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Fig. 1 Advanced state of lymphoedema elephantiasis) (Courtesy of Prof.
Oladele B. Akogun)
Programme for Elimination of Lymphatic Filariasis in the World Health
Organization African Region: Implementation Update as of October 2003
Lymphatic filariasis (LF) is a recognized public health problem and an impediment to socio-economic development. This is particularly significant in Africa, which carries approximately 38% of the disease burden (420 million at risk), where poverty levels are very high. Some of the very advanced manifestations of lymphatic filariasis are shown in figure 1. In the World Health Organisation (WHO) African Region, 39 out of the 46 Member Countries are categorized as LF endemic (where prevalence is greater than or equal to 1% microfilaremia or antigenemia) based on either historical data or on the current known status of the disease.
Following the conceptualization of the Global Programme for Elimination of Lymphatic Filariasis (PELF), four countries (Ghana, Nigeria, Tanzania, and Togo) implemented national programmes in 2000. The PELF consists of two major interventions, 1) to interrupt transmission of infection by treating the entire population at risk mass drug administration (MDA) for a long enough period to ensure that levels of microfilariae in blood remain below those necessary to sustain transmission, and 2) to alleviate and prevent suffering and reduce disability caused by the chronic consequences of lymphatic filariasis. The treatment strategy uses a combination of Mectizan (ivermectin, MSD) or diethylcarbamizine (DEC) with albendazole given annually for five years. The choice of using Mectizan or DEC in MDA is dependent on whether or not onchocerciasis is co-endemic with LF. DEC is contraindicated in areas co-endemic for onchocerciasis as its use may result in serious adverse events. Exclusive consumption of DEC-fortified salt for 6 to 12 months is another available option in areas where onchocerciasis is not endemic. In the WHO African region 28 out of 39 countries are co-endemic and therefore use the Mectizan/albendazole combination.
Identification of the LF-affected communities or implementation units (IUs), the smallest administrative level at which level the LF elimination programme will be implemented, which helps assess the magnitude of the problem, is the first activity in programme implementation. Information arising from this exercise is used to determine the available resources, including drugs, needed to proceed with the next programme activity - MDA. In the WHO African region, 10 countries have completed mapping to identify affected communities, and another 8 are in the process of mapping. It is planned that all countries will have carried out mapping by 2005 (Fig. 2), is the target date for completion of mapping set by the Global Alliance to Eliminate Lymphatic Filariasis (GAELF).
Fig. 2: LF mapping status as of December 2003
