households reported taking azithromycin during the 2016 MDA in Amhara. The regional prevalence of any self-reported side effect was 9.6% (95% CI: 8.3–11.2%) and ranged from 3.9% to 12.4% among the 10 zones. The most common reported side effects were abdominal pain (53.1%), nausea (21.7%), vomiting (12.8%), and diarrhea (12.5%). Side-effect prevalence among female members was higher than in male members (11.6% versus 7.6%; P < 0.001) and increased with age. After an average of 8 years of annual MDA, the prevalence of self-reported side effects was less than 10% in this population.
Collapse
Affiliation(s)
| | - Eshetu Sata
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
| | | | | | | | | | | | - Zebene Ayele
- The Carter Center Ethiopia, Addis Ababa, Ethiopia
| | | | | | | | | | | | | |
Collapse
|
13
|
Nandha B, Meenakshy V, Abdul Khader N, Vijayakumar KN, Jambulingam P. Bridging the gap in outreach and compliance with mass drug administration for lymphatic filariasis elimination in an endemic district in Kerala, India: an intervention research approach. HEALTH EDUCATION RESEARCH 2019; 34:300-309. [PMID: 30805648 DOI: 10.1093/her/cyz005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/15/2019] [Indexed: 06/09/2023]
Abstract
Lymphatic filariasis (LF), a neglected tropical disease is targeted for elimination globally by 2020. National Health Policy of India set the goal by 2017 and annual single-dose mass drug administration (MDA) with anti-filarial drugs is in operation in endemic districts since 2004. Performance and effectiveness of MDA was diverse across the nation and prevalence of infection continues above threshold level in 50% of endemic districts which requires alternative strategies. National programme aims at achieving >65% consumption for transmission control. Post 10 rounds of MDA in an endemic district of Kerala state, a three-arm study identified determinants in gap in outreach and consumption, based on which context-dependent intervention using social group work and networking (SGWN) was implemented and impact assessed. A spill over effect with overall increase in coverage and consumption rates irrespective of arms apparently is due to inclusive improvement in MDA programme whereas, significant relative improvement in intervention arm reflects effectiveness of SGWN strategy. Though reduction in microfilaria prevalence in all arms was observed, it was significant between intervention and comparison arm. This study highlights need for context-dependent communication strategy to improve MDA for accelerating LF elimination by the targeted 2020.
Collapse
Affiliation(s)
- B Nandha
- Vector Control Research Centre, (Indian Council of Medical Research), Medical Complex, Indira Nagar, Pondicherry, India
| | - V Meenakshy
- Office of the Directorate of Health Services, Tiruvananthapuram, Kerala, India
| | | | - K N Vijayakumar
- Vector Control Research Centre, (Indian Council of Medical Research), Medical Complex, Indira Nagar, Pondicherry, India
| | - P Jambulingam
- Vector Control Research Centre, (Indian Council of Medical Research), Medical Complex, Indira Nagar, Pondicherry, India
| |
Collapse
|
14
|
Gonzales M, Baker MC, Celestino A, Santa Morillo D, Chambliss A, Adams S, Gyapong M, Kyelem D. How lymphatic filariasis was eliminated from an urban poor setting in Santo Domingo, Dominican Republic. Int Health 2019; 11:108-118. [PMID: 30285112 PMCID: PMC6398592 DOI: 10.1093/inthealth/ihy059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/11/2018] [Accepted: 09/18/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While progress has been made in the elimination of lymphatic filariasis, challenges that call for innovative approaches remain. Program challenges are increasingly observed in 'hard-to-reach' populations: urban dwellers, migrant populations, those living in insecurity, children who are out of school and areas where infrastructure is weak and education levels are low. 'Business-as-usual' approaches are unlikely to work. Tailored solutions are needed if elimination goals are to be reached. This article focuses on mass drug administrations (MDAs) in urban settings. METHODS We selected the urban poor area of Santo Domingo, Dominican Republic. With three rounds of MDA and with good coverage, elimination was achieved. We wanted to understand contributing factors to achieving good coverage. A qualitative study analyzed context, barriers and facilitators using a predefined framework based on review of the literature. RESULTS Results show that barriers commonly reported in urban settings were present (population density, lack of organization in household layout, population mobility, violence, shortage of human resources and challenges in monitoring treatment coverage). Tactics used included strong visibility in the community leading to high levels of awareness, the use of laminated photo sheets during house-to-house visits and a 1:4 supervision strategy. The importance of working through community leadership structures and building relationships with the community was evident. DISCUSSION The approach developed here has applications for large-scale treatment programs for lymphatic filariasis and other diseases in urban settings.
Collapse
Affiliation(s)
| | - Margaret C Baker
- RTI International, 701 13th Street NW, Suite 750, Washington, DC, USA
| | - Ana Celestino
- Universidad Autónoma de Santo Domingo, Ciudad Universitaria, SD, Dominican Republic
| | | | - Amy Chambliss
- Georgetown University, Department of Global Health, 3700 O St, NW, Washington, DC, USA
| | - Sarah Adams
- George Mason University, 4400 University Drive, Fairfax, VA, USA
| | | | - Dominique Kyelem
- The Taskforce for Global Health, 330 West Ponce de Leon Ave, Decatur, Georgia, USA
| |
Collapse
|
15
|
Eliminating Neglected Tropical Diseases in Urban Areas: A Review of Challenges, Strategies and Research Directions for Successful Mass Drug Administration. Trop Med Infect Dis 2018; 3:tropicalmed3040122. [PMID: 30469342 PMCID: PMC6306919 DOI: 10.3390/tropicalmed3040122] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/06/2018] [Accepted: 11/17/2018] [Indexed: 12/02/2022] Open
Abstract
Since 1950, the global urban population grew from 746 million to almost 4 billion and is expected to reach 6.4 billion by mid-century. Almost 90% of this increase will take place in Asia and Africa and disproportionately in urban slums. In this context, concerns about the amplification of several neglected tropical diseases (NTDs) are warranted and efforts towards achieving effective mass drug administration (MDA) coverage become even more important. This narrative review considers the published literature on MDA implementation for specific NTDs and in-country experiences under the ENVISION and END in Africa projects to surface features of urban settings that challenge delivery strategies known to work in rural areas. Discussed under the thematics of governance, population heterogeneity, mobility and community trust in MDA, these features include weak public health infrastructure and programs, challenges related to engaging diverse and dynamic populations and the limited accessibility of certain urban settings such as slums. Although the core components of MDA programs for NTDs in urban settings are similar to those in rural areas, their delivery may need adjustment. Effective coverage of MDA in diverse urban populations can be supported by tailored approaches informed by mapping studies, research that identifies context-specific methods to increase MDA coverage and rigorous monitoring and evaluation.
Collapse
|
16
|
Derua YA, Kisinza WN, Simonsen PE. Lymphatic filariasis control in Tanzania: infection, disease perceptions and drug uptake patterns in an endemic community after multiple rounds of mass drug administration. Parasit Vectors 2018; 11:429. [PMID: 30029675 PMCID: PMC6053786 DOI: 10.1186/s13071-018-2999-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) control in most countries of sub-Saharan Africa is based on annual mass drug administration (MDA) with a combination of ivermectin and albendazole, in order to interrupt transmission. However, attaining and maintaining high treatment coverage has been a challenge in many LF control programmes. This study was designed to elucidate reasons for continued transmission of LF in an endemic area of Tanga, northeastern Tanzania, where control activities based on MDA had been in place for eight years by the time of this study in 2012. METHODS A cross-sectional questionnaire survey was conducted in three sentinel villages used for monitoring the impact of MDA on LF transmission. A total of 747 individuals were interviewed, out of which 172 (23.0%), 27 (3.6%) and 49 (6.5%) had been shown to have circulating filarial antigens (CFA), microfilaraemia (MF) and LF gross lesions, respectively, prior to the interviews. RESULTS The interviewed population had a mean age of 33.7 years and a male to female ratio of 0.8. Males, individuals aged 30 years and above, peasants/fishermen and recent immigrants to the study communities were significantly more affected (CFA, MF and/ or LF gross lesions) than the other population groups. However, drug uptake rates were not significantly different between LF affected (those with CFA, MF and/ or LF gross lesions) and non-affected individuals. Likewise, drug uptake rates were not significantly different across different demographic parameters of the study population, some of which differed significantly in the level of infection. Moreover, it was found that misconceptions on how LF can be acquired were still evident, linking its transmission to witchcraft, heredity and sexual behaviour. CONCLUSIONS The findings indicated that misconceptions about LF and its transmission still existed despite eight years of control activities in the area. Improved communication on the rationale of MDA and an enhanced drug delivery strategy that is adapted to the local settings and targeting important demographic groups that serve as reservoir of infection will help in reaching the elimination target within a reasonable timeframe.
Collapse
Affiliation(s)
- Yahya A. Derua
- National Institute for Medical Research, Amani Medical Research Centre, P.O. Box 81, Muheza, Tanzania
| | - William N. Kisinza
- National Institute for Medical Research, Amani Medical Research Centre, P.O. Box 81, Muheza, Tanzania
| | - Paul E. Simonsen
- Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 100, 1870 Frederiksberg C, Denmark
| |
Collapse
|
17
|
Abeygunasekera AM, Sutharshan K, Balagobi B. New developments in chyluria after global programs to eliminate lymphatic filariasis. Int J Urol 2017; 24:582-588. [PMID: 28556416 DOI: 10.1111/iju.13378] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/05/2017] [Indexed: 11/28/2022]
Abstract
Chyluria, commonly seen in south Asian countries, is mainly a manifestation of lymphatic filariasis as a result of infestation with Wuchereria bancrofti, although many other causes can contribute. Many patients can be effectively treated with dietary modifications and drug therapy. The most widely used drug is diethyl carbamazine. The recurrences are common after such treatment. Such patients would benefit from sclerotherapy to obliterate the lympatico-renal fistulae located mainly in the renal pelvicalyceal system. The commonly used sclerosing agent is a combination of 5% povidone-iodine and 50% dextrose instilled through a ureteric catheter. A small percentage of patients who recur after sclerotherapy and those with systemic complications, such as hypoproteinemia and edema, might require surgery in the form of renal hilar lymphatic disconnection. Although it is a major operation, the success rates are >90%. Laparoscopic and robotic techniques have minimized the morbidity related to such surgery. With the advent of the global program for eradication of filariasis initiated by the World Health Organization, the incidence of the disease is decreasing. Mass chemotherapy with diethyl carbamazine is the mainstay of this global program. Many years after eliminating filariasis, chyluria continue to occur in such populations, though in dwindling numbers. Future research should aim at finding more efficacious sclerosing agents with minimal recurrences.
Collapse
Affiliation(s)
| | - Kugadas Sutharshan
- Department of Urology, Colombo South Teaching Hospital, Colombo, Sri Lanka
| | | |
Collapse
|
18
|
Biritwum NK, Garshong B, Alomatu B, de Souza DK, Gyapong M, Kyelem D. Improving drug delivery strategies for lymphatic filariasis elimination in urban areas in Ghana. PLoS Negl Trop Dis 2017; 11:e0005619. [PMID: 28493966 PMCID: PMC5441634 DOI: 10.1371/journal.pntd.0005619] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 05/23/2017] [Accepted: 05/02/2017] [Indexed: 11/30/2022] Open
Abstract
The Global Program to Eliminate Lymphatic Filariasis (GPELF) advocates for the treatment of entire endemic communities, in order to achieve its elimination targets. LF is predominantly a rural disease, and achieving the required treatment coverage in these areas is much easier compared to urban areas that are more complex. In Ghana, parts of the Greater Accra Region with Accra as the capital city are also endemic for LF. Mass Drug Administration (MDA) in Accra started in 2006. However, after four years of treatment, the coverage has always been far below the 65% epidemiologic coverage for interrupting transmission. As such, there was a need to identify the reasons for poor treatment coverage and design specific strategies to improve the delivery of MDA. This study therefore set out to identify the opportunities and barriers for implementing MDA in urban settings, and to develop appropriate strategies for MDA in these settings. An experimental, exploratory study was undertaken in three districts in the Greater Accra region. The study identified various types of non-rural settings, the social structures, stakeholders and resources that could be employed for MDA. Qualitative assessment such as in-depth interviews (IDIs) and focus group discussions (FGDs) with community leaders, community members, health providers, NGOs and other stakeholders in the community was undertaken. The study was carried out in three phases: pre-intervention, intervention and post-intervention phases, to assess the profile of the urban areas and identify reasons for poor treatment coverage using both qualitative and quantitative research methods. The outcomes from the study revealed that, knowledge, attitudes and practices of community members to MDA improved slightly from the pre-intervention phase to the post-intervention phase, in the districts where the interventions were readily implemented by health workers. Many factors such as adequate leadership, funding, planning and community involvement, were identified as being important in improving implementation and coverage of MDA in the study districts. Implementing MDA in urban areas therefore needs to be given significant consideration and planning, if the required coverage rates are to be achieved. This paper, presents the recommendations and strategies for undertaking MDA in urban areas. The control of lymphatic filariasis depends on the treatment of entire endemic communities, ensuring that a greater proportion of the population is treated. In urban areas, this can be very difficult to achieve. In Ghana, parts of the Greater Accra Region, where the capital city is located, are also endemic for lymphatic filariasis. Treatment in these areas started in 2006, but the proportion of people treated has continuously been below the required programmatic coverage levels. To understand the reasons behind this, a study was undertaken in three endemic districts. The study was carried out in three stages; pre-treatment, treatment and post-treatment. Individuals and groups of people were interviewed in the pre-treatment phase, following which their concerns were used to plan and execute treatment activities. After treatment, some individuals were again interviewed to assess the effectiveness of the interventions. The results showed that the knowledge and behavior of community members towards the disease and treatment activities improved from the pre-treatment to the post-treatment reviews. Many factors were identified including, financial, management and leadership issues that should be considered when planning treatment activities in urban areas.
Collapse
Affiliation(s)
- Nana-Kwadwo Biritwum
- Neglected Tropical Diseases Program, Ghana Health Service, Accra, Ghana
- * E-mail:
| | - Bertha Garshong
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Bright Alomatu
- Neglected Tropical Diseases Program, Ghana Health Service, Accra, Ghana
| | - Dziedzom K. de Souza
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon-Accra, Ghana
| | | | - Dominique Kyelem
- Taskforce for Global Health, Decatur-Atlanta, Georgia, United States of America
| |
Collapse
|
19
|
Modi A, Gamit S, Jesalpura BS, Kurien G, Kosambiya JK. Reaching endpoints for lymphatic filariasis elimination- results from mass drug administration and nocturnal blood surveys, South Gujarat, India. PLoS Negl Trop Dis 2017; 11:e0005476. [PMID: 28369129 PMCID: PMC5391126 DOI: 10.1371/journal.pntd.0005476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 04/13/2017] [Accepted: 03/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Following the World Health Assembly resolution on Elimination of lymphatic filariasis (ELF) as a public health problem by the year 2020, a Global Program (GPELF) was launched in 1997 to help endemic countries to initiate national programs. The current strategy to interrupt transmission of LF, is administration of once-yearly, single-dose, two-drug regimen (Albendazole with Diethylcarbamazine (DEC) to be used in endemic areas with the goal of reaching 65% epidemiological coverage for 4-6 years. We report findings of independent assessment from year 2010 to 2015 for last six rounds, after initial five rounds of Mass Drug Administration (MDA) since 2005 for ELF in endemic area of Gujarat. METHODS Independent assessment of MDA was performed to find coverage and compliance indicators, reasons for non-coverage and non-compliance in five Implementation Units (IUs). Pre, during and post MDA evaluations were done in three phases. The impact of MDA was measured by microfilaraemia survey. A total of eight sites, four random and four fixed sentinel sites were selected to calculate microfilaria rate (MF) per IUs per year. In years 2010 to 2015, we report results from 125,936 nocturnal blood smears and 17551 population in 120 selected clusters. Four clusters were selected per year in each of the five IUs for assessment of MDA round. RESULT Post MDA survey showed drug coverage between 81%-88% and epidemiological coverage 77%-89% across years. Main reasons for non-coverage were drug administrator related (the team did not visit or missed people) while non-compliance was population related (fear of side effects, sickness, people forgot or absent). During MDA findings show that the directly observed consumption is considerably improved from 58% in 2010 to 82% in 2015. The knowledge about benefits of drug provided also increased from 59% to 90% over the years. The current MF rate is less than one in all IUs with an overall 68% percent decrease from baseline year 2005 to year 2015. The average MF rate of Gujarat is 0.44 for year 2015. CONCLUSIONS The findings show that achieving adequate epidemiological and drug coverage is possible by actual field level operation of the program in large endemic areas. The results and feedback from independent assessment, performed regularly, could guide the policymakers and program managers for mid-term corrections and to frame strategies to enhance program. Monitoring of coverage and impact indicator together informs decisions for reaching end-point of MDA. The impact indicator- microfilaria rate in all IUs of South Gujarat Region has reached and remained less than one percent signaling end-points of MDA. Post MDA stringent monitoring in form of TAS is recommended to keep vigil on maintenance of elimination achieved.
Collapse
Affiliation(s)
- Anjali Modi
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - Sukesha Gamit
- Department of Community Medicine, Government Medical College, Surat, Gujarat, India
| | - Bharat S. Jesalpura
- National Vector Borne Disease Control Department (NVBDCP), Health and Family Welfare Department, Government of Gujarat, Gandhinagar, Gujarat, India
| | - George Kurien
- National Vector Borne Disease Control Department (NVBDCP), Health and Family Welfare Department, Government of Gujarat, Gandhinagar, Gujarat, India
| | | |
Collapse
|
20
|
Lessons Learned From Developing an Eradication Investment Case for Lymphatic Filariasis. ADVANCES IN PARASITOLOGY 2016; 94:393-417. [PMID: 27756458 DOI: 10.1016/bs.apar.2016.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In the last few years, the concepts of disease elimination and eradication have again gained consideration from the global health community, with Guinea worm disease (dracunculiasis) on track to become the first parasitic disease to be eradicated. Given the many complex and interlinking issues involved in committing to a disease eradication initiative, such commitments must be based on a solid assessment of a broad range of factors. In this chapter, we discuss the value and implications of undertaking a systematic and fact-based analysis of the overall situation prior to embarking on an elimination or eradication programme. As an example, we draw upon insights gained from a series of lymphatic filariasis (LF) studies from our research group that adopted an eradication investment case (EIC) framework. The justification for EICs, and related epidemiological, geospatial and other mathematical/operational research modelling, stems from the necessity for proper planning prior to committing to disease eradication. Across all considerations for LF eradication, including: time, treatments, level of investments necessary, health impact, cost-effectiveness, and broader economic benefits, scaling-up mass drug administration coverage to all endemic communities immediately provided the most favourable results. The coherent and consistent pursuit of eradication goals, operationally tailored to a given socioecological system and based on integrated measures of available tools will lead relatively rapidly to elimination in many parts of endemic areas and provide the cornerstone towards eradication.
Collapse
|
21
|
Sinha RK, Ranjan N, Singh N, Amit K. Chyluria: a scourge of our region. BMJ Case Rep 2015; 2015:bcr2014209188. [PMID: 26150622 PMCID: PMC4493223 DOI: 10.1136/bcr-2014-209188] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 11/04/2022] Open
Abstract
Chyluria is endemic in the Gangetic belt of India with an average of 90 cases treated annually at our institute. It is almost exclusively caused by Wuchereria bancrofti in tropical areas. Chylomicrons and triglycerides are lost in the urine from an abnormal lymphourinary fistula due to obstructive lymphatic stasis, most commonly at the renal pelvis. It is a distressingly recurrent condition with multiple exacerbations and remissions over years. Severe weakness, weight loss and haematuria occur in some patients. Diagnosis can be made by visual examination of milky urine along with the ether test of urine for chylomicrons. Intravenous urography is used to locate the site of the fistula, although the detection rate is poor. Treatment starts with conservative measures such as a high-protein low-fat diet and diethylcarbamazine therapy. In cases where conservative measures fail, endoscopic sclerotherapy (renal pelvic instillation of silver nitrate, povidone iodine or others) and surgical therapy are used.
Collapse
Affiliation(s)
| | - Nikhil Ranjan
- Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Neha Singh
- Department of Pathology, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Keshri Amit
- Department of Surgery, SRMS-IMS, Bareilly, Uttar Pradesh, India
| |
Collapse
|
22
|
Babu BV, Babu GR. Coverage of, and compliance with, mass drug administration under the programme to eliminate lymphatic filariasis in India: a systematic review. Trans R Soc Trop Med Hyg 2014; 108:538-49. [PMID: 24728444 DOI: 10.1093/trstmh/tru057] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
India's mass drug administration (MDA) programme to eliminate lymphatic filariasis (PELF) covers all 250 endemic districts, but compliance with treatment is not adequate for the programme to succeed in eradicating this neglected tropical disease. The objective of our study was to systematically review published studies on the coverage of and compliance with MDA under the PELF in India. We searched several databases-PubMed/Medline, Google Scholar, CINAHL/EBSCO, Web of Knowledge (including Web of Science) and OVID-and by applying selection criteria identified a total of 36 papers to include in the review. Overall MDA coverage rates varied between 48.8% and 98.8%, while compliance rates ranged from 20.8% to 93.7%. The coverage-compliance gap is large in many MDA programmes. The effective level of compliance, ≥65%, was reported in only 10 of a total of 31 MDAs (5 of 20 MDAs in rural areas and 2 of 12 MDAs in urban areas). The review has identified a gap between coverage and compliance, and potentially correctable causes of this gap. These causes need to be addressed if the Indian programme is to advance towards elimination of lymphatic filariasis.
Collapse
Affiliation(s)
- Bontha V Babu
- Health Systems Research Division, Indian Council of Medical Research, New Delhi 110 029, India
| | - Gopalan R Babu
- Kerala Unit, National Institute of Virology, Indian Council of Medical Research, Alappuzha 688 005, India
| |
Collapse
|
23
|
Njomo DW, Mukoko DA, Nyamongo NK, Karanja J. Increasing coverage in mass drug administration for lymphatic filariasis elimination in an urban setting: a study of Malindi Town, Kenya. PLoS One 2014; 9:e83413. [PMID: 24454703 PMCID: PMC3891599 DOI: 10.1371/journal.pone.0083413] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 11/05/2013] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Implementation of Mass Drug Administration (MDA) in urban settings is an obstacle to Lymphatic Filariasis (LF) elimination. No urban-specific guidelines on MDA in urban areas exist. Malindi district urban area had received 4 MDA rounds by the time the current study was implemented. Programme data showed average treatment coverage of 28.4% (2011 MDA), far below recommended minimum of 65-80%. METHODS To identify, design and test strategies for increased treatment coverage in urban areas, a quasi-experimental study was conducted in Malindi urban area. Three sub-locations with lowest treatment coverage in 2011 MDA were purposively selected. In the pre-test phase, 947 household heads sampled using systematic random method were interviewed for quantitative data. For qualitative data, 12 Focus Group Discussions (FGDs) with single sex adult and youth male and female groups and 3 with community drug distributors (CDDs) were conducted. Forty in-depth interviews with opinion leaders and self-administered questionnaires with District Public Health officers purposively selected were carried out. The quantitative data were analyzed using SPSS version 16 and statistical significance assessed by χ(2) test.The qualitative data were analyzed manually according to study's themes. RESULTS AND DISCUSSION The identified strategies were implemented prior to and during 2012 MDA in two sub-locations (experimental) while in the third (control), usual MDA strategies were applied. In the post-test phase, 2012 MDA coverage in experimental and control sub-locations was comparatively assessed for effect of the newly designed strategies on urban MDA. Results indicated improved treatment coverage in experimental sub-locations, 77.1% in Shella and 66.0% in Barani. Central (control) sub-location also attained high coverage, 70.4% indicating average treatment coverage of 71%. CONCLUSION The identified strategies contributed to increased treatment coverage in experimental sites and should be applied in urban areas. Due to closeness of sites, spillover effects may have contributed to increased coverage in the control site.
Collapse
Affiliation(s)
- Doris W. Njomo
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Dunstan A. Mukoko
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
| | - Nipher K. Nyamongo
- Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Joan Karanja
- Malindi District Hospital, Ministry of Health, Malindi, Kenya
| |
Collapse
|
24
|
A review of factors that influence individual compliance with mass drug administration for elimination of lymphatic filariasis. PLoS Negl Trop Dis 2013; 7:e2447. [PMID: 24278486 PMCID: PMC3836848 DOI: 10.1371/journal.pntd.0002447] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The success of programs to eliminate lymphatic filariasis (LF) depends in large part on their ability to achieve and sustain high levels of compliance with mass drug administration (MDA). This paper reports results from a comprehensive review of factors that affect compliance with MDA. Methodology/Principal Findings Papers published between 2000 and 2012 were considered, and 79 publications were included in the final dataset for analysis after two rounds of selection. While results varied in different settings, some common features were associated with successful programs and with compliance by individuals. Training and motivation of drug distributors is critically important, because these people directly interact with target populations, and their actions can affect MDA compliance decisions by families and individuals. Other important programmatic issues include thorough preparation of personnel, supplies, and logistics for implementation and preparation of the population for MDA. Demographic factors (age, sex, income level, and area of residence) are often associated with compliance by individuals, but compliance decisions are also affected by perceptions of the potential benefits of participation versus the risk of adverse events. Trust and information can sometimes offset fear of the unknown. While no single formula can ensure success MDA in all settings, five key ingredients were identified: engender trust, tailor programs to local conditions, take actions to minimize the impact of adverse events, promote the broader benefits of the MDA program, and directly address the issue of systematic non-compliance, which harms communities by prolonging their exposure to LF. Conclusions/Significance This review has identified factors that promote coverage and compliance with MDA for LF elimination across countries. This information may be helpful for explaining results that do not meet expectations and for developing remedies for ailing MDA programs. Our review has also identified gaps in understanding and suggested priority areas for further research. Lymphatic filariasis (LF, also known as “elephantiasis”) is a deforming and disabling disease that is caused by roundworm parasites that are transmitted by mosquitoes. The Global Programme to Eliminate Lymphatic Filariasis is the largest public health intervention program attempted to date based on mass drug administration (MDA). MDA does not cure filarial infections, but it can reduce or interrupt transmission of new infections by clearing larval parasites from human blood so that they are not available for mosquitoes. High levels of participation are required for this strategy to work; guidelines from the World Health Organization call for at least 65% of the eligible population to take the medications annually for four to six years. MDA presents logistical challenges that require cooperation between donors, health ministries, and communities. The success of MDA depends on coverage (drug delivery) and compliance (people ingesting antifilarial drugs), which depends on individual interactions between drug distributors and the people who live in LF-endemic areas. This paper focuses on this last step of implementation with a comprehensive review of published and unpublished information on factors that affect compliance with MDA at the level of the individual. We have also provided an outline of current gaps in understanding and recommendations for further research.
Collapse
|
25
|
Nandha B, Krishnamoorthy K, Jambulingam P. Towards elimination of lymphatic filariasis: social mobilization issues and challenges in mass drug administration with anti-filarial drugs in Tamil Nadu, South India. HEALTH EDUCATION RESEARCH 2013; 28:591-598. [PMID: 23503571 DOI: 10.1093/her/cyt042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
India is a signatory to World Health Assembly resolution for elimination of lymphatic filariasis (LF) and National Health Policy has set the goal of LF elimination by 2015. Annual mass drug administration (MDA) is ongoing in endemic districts since 1996-97. Compliance rate is a crucial factor in achieving elimination and was assessed in three districts of Tamil Nadu for 10th and 11th treatment rounds (TRs). An in-depth study assessed the impact of social mobilization by drug distributors (DDs) in two areas from each of the three districts. Overall coverage and compliance for assessed TRs were 76.3 and 67.7% which is below the optimum level to achieve LF elimination. Modifiable determinants continue to be the reason for non-consumption even in the 11th TR and 20.8% were systematic non-compliers. In 76.4% of the cases, DDs failed to adhere to three mandatory visits as per the guidelines. Number of visits by DDs in relation to low and high MDA coverage areas showed a significant relationship (P ≤ 0.000). MDA is limited to drug distribution alone and efforts by DDs in preparing the community were inadequate. Probable means to meet the challenges in preparation of the community is discussed.
Collapse
Affiliation(s)
- B Nandha
- Vector Control Research Centre (Indian Council of Medical Research), Medical Complex, Indira Nagar Pondicherry 605 006, India.
| | | | | |
Collapse
|
26
|
Patel PK. Mass drug administration coverage evaluation survey for lymphatic filariasis in bagalkot and gulbarga districts. Indian J Community Med 2012; 37:101-6. [PMID: 22654283 PMCID: PMC3361792 DOI: 10.4103/0970-0218.96095] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 01/09/2012] [Indexed: 11/15/2022] Open
Abstract
Background: Lymphatic filariasis (LF) is endemic in 83 countries and territories, with more than a billion people at risk of infection. In view with the global elimination, mass drug administration (MDA) with single dose of diethylcarbamazine and albendazole tablets was carried out for the eligible population in Bagalkot and Gulbarga districts. Objective: Assess coverage of MDA against LF in Bagalkot and Gulbarga districts. Materials and Methods: In this cross-sectional coverage evaluation survey, one urban and three rural clusters were selected randomly in each district. The data were collected in a pretested performa, computed and analyzed using SPSS-10 to calculate frequencies and proportions. Results: A total of eight clusters in two districts resulted in a total study population of 1,228 individuals. The overall compliance rate in Bagalkot district was 78.6% and in Gulbarga district it was only 38.8%. The prime reason for noncompliance was fear of side effects and not received tablets. Conclusion: There is an urgent need for more effective drug delivery strategies to improve the compliance in both the districts.
Collapse
|
27
|
Abstract
PURPOSE The currently available drug repertoire against lymphatic filariasis, a major health hazard in the developing world, is inadequate and is fraught with serious limitations. Thus, the development of an effective antifilarial strategy has become a global research thrust mandated by the World Health Organization. Nanoparticles of silver endowed with antibacterial potency are known to induce apoptosis in eukaryotic cells. The present study was designed to investigate the possible microfilaricidal efficacy of silver nanoparticles and to establish the validity of apoptotic rationale in antifilarial drug designing. METHODS This report analyzed the effect of nanoparticles of silver as well as gold (size range: 10-15 nm) on the microfilariae of Brugia malayi obtained from the lavage of peritoneal cavities of infected jirds (Meriones unguiculatus). The study included a microfilarial motility assay, a trypan blue exclusion test, a poly(adenosine diphosphate-ribose) polymerase activity study, ethidium bromide/acridine orange differential staining, and transmission, as well as scanning electron microscopic evaluation of ultrastructural changes in microfilariae. RESULTS The study demonstrates that nanoparticles of silver, but not of gold, elicited significant loss in microfilarial motility. Differential staining of parasites with ethidium bromide and acridine orange, poly(adenosine diphosphate-ribose) polymerase activity in microfilarial lysate, and electron microscopic findings underscored apoptotic death of parasites attributable to nanosilver. In a trypan blue exclusion test, the 50% lethal dose of nanosilver was measured to be 101.2 μM, which was higher than the recorded complete inhibitory concentration value (50.6 μM), thus supporting nanosilver as a potential drug candidate against lymphatic filariasis. CONCLUSION The present report provides the first ever conclusive proof in support of apoptosis as a novel stratagem in antifilarial drug designing and nanoscale silver as a valid lead in research on antifilarial therapeutics. The main embargo about the current drug diethylcarbamazine citrate is its empirical use without rationale. Effective microfilaricidal activity of nanosilver at relatively low concentrations as reported in this study, with evidence of the induction of apoptosis in microfilariae, projects nanosilver as a potential drug adjuvant against lymphatic filariasis. The much higher 50% lethal dose value of nanosilver compared to the complete inhibitory concentration value reported in this study argues in favor of a safe therapeutic window of this agent in its antifilarial efficacy.
Collapse
Affiliation(s)
- Sunil K Singh
- Department of Biochemistry, Institute of Medical Sciences, Banaras Hindu University, Varanasi
| | - Kalyan Goswami
- Department of Biochemistry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - Richa D Sharma
- Department of Biochemistry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - Maryada VR Reddy
- Department of Biochemistry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - Debabrata Dash
- Department of Biochemistry, Institute of Medical Sciences, Banaras Hindu University, Varanasi
| |
Collapse
|
28
|
Interaction of a Wolbachia WSP-like protein with a nuclear-encoded protein of Brugia malayi. Int J Parasitol 2011; 41:1053-61. [PMID: 21782817 DOI: 10.1016/j.ijpara.2011.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 05/21/2011] [Accepted: 05/23/2011] [Indexed: 11/23/2022]
Abstract
The Brugia malayi endosymbiont Wolbachia has recently been shown to be essential for its host's survival and development. However, relatively little is known about Wolbachia proteins that interact with the filarial host and which might be important in maintaining the obligate symbiotic relationship. The Wolbachia surface proteins (WSPs) are members of the outer membrane protein family and we hypothesise that they might be involved in the Wolbachia-Brugia symbiotic relationship. Notably, immunolocalisation studies of two WSP members, WSP-0432 and WSP-0284 in B. malayi female adult worms showed that the corresponding proteins are not only present on the surface of Wolbachia but also in the host tissues, with WSP-0284 more abundant in the cuticle, hypodermis and the nuclei within the embryos. These results confirmed that WSPs might be secreted by Wolbachia into the worm's tissue. Our present studies focus on the potential involvement of WSP-0284 in the symbiotic relationship of Wolbachia with its filarial host. We show that WSP-0284 binds specifically to B. malayi crude protein extracts. Furthermore, a fragment of the hypothetical B. malayi protein (Bm1_46455) was found to bind WSP-0284 by panning of a B. malayi cDNA library. The interaction of WSP-0284 and this protein was further confirmed by ELISA and pull-down assays. Localisation by immunoelectron microscopy within Wolbachia cells as well as in the worm's tissues, cuticle and nuclei within embryos established that both proteins are present in similar locations within the parasite and the bacteria. Identifying such specific interactions between B. malayi and Wolbachia proteins should lead to a better understanding of the molecular basis of the filarial nematode and Wolbachia symbiosis.
Collapse
|
29
|
Cantey PT, Rout J, Rao G, Williamson J, Fox LM. Increasing compliance with mass drug administration programs for lymphatic filariasis in India through education and lymphedema management programs. PLoS Negl Trop Dis 2010; 4:e728. [PMID: 20628595 PMCID: PMC2900179 DOI: 10.1371/journal.pntd.0000728] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 05/10/2010] [Indexed: 11/18/2022] Open
Abstract
Background Nearly 45% of people living at risk for lymphatic filariasis (LF) worldwide live in India. India has faced challenges obtaining the needed levels of compliance with its mass drug administration (MDA) program to interrupt LF transmission, which utilizes diethylcarbamazine (DEC) or DEC plus albendazole. Previously identified predictors of and barriers to compliance with the MDA program were used to refine a pre-MDA educational campaign. The objectives of this study were to assess the impact of these refinements and of a lymphedema morbidity management program on MDA compliance. Methods/Principal Findings A randomized, 30-cluster survey was performed in each of 3 areas: the community-based pre-MDA education plus community-based lymphedema management education (Com-MDA+LM) area, the community-based pre-MDA education (Com-MDA) area, and the Indian standard pre-MDA education (MDA-only) area. Compliance with the MDA program was 90.2% in Com-MDA+LM, 75.0% in Com-MDA, and 52.9% in the MDA-only areas (p<0.0001). Identified barriers to adherence included: 1) fear of side effects and 2) lack of recognition of one's personal benefit from adherence. Multivariable predictors of adherence amenable to educational intervention were: 1) knowing about the MDA in advance of its occurrence, 2) knowing everyone is at risk for LF, 3) knowing that the MDA was for LF, and 4) knowing at least one component of the lymphedema management techniques taught in the lymphedema management program. Conclusions/Significance This study confirmed previously identified predictors of and barriers to compliance with India's MDA program for LF. More importantly, it showed that targeting these predictors and barriers in a timely and clear pre-MDA educational campaign can increase compliance with MDA programs, and it demonstrated, for the first time, that lymphedema management programs may also increase compliance with MDA programs. Global elimination of lymphatic filariasis requires giving drugs at least annually to populations who live at risk of becoming infected with the parasite. At least 80% of people at risk need to take the drugs annually for 5 or more years to stop transmission of the infection. People suffering from the long-term effects of infection, such as swollen legs, benefit from programs that teach self-care of their affected limbs. In this study, we assessed the impact of an educational campaign that, after addressing previously identified predictors of compliance, significantly improved drug compliance. The specific factors improving compliance included knowing about the drug distribution in advance, knowing that everyone is at risk for acquiring the infection, knowing that the drug distribution was for lymphatic filariasis prevention, and knowing at least one component of leg care. We also found that areas with programs to assist people with swollen legs had greater increases in compliance. This research provides evidence that program evaluation can be used to improve drug compliance. In addition, our work shows for the first time that programs to benefit people with swollen legs caused by lymphatic filariasis also increase the participation of people without disease in drug treatment programs.
Collapse
Affiliation(s)
- Paul T Cantey
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
| | | | | | | | | |
Collapse
|
30
|
Aswathy S, Beteena K, Leelamoni K. Mass drug administration against filariasis in India: perceptions and practices in a rural community in Kerala. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2010; 103:617-24. [PMID: 19825283 DOI: 10.1179/000349809x12459740922255] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In India, annual rounds of mass drug administration (MDA) based on diethylcarbamazine and albendazole are used to control filariasis, which is a major public-health problem. In December 2007/January 2008, a few weeks after one such MDA, a household survey was conducted in the Ernakulam district of Kerala to evaluate coverage and compliance. After one member aged >14 years from each of 599 households was interviewed, coverage of the last MDA was estimated to be 77.0% and compliance only 39.6%. Most (67.4%) of the interviewees were not aware of the term 'mass drug administration' but 20.9% of the others thought that MDA prevented the occurrence of filariasis. Most (62.3%) of those interviewed said that they obtained information about MDA from television or radio programmes and/or newspapers and most (66.3%) considered MDA to be useful (only 5.0% said that MDA were not useful, the other interviewees saying that they did not know whether MDA were useful or not). Those who had not ingested the tablets given to them in the last MDA said that they were fearful of the drugs (39.4% of the non-compliers), were too ill to take the drugs (22.5%) or had misconceptions about the aims of the MDA (12.5%). Only 2.7% of the interviewees who had ingested the distributed tablets reported adverse effects and these were mild (fever, drowsiness, swelling/oedema and/or vomiting) and only occurred within 24 h of tablet ingestion. In a univariate analysis, individual compliance in the last MDA was found to be positively associated with perceived benefits to the individual (P<0.001), the perceived usefulness of MDA (P=0.001) and certain study wards within the panchayat (P=0.032). It therefore appears that communication exercises targeted at the areas with relatively low compliance and designed to improve perceptions of the benefits and usefulness of MDA against filariasis could be the key to a successful control programme.
Collapse
Affiliation(s)
- S Aswathy
- Department of Community Medicine, Amrita School of Medicine, AIMS Ponnekkara PO, Kochi, Kerala 682 041, India.
| | | | | |
Collapse
|
31
|
Cantey PT, Rao G, Rout J, Fox LM. Predictors of compliance with a mass drug administration programme for lymphatic filariasis in Orissa State, India 2008. Trop Med Int Health 2009; 15:224-31. [PMID: 20002615 DOI: 10.1111/j.1365-3156.2009.02443.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the performance of an educational campaign to increase adherence to a mass-administered DEC regimen against lymphatic filariasis (LF) in Orissa, and to identify factors that could enhance future campaigns. METHOD Randomized cluster survey, comparing areas that did and did not receive the educational campaign, using a household coverage survey and knowledge, attitudes and practices (KAP) survey. RESULTS LF MDA coverage for the entire population (n = 3449) was 56% (95% CI: 50.0-61.9). There was no statistical difference between the areas that did and did not receive the educational campaign. The most common barriers to adherence were fear of medication side effects (47.4%) and lack of recognition of one's risk for LF (15.8%). Modifiable, statistically significant, multivariable predictors of adherence were knowing that DEC prevents LF (aOR = 2.6, 95% CI: 1.4-5.1), knowing that mosquitoes transmit LF (aOR = 1.9, 95% CI: 1.1-3.2), and knowing both about the mass drug administration (MDA) in advance and that mosquitoes transmit LF (aOR = 5.4, 95% CI: 2.8-10.4). CONCLUSIONS India needs to increase compliance with MDA programmes to reach its goal of interrupting LF transmission. Promoting a simple public health message before MDA distribution, which takes into account barriers to and predictors of adherence, could raise compliance with the LF MDA programme.
Collapse
Affiliation(s)
- P T Cantey
- Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | | | |
Collapse
|
32
|
Lillerud LE, Stuestoel VM, Hoel RE, Rukeba Z, Kjetland EF. Exploring the feasibility and possible efficacy of mass treatment and education of young females as schistosomiasis influences the HIV epidemic. Arch Gynecol Obstet 2009; 281:455-60. [DOI: 10.1007/s00404-009-1108-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 04/23/2009] [Indexed: 11/27/2022]
|