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Programme for Elimination of Lymphatic Filariasis in the World Health Organization African Region: Implementation Update as of October 2003 (page 2)

The expansion of mapping in the WHO African region prioritizes 1) completion of mapping in those countries that have started MDA (treating Nigeria and Tanzania as exceptional cases that will continue mapping up to 2005), 2) extending mapping to countries neighbouring those already carrying out MDA, and 3) the island nations that have not yet been involved in any LF programme activities (other than Comoros which is already implementing the MDA) are in the last group of countries to be mapped together with those countries isolated from other endemic areas. This plan was developed to promote effectiveness of the MDA on interruption of transmission by having geographically contiguous areas treated within the same period. However, this plan is flexible to accommodate preferences of partners who may wish to support a specific country at any time.

MDA has progressed from 4 countries in 2000 to 9 countries in 2002. MDA implementation status as of December is shown in figure 3.
Fig. 3: LF MDA implementation status as of December 2003

To date, no additional countries have implemented MDA due to insufficient funding and technical problems encountered with the diagnostic kit used to map LF, which created an interruption in mapping. It is, however, noteworthy that although 9 countries are implementing MDA, only the programmes in Comoros, and Togo are currently covering the entire at-risk population. Rapid scaling up in the remaining countries to reach national scale is a priority and highly desirable. The current status of mapping and MDA implementation in the WHO African Region is shown in figure 4.


Fig. 4: Status of LF mapping and MDP implementation in the WHO African Region

Rapid expansion in geographical coverage both within the countries and in the region as a whole, is one of the major priorities of the programme; the other is achievement of high therapeutic coverage during the MDA campaigns. In 2002, 9,956,118 people were treated against a regional annual treatment objective (RATO) of 16.1 million representing 60% of the RATO. For 2003, tentative figures indicate that 17,071,155 have been treated against a RATO of 21.6 million, which represents 79% of the set RATO. Based on the 2002 MDA, national average figures of reported therapeutic coverage rates range from 56.8% in Comoros to 83.1% in Zanzibar, Tanzania. The lowest coverage rate obtained in an IU is 49.7% and the highest is 92.7% (both figures from the Ghana programme). There are exceptional observations in Nigeria where the range is 59.8 - 153.1%. Coverage rates higher than 85% indicate treatment of populations external to the implementation unit that are untracked and/or some national programmes, are using the eligible population instead of the population at risk as the denominator to calculate therapeutic coverage in the IU. This may be true to varying extents in many of the national programmes and it is an important confounder during monitoring and evaluation of the impact of MDA. Coverage rates that are well below the 65% minimum determined for effective impact on transmission remain a major concern as these treatment rounds might as well be disregarded since they are likely to have a negligible effect on community parasite loads. Factors contributing to low therapeutic coverage reported by most countries include 1) lack of motivation of drug distributors, 2) refusals (noncompliance), 3) inadequate or delayed information, education and communication (IEC) materials, and 4) heavy workloads.

Conclusion

By:

Dr. Jean Baptiste Roungou, Dr. Likezo Mubila, Mr. Ekoue Kinvi, Mr. Adolphe Dabire
Other Tropical Diseases Unit
Division of Prevention and Control of Communicable Diseases
WHO African Region

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