Abstract
ABSTRACT.We compared the impact of three rounds of annual and five rounds of semiannual mass drug administration (MDA) with albendazole plus ivermectin on helminthic infections in Liberia. Repeated annual cross-sectional community surveys were conducted between 2013 and 2019 in individuals of 5 years and older. Primary outcome was the change of infection prevalence estimates from baseline to month 36 (12 months after the last treatment). After three rounds of annual MDA, Wuchereria bancrofti circulating filarial antigen (CFA) and microfilaria (Mf) prevalence estimates decreased from 19.7% to 4.3% and from 8.6% to 0%, respectively; after semiannual MDA, CFA and Mf prevalences decreased from 37.8% to 16.8% and 17.9% to 1%, respectively. Mixed effects logistic regression models indicated that the odds of having Mf decreased by 97% (P < 0.001) at month 36 (similar odds for annual and semiannual MDA zones). A parallel analysis showed that the odds of CFA were reduced by 83% and 69% at 36 months in the annual and semiannual treatment zones, respectively (P < 0.001). Onchocerca volvulus Mf prevalence decreased slightly after multiple MDA rounds in both treatment zones. Reductions in hookworm and Trichuris trichiura prevalences and intensities were slightly greater in the annual treatment zone. Ascaris lumbricoides prevalence rates were relatively unchanged, although infection intensities decreased sharply throughout. Results show that annual and semiannual MDA were equally effective for reducing LF and soil-transmitted helminth infection parameters over a 3-year period, and reductions recorded at month 36 were sustained by routine annual MDA through month 72.
Highlights
Neglected tropical diseases (NTDs) are a diverse set of 20 diseases that cause significant morbidity, primarily in the developing world.[1]
Latrine ownership can be used as a proxy for socioeconomic status, and was higher in the zone that received annual mass drug administration (MDA) compared with the coastal zone that received semiannual MDA
This study has provided a comprehensive assessment of the impact of three annual rounds and five semiannual rounds of MDA with ivermectin plus albendazole (IA) on major helminthic NTDs in Liberia
Summary
Neglected tropical diseases (NTDs) are a diverse set of 20 diseases that cause significant morbidity, primarily in the developing world.[1]. LF was mapped in 2010, and annual mass drug administration (MDA) for LF with ivermectin plus albendazole (IA) started in some areas in 2012. This often used the same CDTi infrastructure that had been used for ivermectin distribution.[2,5] Schistosomiasis and STH control programs in Liberia provide praziquantel and albendazole to school-aged children. Many years of civil unrest (1990–2003) and the 2014 West Africa Ebola outbreak further weakened the fragile public health infrastructure in Liberia and interrupted MDA program activities.[1,6] As MDA is still required to control and eliminate NTDs in Liberia, detailed information on the impact of MDA could help the country to plan future intervention activities
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