Biritwum Nana-Kwadwo, Yikpotey Paul, Marfo Benjamin K, Odoom Samuel, Mensah Ernest O, Asiedu Odame, Alomatu Bright, Hervie Edward T, Yeboah Abednego, Ade Serge, Hinderaker Sven G, Reid Anthony, Takarinda Kudakwashe C, Koudou Benjamin, Koroma Joseph B
Neglected Tropical Diseases Programme, Ghana.
Family Health International (FHI360), P.O. Box 4033, Accra, Ghana.
Trans R Soc Trop Med Hyg. 2016 Dec 1;110(12):690-695. doi: 10.1093/trstmh/trx007.
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'.
An ecological study was carried out to compare baseline mf prevalence and anti-microfilaria interventions between hotspot and stopped-MDA districts.
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.
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.
在加纳的216个区中，1999年经排查后有98个区被宣布为淋巴丝虫病流行区。为实现消除目标，世界卫生组织建议采用群体药物给药（MDA）进行年度治疗，至少持续5年。该国于2001年开始实施MDA，并于2006年实现全国覆盖。到2014年，69个区已“停止MDA”（通过传播评估调查后），而另外29个区尽管进行了11年多的MDA，但微丝蚴血症（mf）患病率仍持续较高（≥1%），被归类为“热点地区”。
开展了一项生态学研究，以比较热点地区和停止MDA地区的基线mf患病率及抗微丝蚴干预措施。
热点地区的基线mf患病率显著高于停止MDA的地区（p<0.001）。经过三年的MDA，热点地区的mf患病率显著下降，但仍高于停止MDA的地区。热点地区的MDA轮次略多（p<0.001），但在MDA覆盖率或长效驱虫蚊帐覆盖率方面没有差异。
热点地区和停止MDA地区的主要差异在于基线mf患病率较高。这一发现表明，建议的每年5 - 6轮治疗可能无法实现传播阻断。
