Abstract
The Global Programme to Eliminate Lymphatic Filariasis has made considerable progress but is experiencing challenges in meeting targets in some countries. Recent World Health Organization guidelines have recommended two rounds of triple-drug therapy with ivermectin, diethylcarbamazine (DEC), and albendazole (IDA), in areas where mass drug administration (MDA) results with two drugs (DEC and albendazole) have been suboptimal, as is the case in Samoa. In August 2018, Samoa was the first country in the world to implement countrywide triple-drug MDA. This paper aims to describe Samoa’s experience with program coverage and adverse events (AEs) in the first round of triple-drug MDA. We conducted a large cross-sectional community survey to assess MDA awareness, reach, compliance, coverage and AEs in September/October 2018, 7–11 weeks after the first round of triple-drug MDA. In our sample of 4420 people aged ≥2 years (2.2% of the population), age-adjusted estimates indicated that 89.0% of the eligible population were offered MDA, 83.9% of the eligible population took MDA (program coverage), and 80.2% of the total population took MDA (epidemiological coverage). Overall, 83.8% (2986/3563) reported that they did not feel unwell at all after taking MDA. Mild AEs (feeling unwell but able to do normal everyday things) were reported by 13.3% (476/3563) and moderate or severe AEs (feeling unwell and being unable to do normal everyday activities such as going to work or school) by 2.9% (103/3563) of participants. This study following the 2018 triple-drug MDA in Samoa demonstrated a high reported program awareness and reach of 90.8% and 89.0%, respectively. Age-adjusted program coverage of 83.9% of the total population showed that MDA was well accepted and well tolerated by the community.
Highlights
Lymphatic filariasis (LF) is a disabling and disfiguring neglected tropical disease caused by infection with three species of filarial worms (Wuchereria bancrofti, Brugia malayi, and B. timori) [1]
We recruited a total of 4420 participants from 35 primary sampling units (PSUs) (43 villages) (~2.2% of the total population), including 281 children aged 2–4 years (6.4%), 1942 children aged 5–9 years (43.9%), and 1999 aged 10 years (45.2%) (Table 1)
A total of 2680 participants aged 2 years (63.5%) were sampled via the randomly selected households, and 1542 (36.5%) participants were sampled via the convenience survey
Summary
Lymphatic filariasis (LF) is a disabling and disfiguring neglected tropical disease caused by infection with three species of filarial worms (Wuchereria bancrofti, Brugia malayi, and B. timori) [1]. Transmission is by mosquito vectors, which deposit larvae onto the skin when biting humans. The larvae enter the body and migrate to the lymphatic system where they develop into adult worms. Microfilariae (immature larvae), produced by the adult worms, circulate in the blood and infect biting mosquitos, enabling ongoing transmission [2]. Typically in the lower limbs, elephantiasis (skin/tissue thickening), and scrotal hydrocoele, which can cause significant disability and social stigma [1,3]. Laboratory diagnostic tests include detection of microfilariae and circulating filarial antigen (Ag) in the blood [4]
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