A Success Story: Togo Is Moving toward Becoming the First Sub-Saharan African Nation to Eliminate Lymphatic Filariasis through Mass Drug Administration and Countrywide Morbidity Alleviation

Yao K Sodahlon,Ameyo Monique Dorkenoo,Kodjo Morgah,Komlan Nabiliou,Anders Seim,Kossivi Agbo,Els Mathieu,Michel Datagni,Rebecca Miller,Patrick J Lammie

doi:10.1371/journal.pntd.0002080

Abstract

Lymphatic filariasis (LF) is a debilitating vector-borne disease predominantly caused by the helminths Wuchereria bancrofti and Brugia malayi [1], [2]. Endemic in 72 countries, LF is responsible for 5.9 million DALYs lost and is implicated as the second leading cause of disability worldwide by the World Health Organization (WHO) [3]–[5]. Although 70% of those infected do not exhibit symptoms, almost all persons infected have subclinical damage to the lymphatic vessels [6], [7]. An estimated 40 million people are symptomatic with the predominant morbidities associated with LF: lymphedema and/or hydrocele [8]. In recognition of the worldwide burden of LF, in 1997, the World Health Assembly passed the resolution WHA 50.29 calling for collaborative efforts by member states to eliminate the disease as a public health problem [9]. In 2000, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) was formed in response to the WHA resolution and aimed to eliminate the disease by 2020. The program adopted a two-pronged strategy: (1) to interrupt transmission of the causal parasite and (2) to alleviate morbidities associated with the disease [10]. The two pillars of the GPELF's strategy form the basic framework for any successful LF program. Togo is one of the 34 African countries endemic for lymphatic filariasis and is surrounded by the endemic countries of Benin, Ghana, and Burkina Faso [11]. The National Program to Eliminate Lymphatic Filariasis (NPELF) was founded in 2000 and is one of the few LF programs that address the dual goals of the global elimination program on a national scale. Togo is the first sub-Saharan country to achieve probable interruption of transmission and to move to the post-MDA surveillance phase as defined by the WHO [12]. Here we describe the elements that proved successful in the national strategy to address LF in Togo.

Highlights

Lymphatic filariasis (LF) is a debilitating vector-borne disease predominantly caused by the helminths Wuchereria bancrofti and Brugia malayi [1,2]
Additional mass drug administration (MDA) campaigns were conducted in 2009 in two districts: i) in Tone, after seven MDAs, where a prevalence of 2% was detected at the spot-check site of Woriwouri, a village in close proximity to endemic areas in Burkina Faso and Ghana and ii) in Doufelgou, where an additional MDA was organized because, prevalence level was reported at 0% in the sentinel site after the third MDA, this sentinel village was not assessed after the fifth MDA
The results suggested that all evaluation units (EU) passed as the number of immunochromatographic tests (ICT)-positive cases was below the cut-off value of 18

Summary

Introduction

Lymphatic filariasis (LF) is a debilitating vector-borne disease predominantly caused by the helminths Wuchereria bancrofti and Brugia malayi [1,2]. Lymphedema Management In collaboration with the CDC and funded by IMA World Health-USAID, the Togo MoH engaged in an innovative approach to implement WHO-recommended lymphedema management techniques on a national scale (including the nonendemic districts).

Results

Conclusion