Abstract
To eliminate lymphatic filariasis (LF) by 2020, the World Health Organization (WHO) has launched a campaign against the disease. Since the launch in 2000, significant progress has been made to achieve this ambitious goal. In this article we review the progress and status of the LF programme in Africa through the WHO neglected tropical diseases preventive chemotherapy databank, the Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN) portal and other publications. In the African Region there are 35 countries endemic for LF. The Gambia was reclassified as not requiring preventive chemotherapy in 2015, while Togo and Malawi eliminated LF as a public health problem in 2017 and 2020, respectively. Cameroon discontinued mass drug administration (MDA) and transitioned to post-MDA surveillance to validate elimination. The trajectory of coverage continues to accelerate; treatment coverage increased from 0.1% in 2000 to 62.1% in 2018. Geographical coverage has also significantly increased, from 62.7% in 2015 to 78.5% in 2018. In 2019, 23 of 31 countries requiring MDA achieved 100% geographic coverage. Although much remains to be done, morbidity management and disability prevention services have steadily increased in recent years. Vector control interventions conducted by other programmes, particularly malaria vector control, have had a profound effect in stopping transmission in some endemic countries in the region. In conclusion, significant progress has been made in the LF programme in the region while we identify the key remaining challenges in achieving an Africa free of LF.
Highlights
In the past 20 y, momentum to eliminate lymphatic filariasis (LF) in Africa has significantly improved as a result of development of single-dose treatment strategies, point-of-care diagnostic tools, generous donations of medicines from pharmaceutical companies and financial support for programme implementation from the donor community.[1]
Of the 35 LF-endemic countries in the region, 2 have eliminated LF as a public health problem (Malawi and Togo), The Gambia was reclassified as not requiring preventive chemotherapy and Cameroon is under postMDA surveillance to validate if elimination targets have been achieved
A Transmission assessment survey (TAS) is recommended in an evaluation unit (EU) after a successful preliminary survey to determine when infections have been reduced below target thresholds and mass drug administration (MDA) can stop after at least five consecutive rounds with effective coverage
Summary
In the past 20 y, momentum to eliminate lymphatic filariasis (LF) in Africa has significantly improved as a result of development of single-dose treatment strategies, point-of-care diagnostic tools, generous donations of medicines from pharmaceutical companies and financial support for programme implementation from the donor community.[1] The African Region (AFRO) of the World Health Organization (WHO) includes 38.3% of the global population and 31 of the 49 countries requiring preventive chemotherapy for LF, a debilitating vector-borne infection that affects the poorest populations.[2] In Africa it is caused by Wuchereria bancrofti and is mainly transmitted to humans by mosquito species belonging to Anopheles and Culex.[3] In 2000 there were 39 countries believed to be endemic for LF in the WHO AFRO. 405.9 million people in 39 countries in Africa were estimated to require preventive chemotherapy.
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