National Institute for Medical Research, Amani Medical Research Centre, P.O. Box 81, Muheza, Tanzania.
Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Dyrlægevej 100, 1870, Frederiksberg C, Denmark.
Parasit Vectors. 2018 Jul 20;11(1):429. doi: 10.1186/s13071-018-2999-x.
Lymphatic filariasis (LF) control in most countries of sub-Saharan Africa is based on annual mass drug administration (MDA) with a combination of ivermectin and albendazole, in order to interrupt transmission. However, attaining and maintaining high treatment coverage has been a challenge in many LF control programmes. This study was designed to elucidate reasons for continued transmission of LF in an endemic area of Tanga, northeastern Tanzania, where control activities based on MDA had been in place for eight years by the time of this study in 2012.
A cross-sectional questionnaire survey was conducted in three sentinel villages used for monitoring the impact of MDA on LF transmission. A total of 747 individuals were interviewed, out of which 172 (23.0%), 27 (3.6%) and 49 (6.5%) had been shown to have circulating filarial antigens (CFA), microfilaraemia (MF) and LF gross lesions, respectively, prior to the interviews.
The interviewed population had a mean age of 33.7 years and a male to female ratio of 0.8. Males, individuals aged 30 years and above, peasants/fishermen and recent immigrants to the study communities were significantly more affected (CFA, MF and/ or LF gross lesions) than the other population groups. However, drug uptake rates were not significantly different between LF affected (those with CFA, MF and/ or LF gross lesions) and non-affected individuals. Likewise, drug uptake rates were not significantly different across different demographic parameters of the study population, some of which differed significantly in the level of infection. Moreover, it was found that misconceptions on how LF can be acquired were still evident, linking its transmission to witchcraft, heredity and sexual behaviour.
The findings indicated that misconceptions about LF and its transmission still existed despite eight years of control activities in the area. Improved communication on the rationale of MDA and an enhanced drug delivery strategy that is adapted to the local settings and targeting important demographic groups that serve as reservoir of infection will help in reaching the elimination target within a reasonable timeframe.
在撒哈拉以南非洲的大多数国家，淋巴丝虫病（LF）的控制基于每年一次的大规模药物治疗（MDA），联合使用伊维菌素和阿苯达唑，以阻断传播。然而，在许多 LF 控制项目中，实现和维持高治疗覆盖率一直是一个挑战。本研究旨在阐明在坦噶东北部的一个 LF 流行地区，尽管已经开展了八年的 MDA 为基础的控制活动，但 LF 仍在继续传播的原因。
在三个用于监测 MDA 对 LF 传播影响的哨点村庄进行了横断面问卷调查。共有 747 人接受了访谈，其中 172 人（23.0%）、27 人（3.6%）和 49 人（6.5%）在访谈前分别显示有循环丝状抗原（CFA）、微丝蚴血症（MF）和 LF 肉眼病变。
接受访谈的人群平均年龄为 33.7 岁，男女比例为 0.8。男性、30 岁及以上的个体、农民/渔民和最近移民到研究社区的人比其他人群更容易受到影响（CFA、MF 和/或 LF 肉眼病变）。然而，药物摄取率在 LF 感染（CFA、MF 和/或 LF 肉眼病变）和非感染个体之间没有显著差异。同样，药物摄取率在研究人群的不同人口参数之间也没有显著差异，其中一些参数在感染水平上有显著差异。此外，发现尽管该地区已经开展了八年的控制活动，但人们对 LF 及其传播的误解仍然存在。改善 MDA 的基本原理的沟通，并实施一种适应性强的药物输送策略，针对重要的人口群体（这些群体是感染的储库），将有助于在合理的时间内实现消除目标。
