Bhullar Navneet, Maikere Jacob
Médecins Sans Frontières - Operational Center Brussels (OCB), Rue Dupre 94, Brussels 1090, Belgium.
Parasit Vectors. 2010 Aug 11;3:70. doi: 10.1186/1756-3305-3-70.
The World Health Organization (WHO) Global Program to Eliminate Lymphatic Filariasis relies on mass drug administration (MDA) of two drugs annually for 4 to 6 years. The goal is to reduce the reservoir of microfilariae in the blood to a level insufficient to maintain transmission by the mosquito vector. In 2008, the international medical aid organization Médecins Sans Frontières (MSF) performed the first round of a MDA in the high-burden area of Asmat district, in Papua, Indonesia. We report the challenges faced in this MDA on a remote Indonesian island and propose solutions to overcome these hurdles in similar future contexts.
During the MDA, we encountered difficult challenges in accessing as well as persuading the patient population to take the antifilarial drugs. Health promotion activities supporting treatment need to be adapted and repetitive, with adequate time and resources allocated for accessing and communicating with local, seminomadic populations. Distribution of bednets resulted in an increase in MDA coverage, but it was still below the 80-85% target.
MDA for lymphatic filariasis is how the WHO has planned to eliminate the disease from endemic areas. Our programmatic experience will hopefully help inform future campaign planning in difficult-to-access, high-burden areas of the world to achieve target MDA coverage for elimination of lymphatic filariasis.
世界卫生组织（WHO）消除淋巴丝虫病全球计划依靠每年大规模药物治疗（MDA）两种药物，持续4至6年。目标是将血液中微丝蚴的储存库减少到不足以维持蚊媒传播的水平。2008年，国际医疗援助组织无国界医生组织（MSF）在印度尼西亚巴布亚阿斯马特地区的高负担地区开展了第一轮大规模药物治疗。我们报告了在这个印度尼西亚偏远岛屿上开展大规模药物治疗时面临的挑战，并提出了在未来类似情况下克服这些障碍的解决方案。
在大规模药物治疗期间，我们在接触以及说服患者群体服用抗丝虫药物方面遇到了艰巨挑战。支持治疗的健康促进活动需要进行调整并反复开展，要为接触当地半游牧人群并与之沟通分配足够的时间和资源。分发蚊帐使大规模药物治疗的覆盖率有所提高，但仍低于80%-85%的目标。
淋巴丝虫病的大规模药物治疗是世界卫生组织计划从流行地区消除该疾病的方式。我们的项目经验有望为未来在世界上难以到达的高负担地区开展的运动规划提供参考，以实现消除淋巴丝虫病的大规模药物治疗目标覆盖率。
