Abstract
BackgroundThe Democratic Republic of Congo (DRC) has a significant burden of lymphatic filariasis (LF) caused by the parasite Wuchereria bancrofti. A major impediment 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 for onchocerciasis and loiasis. It is important to analyse these and other factors, such as soil transmitted helminths (STH) and malaria co-endemicity, which will impact on LF elimination.ResultsWe analysed maps of onchocerciasis community-directed treatment with ivermectin (CDTi) from the African Programme for Onchocerciasis Control (APOC); maps of predicted prevalence of Loa loa; planned STH control maps of albendazole (and mebendazole) from the Global Atlas of Helminth Infections (GAHI); and bed nets and insecticide treated nets (ITNs) distribution from Demographic and Health Surveys (DHS) as well as published historic data which were incorporated into overlay maps. We developed an approach we designate as micro-stratification overlap mapping (MOM) to identify areas that will assist the implementation of LF elimination in the DRC. The historic data on LF was found through an extensive review of the literature as no recently published information was available.ConclusionsThis paper identifies an approach that takes account of the various factors that will influence not only country strategies, but suggests that country plans will require a finer resolution mapping than usual, before implementation of LF activities can be efficiently deployed. This is because 1) distribution of ivermectin through APOC projects will already have had an impact of LF intensity and prevalence 2) DRC has been up scaling bed net distribution which will impact over time on transmission of W. bancrofti and 3) recently available predictive maps of L. loa allow higher risk areas to be identified, which allow LF implementation to be initiated with reduced risk where L. loa is considered non-endemic. We believe that using the proposed MOM approach is essential for planning the expanded distribution of drugs for LF programmes in countries co-endemic for filarial infections.
Highlights
The Democratic Republic of Congo (DRC) has a significant burden of lymphatic filariasis (LF) caused by the parasite Wuchereria bancrofti
The aim of this paper is to review and synthesise the current knowledge of the distribution of W. bancrofti in the DRC, and factors that will impact on the control and elimination of LF such as loiasis co-endemicity, onchocerciasis control programmes, soil transmitted helminths (STH) deworming activities and malaria bed net distributions
We introduce a new term Micro-stratification Overlap Mapping (MOM), which we suggest is a prerequisite for planning any future LF programmes in countries where there is co-endemic loiasis and other control programmes which impact on LF implementation
Summary
The Democratic Republic of Congo (DRC) has a significant burden of lymphatic filariasis (LF) caused by the parasite Wuchereria bancrofti. The Democratic Republic of Congo (DRC) is the largest lymphatic filariasis (LF) endemic country in Africa with over 49 million people at risk [1,2,3]. Scaling up treatment for soil transmitted helminths (STH) with albendazole and widespread distribution of long-lasting insecticidal treated nets (LLINs) will positively impact LF endemicity. Incorporating these factors into an overlap mapping strategy will constitute a valuable prerequisite for LF control and surveillance. Africa has a significant burden of LF caused by the parasite Wuchereria bancrofti with 35 endemic countries, and a further 6 countries where the process of the verification of the absence of transmission is underway [1,2,3]
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