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Rainima-Qaniuci M, Lepaitai HB, Bhagirov R, Padmasiri E, Naseri T, Thomsen R, Won KY, Brant TA, Dodd E, Nua MT, Utu F, Tufa A, Chutaro E, Camacho J, Suiaunoa-Scanlan L, Thean LJ, Mani J, Hardy M, Samuela J, Romani L, Kaldor J, Steer AC, Faktaufon D, Bechu V, Naqio F, Sosene V, Sekihara M, Otaki J, Buhagiar TS, Yajima A. The Importance of Partnership in the Rollout of Triple-Drug Therapy to Eliminate Lymphatic Filariasis in the Pacific. Am J Trop Med Hyg 2022; 106:39-47. [PMID: 35292579 PMCID: PMC9154648 DOI: 10.4269/ajtmh.21-1085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/24/2022] [Indexed: 12/27/2022] Open
Abstract
We discuss the experience of some Pacific island countries in introducing the new WHO-recommended treatment protocol for lymphatic filariasis-a triple-drug therapy composed of ivermectin, diethylcarbamazine, and albendazole. The successful rollout of the new treatment protocol was dependent on strong partnerships among these countries' ministries of health, WHO, and other stakeholders. Effective communication among these partners allowed for lessons learned to cross borders and have a positive impact on the experiences of other countries. We also describe various challenges confronted during this process and the ways these countries overcame them.
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Affiliation(s)
| | | | | | | | | | | | - Kimberly Y. Won
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tara A. Brant
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily Dodd
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Fara Utu
- American Samoa Department of Health, Pago Pago, American Samoa
| | - Aifili Tufa
- American Samoa Department of Health, Pago Pago, American Samoa
| | - Emi Chutaro
- Pacific Island Health Officers’ Association, Honolulu, Hawaii
| | - Janet Camacho
- Pacific Island Health Officers’ Association, Honolulu, Hawaii
| | | | - Li Jun Thean
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Jyotishna Mani
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Myra Hardy
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - Josaia Samuela
- Samoa Ministry of Health, Apia, Samoa;,Murdoch Children’s Research Institute, Melbourne, Australia
| | - Lucia Romani
- Murdoch Children’s Research Institute, Melbourne, Australia;,Kirby Institute in the University of New South Wales, Sydney, Australia
| | - John Kaldor
- Kirby Institute in the University of New South Wales, Sydney, Australia
| | | | | | - Vinaisi Bechu
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | | | | | | | - Junko Otaki
- Japan International Cooperation Agency, Tokyo, Japan
| | - Tamara S. Buhagiar
- Australian Institute of Tropical Health & Medicine at James Cook University, Smithfield, Australia
| | - Aya Yajima
- World Health Organization, Manila, Philippines;,Address correspondence to Aya Yajima, World Health Organization Western Pacific Regional Office, United Nations Ave., Ermita, Manila, Philippines. E-mail:
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Manolas RK, Kama M, Rainima-Qaniuci M, Bechu VD, Tuibeqa S, Winston MV, Ram N, Naqio F, Ichimori K, Capuano C, Ozaki M, Kim SH, Aratchige P, Sahukhan A, Graves PM. Lymphatic filariasis in Fiji: progress towards elimination, 1997-2007. Trop Med Health 2020; 48:88. [PMID: 33132735 PMCID: PMC7592542 DOI: 10.1186/s41182-020-00245-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 06/29/2020] [Indexed: 11/20/2022] Open
Abstract
Background Lymphatic filariasis (LF) is a major public health problem in the Pacific Region, including in Fiji. Through transmission by the mosquito vector Aedes, Fiji has suffered the burden of remaining endemic with LF despite efforts at elimination prior to 1999. In the year 1999, Fiji agreed to take part in the Pacific Programme for Elimination of LF (PacELF) and the Global Programme to Eliminate LF. Methods This study reviewed and collated past data on LF in Fiji between 1997 and 2007. Sources included published papers as well as unpublished PacELF and WHO program meeting and survey reports. Records were held at Fiji’s Department of Health and Medical Services, James Cook University and the WHO office in Suva, Fiji. Results Baseline surveys between 1997 and 2002 showed that Fiji was highly endemic for LF with an estimated 16.6% of the population antigen positive and 6.3% microfilaria positive at that time. Five rounds of annual mass drug administration (MDA) using albendazole and diethylcarbamazine commenced in 2002. Programmatic coverage reported was 58–70% per year, but an independent coverage survey in 2006 in Northern Division after the fifth MDA suggested that actual coverage may have been higher. Monitoring of the program consisted of antigen prevalence surveys in all ages with sentinel and spot check surveys carried out in 2002 (pre MDA), 2004, and 2005, together with knowledge, attitude, and practice surveys. The stop-MDA survey (C survey) in 2007 was a nationwide stratified cluster survey of all ages according to PacELF guidelines, designed to sample by administrative division to identify areas still needing MDA. The national antigen prevalence in 2007 was reduced by more than a third to 9.5%, ranging from 0.9% in Western Division to 15.4% in Eastern Division, while microfilaria prevalence was reduced by almost four-fifths to 1.4%. Having not reached the target threshold of 1% prevalence in all ages, Fiji wisely decided to continue MDA after 2007 but to move from nationwide implementation to four (later five) separate evaluation units with independent timelines using global guidelines, building on program experience to put more emphasis on increasing coverage through prioritized communication strategies, community participation, and morbidity alleviation. Conclusion Fiji conducted nationwide MDA for LF annually between 2002 and 2006, monitored by extensive surveys of prevalence, knowledge, and coverage. From a high baseline prevalence in all divisions, large reductions in overall and age-specific prevalence were achieved, especially in the prevalence of microfilariae, but the threshold for stopping MDA was not reached. Fiji has a large rural and geographically widespread population, program management was not consistent over this period, and coverage achieved was likely not optimal in all areas. After learning from these many challenges and activities, Fiji was able to build on the progress achieved and the heterogeneity observed in prevalence to realign towards a more stratified and improved program after 2007. The information presented here will assist the country to progress towards validating elimination in subsequent years.
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Affiliation(s)
- Rosie K Manolas
- College of Public Health, Medical and Veterinary Sciences and JCU WHO Collaborating Centre for Vector-Borne and Neglected Tropical Diseases, College of Public Health, James Cook University, Cairns and Townsville, Queensland Australia
| | - Mike Kama
- Fiji Centre for Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | | | - Vinaisi D Bechu
- Fiji Centre for Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | - Samuela Tuibeqa
- Fiji Centre for Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | - Mareta V Winston
- Fiji Centre for Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | - Nomeeta Ram
- Fiji Centre for Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | - Flora Naqio
- Fiji Centre for Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | - Kazuyo Ichimori
- WHO Office of Pacific Support, Suva, Fiji.,Nagasaki University, Nagasaki, Japan
| | | | | | - Sung Hye Kim
- Department of Environmental Biology and Medical Parasitology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | | | - Aalisha Sahukhan
- Fiji Centre for Disease Control, Ministry of Health and Medical Services, Suva, Fiji
| | - Patricia M Graves
- College of Public Health, Medical and Veterinary Sciences and JCU WHO Collaborating Centre for Vector-Borne and Neglected Tropical Diseases, College of Public Health, James Cook University, Cairns and Townsville, Queensland Australia
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