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The global elimination of lymphatic filariasis (LF) is a major focus of the World Health Organization. One key challenge is locating residual infections that can perpetuate the transmission cycle. We show how a targeted sampling strategy using predictions from a geospatial model, combining random forests and geostatistics, can improve the sampling efficiency for identifying locations with high infection prevalence. Predictions were made based on the household locations of infected persons identified from previous surveys, and environmental variables relevant to mosquito density. Results show that targeting sampling using model predictions would have allowed 52% of infections to be identified by sampling just 17.7% of households. The odds ratio for identifying an infected individual in a household at a predicted high risk compared to a predicted low risk location was 10.2 (95% CI 4.2-22.8). This study provides evidence that a 'one size fits all' approach is unlikely to yield optimal results when making programmatic decisions based on model predictions. Instead, model assumptions and definitions should be tailored to each situation based on the objective of the surveillance program. When predictions are used in the context of the program objectives, they can result in a dramatic improvement in the efficiency of locating infected individuals.

: Objective: Samoa needs to intensify the response to the growing non?communicable disease burden. This study aimed to assess bottlenecks in the care continuum and identify possible solutions. Methods: The mixed?methods study used the cascade framework as an analysis tool and hypertension as a tracer condition for chronic non?communicable diseases. Household survey data were integrated with medical record data of hypertension patients and results from focus group discussions with patients and healthcare providers. Results: Hypertension prevalence was 38.1% but only 4.7% of hypertensive individuals had controlled blood pressure. There were large gaps in the care continuum especially at screening and referral due to multiple socio?cultural, economic and service delivery constraints. Conclusions: In Samoa, care for chronic non?communicable diseases is not effectively addressing patient needs. This calls for better health communication, demand creation, treatment support, nutritional interventions and health service redesign, with a focus on primary healthcare and effective patient and community engagement. Implications for public health: The proposed actions can improve the reach, accessibility, quality and effectiveness of Samoa's chronic care services. Health system redesign is necessary to ensure continuity of care and more effective primary prevention. The findings are useful for other countries in the region facing similar challenges., Samoa is a Polynesian island state in the South Pacific with two main islands (Upolu and Savai'i) and an estimated population of 196,130 people in 2018.[sup.1] The country has recently [...]

Background: To monitor the progress of lymphatic filariasis (LF) elimination programmes, field surveys to assess filarial antigen (Ag) prevalence require access to reliable, user-friendly rapid diagnostic tests. We aimed to evaluate the performance of the new Q Filariasis Antigen Test (QFAT) with the currently recommended Filariasis Test Strip (FTS) for detecting the Ag of Wuchereria bancrofti, the causative agent of LF, under field laboratory conditions. Methodology/Principal findings: During an LF survey in Samoa, 344 finger-prick blood samples were tested using FTS and QFAT. Microfilariae (Mf) status was determined from blood slides prepared from any sample that reported Ag-positive by either Ag-test. Each test was re-read at 1 hour and the next day to determine the stability of results over time. Overall Ag-positivity by FTS was 29.0% and 30.2% by QFAT. Concordance between the two tests was 93.6% (kappa = 0.85). Of the 101 Mf slides available, 39.6% were Mf-positive, and all were Ag-positive by both tests. Darker test line intensities from Ag-positive FTS were found to predict Mf-positivity (compared to same/lighter line intensities). QFAT had significantly higher reported test result changes than FTS, mostly reported the next day, but fewer changes were reported between 10 minutes to 1-hour. The field laboratory team preferred QFAT over FTS due to the smaller blood volume required, better usability, and easier readability. Conclusion/Significance: QFAT could be a suitable and user-friendly diagnostic alternative for use in the monitoring and surveillance of LF in field surveys based on its similar performance to FTS under field laboratory conditions. Author summary: Lymphatic filariasis (LF) is a debilitating tropical disease caused by infection with parasitic filarial worms that are transmitted by mosquitoes. Long-term infection can lead to stigmatising chronic conditions like lymphoedema and elephantiasis. The World Health Organization initiated the global programme to eliminate lymphatic filariasis (GPELF) in 2000, focusing on mass drug administration (MDA) of anti-LF drugs to stop transmission in endemic countries. However, to monitor the success of this programme and to make informed decisions to stop costly MDA, it is crucial to have access to accurate and reliable rapid diagnostics. Here, we evaluated the performance of a new rapid antigen test called the Q Filariasis antigen test and compared it to the currently recommended filariasis test strip under field laboratory conditions in Samoa. This study showed that the new rapid test could be a suitable alternative to the currently recommended test for use in GPELF-related activities with more user-friendly features. [ABSTRACT FROM AUTHOR]

Background: Lymphatic filariasis (LF) remains a significant global issue. To eliminate LF as a public health problem, the World Health Organization (WHO) recommends multiple rounds of mass drug administration (MDA). In certain scenarios, including when elimination targets have not been met with two-drug MDA, triple-drug MDA (using ivermectin, diethylcarbamazine and albendazole) is recommended. In this study, we report on antigen (Ag) and microfilaria (Mf) prevalence in eight primary sampling units (PSUs) in Samoa 4.5 years after one round of triple-drug MDA. Methodology: In 2023, community surveys were conducted in eight PSUs that had been surveyed previously in 2018 (between 1.5 and 3.5 months post triple-drug MDA) and 2019 (six to eight-months post triple-drug MDA). Fifteen houses were randomly selected in each PSU with household members aged ≥ 5 years invited to participate. Blood samples were tested for Ag and Mf. Principal findings: Ag-positive participants were observed in six of the eight PSUs, and Ag prevalence was significantly above the 1% threshold in four PSUs. The presence of Mf-positive participants in five PSUs confirms the presence of residual active infections. Conclusions/Significance: This study provides evidence of persistent LF transmission in Samoa 4.5 years after one round of triple-drug MDA, confirming that one round was insufficient for interruption of transmission in this setting. Our findings highlight the negative impact of delaying MDA rounds, for example, due to public health emergencies. Author summary: The World Health Organization (WHO) recommends triple-drug mass drug administration (MDA) for the elimination of lymphatic filariasis (LF) as a public health problem for countries where targets have not been achieved using two-drug MDA, and where onchocerciasis is non-endemic. In 2018, Samoa was the first country to implement a national triple-drug MDA. This study surveyed 623 randomly selected participants across eight primary sampling units (PSUs) in Samoa, 4.5 years after the first round of triple-drug MDA. These results support the current WHO recommendations that multiple rounds of triple-drug MDA are required to interrupt transmission. A gap of 4.5 years between rounds of triple-drug MDA can result in a resurgence, with persistence of LF transmission and burden levels comparable to those observed before the MDA. [ABSTRACT FROM AUTHOR]

Problem Samoa has been struggling to address the burden of noncommunicable diseases at the health system, community and individual levels. Approach The World Health Organization (WHO) package of essential noncommunicable disease interventions for primary health care in low-resource settings was adopted in seven villages throughout Samoa in 2015. The National Steering Committee Members designed and implemented a screening process, and local facilitators and health-care workers collected health and lifestyle data. The WHO/lnternational Society of Hypertension risk assessment was used on villagers older than 40 years to identify people at high risk of noncommunicable disease. Local setting Samoa is a small island developing state with increasing morbidity and mortality due to noncommunicable diseases. A national representative survey indicated that 50.1% (595/1188) ofthe Samoan adult population is at high risk of such diseases. High numbers of noncommunicable diseases are undiagnosed or untreated, because of shortage of health-care staff and lack of awareness of risk factors. Relevant changes The teams collected data from 2234 adults. For people older than 40 years, 6.7% (54/804) were identified as being at high-risk and were encouraged to seek treatment or manage risk factors. Community members developed an awareness programme to improve understanding of lifestyle risk factors. Lessons learnt Engaging community members was crucial in conducting a successful screening campaign. By identifying those villagers at high risk of developing noncommunicable diseases, early intervention was possible. Education improved awareness of the symptom-free nature of early-stage noncommunicable diseases. Probleme Les Samoa sempploient a agir contre la charge que representent les maladies non transmissibles aux niveaux du systeme de sante, de la communaute et des individus. Approche L'ensemble d'interventions essentielles de l'Organisation mondiale de la Sante contre les maladies non transmissibles pour les soins de sante primaire dans les structures a faibles ressources a ete adopte dans sept villages des Samoa en 2015. Les membres du Comite directeur national ont concu et mis en ceuvre un processus de depistage, et des facilitateurs et prestataires de soins locaux ont collecte des donnees sur l'etat de sante et le mode de vie. Evaluation des risques de l'OMS/la Societe internationale d'hypertension a ete utilisee sur les villageois ages de plus de 40 ans afin d'identifier les personnes exposees a un risque eleve de developper une maladie non transmissible. Environnement local Les Samoa sont un petit Etat insuiaire en developpement qui affiche des taux croissants de morbidite et de mortalite lies a des maladies non transmissibles. Une enquete representative a l'echelle nationale a indique que 50,1% (595/1188) de la population adulte des Samoa est exposee a un risque eleve de developper une maladie non transmissible. Un grand nombre de maladies non transmissibles ne sont pas diagnostiquees ou ne sont pas traitees en raison d'un manque de personnel de sante et de sensibilisation auxfacteurs de risque. Changements significatifs Les equipes ont collecte des donnees aupres de 2234 adultes. Dans les cas des personnes agees de plus de 40 ans, 6,7% (54/804) ont ete identlfiees comme etant exposees a un risque eleve et encouragees a se faire soigner ou a maitriser les facteurs de risque. Les membres de la communaute ont elabore un programme de sensibilisation afin de mieux faire connaitre les facteurs de risque lies au mode de vie. Lecons tirees La participation des membres de la communaute s'est averee essentielle pour mener une campagne de depistage efficace. ^identification des villageois exposes a un risque eleve de developper une maladie non transmissible a permis une intervention precoce. La sensibilisation a permis de mieux faire connaitre la nature asymptomatique des maladies non transmissibles a un stade precoce. Problema Samoa se esfuerza por hacer frente a la carga de las enfermedades no contagiosas a nivel del sistema de salud, la comunidad y los individuos. Enfoque En 2015 se aprobo en siete aldeas de Samoa el Conjunto de intervenciones esenciales de la Organizacion Mundial de la Salud (OMS) para las enfermedades no contagiosas para la atencion primaria en entornos de bajos recursos. Los miembros del Comite Directivo Nacional disenaron e implementaron un proceso de evaluacion, mientras que los coordinadores locales y los trabajadores de la salud recopilaron datos sobre la salud y el estilo de vida. La evaluacion del riesgo de hipertension de la OMS/Sociedad Internacional de Hipertension se utilizo en los aldeanos mayores de 40 anos para identificar a las personas con un alto riesgo de padecer enfermedades no contagiosas. Marco regional Samoa es un pequeno Estado insular en desarrollo con una incidencia cada vez mayor de morbilidad y mortalidad por enfermedades no contagiosas. Una encuesta nacional representativa indico que el 50,1 % (595/1188) de la poblacion adulta de Samoa tiene un alto riesgo de contraer tales enfermedades. Un elevado numero de enfermedades no contagiosas no se diagnostican ni se tratan, debido a la escasez de personal medico y la falta de concienciacion sobre los factores de riesgo. Cambios importantes El equipo ha recopilado datos de 2234 adultos. Para las personas mayores de 40 anos, se identifico que el 6,7 % (54/804) tenian un alto riesgo y se les animo a buscar tratamiento o controlar los factores de riesgo. Los miembros de la comunidad desarrollaron un programa de concienciacion para mejorar la comprension de los factores de riesgo en el estilo de vida. Lecciones aprendidas Involucrar a los miembros de la comunidad fue crucial para llevar a cabo una campana de deteccion de exito. Al identificar a los aldeanos que corren un mayor riesgo de contraer enfermedades no contagiosas, es posible la intervencion temprana. La educacion mejoro la concienciacion sobre la ausencia de sintomas de las enfermedades no contagiosas en la fase inicial, Abstracts in [phrase omitted], Francais, PyccKnu and Espanol at the end of each article. [phrase omitted] Introduction More than 90% of premature and largely preventable deaths from noncommunicable diseases, including [...]