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The author discusses the implementation of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) by the World Health Organization (WHO) that aim to eradicate the lymphatic filariasis (LF) in Ghana. Topics discussed include the effect of mass drug administration (MDA) in the immunoparasitological indicators, the use of albendazole (ALB) and ivermectin (IVM) as a treatment for lymphatic filariasis, and the challenges encountered while implementing the national program.

Background: Among the 216 districts in Ghana, 98 were declared endemic for lymphatic filariasis in 1999 after mapping. Pursuing the goal of elimination, WHO recommends annual treatment using mass drugs administration (MDA) for at least 5 years. MDA was started in the country in 2001 and reached national coverage in 2006. By 2014, 69 districts had ‘stopped-MDA’ (after passing the transmission assessment survey) while 29 others remained with persistent microfilaraemia (mf) prevalence (≥1%) despite more than 11 years of MDA and were classified as ‘hotspots’. Methods: An ecological study was carried out to compare baseline mf prevalence and anti-microfilaria interventions between hotspot and stopped-MDA districts. Results: Baseline mf prevalence was significantly higher in hotspots than stopped-MDA districts (p<0.001). After three years of MDA, there was a significant decrease in mf prevalence in hotspot districts, but it was still higher than in stopped-MDA districts. The number of MDA rounds was slightly higher in hotspot districts (p<0.001), but there were no differences in coverage of MDA or long-lasting-insecticide-treated nets. Conclusions: The main difference in hotspots and stopped-MDA districts was a high baseline mf prevalence. This finding indicates that the recommended 5–6 rounds annual treatment may not achieve interruption of transmission. [ABSTRACT FROM AUTHOR]

This article discusses the management of onchocerciasis, or river blindness, in Africa. The Onchocerciasis Control Programme in the Volta River Basin (OCP) was established in 1975 to combat the disease in seven West African countries. It later expanded to include four additional countries and changed its name to the Onchocerciasis Control Programme in West Africa (OCP). In 1995, the African Programme for Onchocerciasis Control (APOC) was launched to control the disease in all endemic countries in sub-Saharan Africa. APOC used community-directed treatment with ivermectin (CDTi) as its core strategy, leading to a significant decrease in infections and preventing millions of disability-adjusted life years (DALYs). The program also expanded its efforts to include other neglected tropical diseases (NTDs) susceptible to mass drug administration. APOC operates through a partnership between affected communities, governments, NGOs, and other stakeholders, with the World Health Organization (WHO) as the executing agency. APOC's success is attributed to its participative governance and engagement of communities through the CDTi strategy, empowering them to take responsibility for delivering treatment and expanding access to other health interventions. The document emphasizes the importance of community engagement, collaboration, and strengthening health systems at the community level in the planning, implementation, and monitoring of interventions for onchocerciasis control and other NTDs. The success [Extracted from the article]

Background: A national mapping of Schistosoma haematobium was conducted in Sierra Leone before the mass drug administration (MDA) with praziquantel. Together with the separate mapping of S. mansoni and soil-transmitted helminths, the national control programme was able to plan the MDA strategies according to the World Health Organization guidelines for preventive chemotherapy for these diseases. Methodology/Principal Findings: A total of 52 sites/schools were selected according to prior knowledge of S. haematobium endemicity taking into account a good spatial coverage within each district, and a total of 2293 children aged 9–14 years were examined. Spatial analysis showed that S. haematobium is heterogeneously distributed in the country with significant spatial clustering in the central and eastern regions of the country, most prevalent in Bo (24.6% and 8.79 eggs/10 ml), Koinadugu (20.4% and 3.53 eggs/10 ml) and Kono (25.3% and 7.91 eggs/10 ml) districts. By combining this map with the previously reported maps on intestinal schistosomiasis using a simple probabilistic model, the combined schistosomiasis prevalence map highlights the presence of high-risk communities in an extensive area in the northeastern half of the country. By further combining the hookworm prevalence map, the at-risk population of school-age children requiring integrated schistosomiasis/soil-transmitted helminth treatment regimens according to the coendemicity was estimated. Conclusions/Significance: The first comprehensive national mapping of urogenital schistosomiasis in Sierra Leone was conducted. Using a new method for calculating the combined prevalence of schistosomiasis using estimates from two separate surveys, we provided a robust coendemicity mapping for overall urogenital and intestinal schistosomiasis. We also produced a coendemicity map of schistosomiasis and hookworm. These coendemicity maps can be used to guide the decision making for MDA strategies in combination with the local knowledge and programme needs. Author Summary: Two forms of schistosomiasis or bilharzia (intestinal and urogenital) exist in Sierra Leone. The main control strategy for this disease currently is through mass drug administration (MDA) according to the World Health Organization recommended anthelminthic chemotherapy guidelines, and others include snail control, behavior change, and safe water, sanitation and hygiene. Survey on distribution and prevalence of the disease is vital to the planning of MDA in each district. The distribution of intestinal schistosomiasis in the country has been reported previously. The current national survey showed that urogenital schistosomiasis has a specific focal distribution particularly in the central and eastern regions of the country, most prevalent in Bo (24.6%), Koinadugu (20.4%) and Kono (25.3%) districts. Using a simple probabilistic model, this map was combined with the previously reported maps on intestinal schistosomiasis and the combined schistosomiasis prevalence was estimated. The combined schistosomiasis map highlights the presence of high-risk communities in an extensive area in the northeastern half of the country, which provides a tool for planning the national MDA activities. [ABSTRACT FROM AUTHOR]

Purpose: In 2008, a trachoma prevalence survey was conducted in the five northern districts of Sierra Leone to determine if and where specific components of the SAFE strategy ( Surgery, Antibiotics, Face washing, Environmental change) should be initiated. Methods: A cross-sectional survey at district level was implemented using two-stage random cluster sampling: probability proportionate sampling was used to select villages in the first stage and compact segment sampling of households in the second stage. Both eyes of 16,780 individuals were examined using the World Health Organization simplified trachoma grading system. Data were also collected on village- and household-level behavior and environmental factors related to trachoma. Results: Prevalence of trachomatous inflammation-follicular (TF) in children aged 1--9 years was highest in Kambia at 3.52% (95% Confidence Interval (CI): 2.28--4.75%), while the prevalence of trachomatous trichiasis (TT) in persons over 15 years of age was highest in Port Loko at 0.27% (95% CI: 0.03--0.50%). Across all districts, the percentage of households reporting washing children''s faces less than once per day was very low, while latrine coverage and accessible and safe water sources were not highly prevalent. Conclusions: In all districts but Koinadugu, TT prevalence was greater than the WHO elimination threshold, indicating the need for 1,016 TT surgeries to prevent blindness. District TF prevalence rates did not warrant mass antibiotic distribution. Although not required given the low prevalence of TF, we recommend the construction of 35,941 household latrines and provision of water sources within a 30-minute walk roundtrip for 17,551 households to bring Sierra Leone closer to reaching Millennium Development Goal 7. [ABSTRACT FROM AUTHOR]

Background: A national baseline mapping of schistosomiasis and soil-transmitted helminthiasis (STH) was performed in Sierra Leone. The aim was to provide necessary tools for the Ministry of Health and Sanitation to plan the intervention strategies in the national integrated control program on neglected tropical diseases according to the World Health Organization (WHO) guidelines for preventative chemotherapy (PCT) and for future monitoring and evaluation. Methodology/Principal Findings: 53 primary schools were randomly selected through a two-staged random sampling throughout the country. Approximately one hundred children aged 5-16 years of age were systematically selected from each school and their stool samples examined in a field laboratory. A total of 5,651 samples were examined. Data were analyzed with multivariable logistic regression models using model-based geostatistics. Spatial analysis predicted that S. mansoni infection was positively associated with population density and elevation and that there was a large cluster of high risk of S. mansoni infection (prevalence .70%) in the north and most of the eastern areas of the country, in line with the observed prevalence in Kono (63.8-78.3%), Koinadugu (21.6-82.1%), Kailahun (43.5-52.6%), Kenema (6.1-68.9%) and Tonkolili (0-57.3%). Hookworm infection was negatively associated with population density and land surface temperature, and was high across Sierra Leone with a large cluster of high infection risk (prevalence .70%) in the north-eastern part of the country. Remarkably low prevalence of Ascaris lumbricoides (7.2%) and Trichuris trichiura (3.3%) was recorded when compared with results published in the 1990s. Conclusions/Significance: Results justify PCT for schistosomiasis for school age children and at-risk adults every year in high-risk communities in five districts and every two years in moderate-risk communities in one more district. The high prevalence of STH, particularly hookworm, coupled with widespread anemia according to a national report in Sierra Leone, suggests all but one district justifying biannual PCT for STH for pre-school children, school age children, and at-risk adults. PCT for STH in the remaining district, Kono is justified annually. [ABSTRACT FROM AUTHOR]