Abstract
BackgroundNigeria has a significant burden of lymphatic filariasis (LF) caused by the parasite Wuchereria bancrofti. A major concern to the expansion of the LF elimination programme is the risk of serious adverse events (SAEs) associated with the use of ivermectin in areas co-endemic with Loa filariasis. To better understand this, as well as other factors that may impact on LF elimination, we used Micro-stratification Overlap Mapping (MOM) to highlight the distribution and potential impact of multiple disease interventions that geographically coincide in LF endemic areas and which will impact on LF and vice versa.Methodology/Principal findingsLF data from the literature and Federal Ministry of Health (FMoH) were collated into a database. LF prevalence distributions; predicted prevalence of loiasis; ongoing onchocerciasis community-directed treatment with ivermectin (CDTi); and long-lasting insecticidal mosquito net (LLIN) distributions for malaria were incorporated into overlay maps using geographical information system (GIS) software. LF was prevalent across most regions of the country. The mean prevalence determined by circulating filarial antigen (CFA) was 14.0% (n = 134 locations), and by microfilaria (Mf) was 8.2% (n = 162 locations). Overall, LF endemic areas geographically coincided with CDTi priority areas, however, LLIN coverage was generally low (<50%) in areas where LF prevalence was high or co-endemic with L. loa.Conclusions/SignificanceThe extensive database and series of maps produced in this study provide an important overview for the LF Programme and will assist to maximize existing interventions, ensuring cost effective use of resources as the programme scales up. Such information is a prerequisite for the LF programme, and will allow for other factors to be included into planning, as well as monitoring and evaluation activities given the broad spectrum impact of the drugs used.
Highlights
Lymphatic filariasis (LF) is one of the most debilitating neglected tropical diseases (NTD) in the world [1]
lymphatic filariasis (LF) data summary In total, 41 studies [41]–[81] from 68 published and unpublished filariasis studies identified in the literature were found to have examined the prevalence, clinical manifestations and entomological aspects of LF in Nigeria (Table S1)
The role of xenomonitoring should be considered as it may be more reliable and cost effective in the long term, especially in Nigeria where there is a wide range of existing entomological capacity and expertise that could be developed and strengthened to help monitor the elimination of the disease. This Micro-stratification Overlap Mapping (MOM) work builds on the recent study carried out in Democratic Republic of Congo [24], which first used the new overlap mapping approach to collate and map all available country data on W. bancrofti, examine the extent of L. loa coendemicity and determine the risk and benefits of different intervention strategies
Summary
Lymphatic filariasis (LF) is one of the most debilitating neglected tropical diseases (NTD) in the world [1] It is caused by the parasitic worms Wuchereria bancrofti, Brugia malayi and B. timori and is transmitted by Anopheles, Culex, Aedes, Ochlerotatus and Mansoni mosquitoes [1]. The wide and overlapping distribution of the filarial parasite Loa in Africa [7] is a major impediment due to the risk of severe adverse events (SAEs) in co-infected individuals when treated with ivermectin [8] [9]. A major concern to the expansion of the LF elimination programme is the risk of serious adverse events (SAEs) associated with the use of ivermectin in areas co-endemic with Loa filariasis. As well as other factors that may impact on LF elimination, we used Micro-stratification Overlap Mapping (MOM) to highlight the distribution and potential impact of multiple disease interventions that geographically coincide in LF endemic areas and which will impact on LF and vice versa
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