Abstract
BackgroundLittle is known regarding risk factors for lymphatic filariasis (LF) in Central Africa. To expand on what is known, we studied the epidemiology of LF in two endemic villages in the Democratic Republic of the Congo.MethodsDependent variables were Wuchereria bancrofti antigenaemia detected with filarial test strips (FTS) and microfilaraemia detected by night blood smears. The following factors were investigated: sex, age, the use of bednets, the use of latrines, hunting, fishing and agricultural activities, history of treatment with anthelmintic drugs, overnight stays in the bush, population density, the number of household members, and distance to rivers. Mixed multivariate logistic regression models were used.ResultsTwo hundred and fifty nine out of 820 (31.6%) of subjects aged ≥ 5 years had W. bancrofti antigenaemia and 11.8% (97/820) had microfilaraemia. Multivariable analysis of risk factors for antigenaemia demonstrated increased risk for males (aOR = 1.75, 95% CI: 1.20–2.53, P = 0.003), for older individuals (aOR = 9.12 in those aged > 35 years, 95% CI: 4.47–18.61, P < 0.001), for people not using bednets (aOR = 1.57, 95% CI: 1.06–2.33, P = 0.023), for farmers (aOR = 2.21, 95% CI: 1.25–3.90, P = 0.006), and for those who live close to a river (aOR = 2.78, 95% CI: 1.14–6.74, P = 0.024). Significant risk factors for microfilaraemia included age, male gender, overnight stay in the bush, and residence close to a river (aOR = 1.86, 2.01, 2.73; P = 0.011, 0.010, 0.041; for the three latter variables, respectively). People who reported having taken levamisole (n = 117) during the prior year had a significantly decreased risk of having filarial antigenaemia (aOR = 0.40, 95% CI: 0.21–0.76, P = 0.005).ConclusionsAge, sex, not using bednets, and occupation-dependent exposure to mosquitoes were important risk factors for infection with W. bancrofti in this study. The association with levamisole use suggests that the drug may have prevented filarial infections. Other results suggest that transmission often occurs outside of the village. This study provides interesting clues regarding the epidemiology of LF in Central Africa.
Highlights
Little is known regarding risk factors for lymphatic filariasis (LF) in Central Africa
Lymphatic filariasis (LF), a major neglected tropical disease (NTD), is a mosquito-borne parasitic infection caused by Wuchereria bancrofti, Brugia malayi and B. timori
The delay observed in Central Africa was due to (i) a lack of accurate epidemiological and geographical information on LF distribution [2,3,4,5]; (ii) concern about the potential risk of serious adverse events after ivermectin treatment in areas where Loa loa is co-endemic [6]; and (iii) insecurity and political instability in some countries
Summary
Little is known regarding risk factors for lymphatic filariasis (LF) in Central Africa. LF elimination programmes are not as advanced in Central Africa as in other regions, there have been improvements in MDA coverage in recent years. The delay observed in Central Africa was due to (i) a lack of accurate epidemiological and geographical information on LF distribution [2,3,4,5]; (ii) concern about the potential risk of serious adverse events after ivermectin treatment in areas where Loa loa is co-endemic [6]; and (iii) insecurity and political instability in some countries. Large-scale mapping surveys conducted in recent years revealed that LF distribution in this region is highly focal [5] and that the total population requiring MDA for LF was lower than expected [7]. Mapping for LF based on CFA testing overestimated the extent of LF in some areas (e.g. in Cameroon) [9]
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