Abstract
Lymphatic filariasis is widely endemic in Myanmar. Despite the establishment of an elimination program in 2000, knowledge of the remaining burden of disease relies predominantly on programmatic information. To assist the program, we conducted an independent cross-sectional household cluster survey to determine the prevalence of filariasis infection, morbidity and mass-drug administration coverage in four townships of the Mandalay Region: Amarapura, Patheingyi, Tada-U and Wundwin. The survey included 1014 individuals from 430 randomly selected households in 24 villages. Household members one year and older were assessed for antigenaemia using immunochromatographic test cards and if positive, microfilaraemia by night-time thick blood smear. Participants 15 years and older were assessed for filariasis morbidity by ultrasound-assisted clinical examination. The overall prevalence of infection was 2.63% by antigenaemia (95% confidence interval (CI) 1.71–4.04%) and 1.03% by microfilaraemia (95%CI 0.59–1.47%). The prevalence of hydrocoele in adult males was 2.78% (95%CI 1.23–6.15%) and of lymphoedema in both genders was 0% (95%CI 0–0.45%). These results indicate the persistence of filarial infection and transmission despite six rounds of annual mass drug administration and highlight the need for further rounds as well as the implementation of morbidity management programs in the country.
Highlights
Lymphatic filariasis (LF) remains a major cause of permanent disability in tropical and subtropical countries[1]
The study found ongoing filarial infection suggesting that the six rounds of mass drug administration (MDA) had not been sufficient to stop LF transmission in the area. It identified a substantial burden of hydrocoele but no cases of lymphoedema. These results suggest that further rounds of effective MDA are required to halt LF transmission and highlight the urgent need for morbidity management programs in the country
The National Program to Eliminate LF (NPELF) drew upon historical reports, national data and a 1997 World Health Organization (WHO) multi-country prevalence mapping survey to define endemic districts (the implementation unit (IU) used in the country).[5, 6]
Summary
Lymphatic filariasis (LF) remains a major cause of permanent disability in tropical and subtropical countries[1]. Myanmar established a National Program to Eliminate LF (NPELF) in 2000 as part of the World Health Organization’s (WHO) broader Global Program to Eliminate LF. The NPELF drew upon historical reports, national data and a 1997 WHO multi-country prevalence mapping survey to define endemic districts (the implementation unit (IU) used in the country).[5, 6] Forty-five of the 65 districts in Myanmar were classified as LF-endemic, with 47 million people at-risk (85.5% of the total population).[4, 5, 7] Baseline, pre– mass drug administration (MDA), surveys indicated high levels of antigenaemia (20–30%) in the central and western dry zones, consistent with that seen in Myanmar migrants living in Thailand.[3, 5, 6] the northern, eastern and southern areas of the country were less endemic or free from filariasis.[5, 6] In Mandalay Region, the site of this study, the baseline prevalence by microfilaraemia (mf) was 5.2% (range: 0.2 to 14.7%) and by antigenaemia ranged from 2 to >25%.[5,6,7] The parasite Wuchereria bancrofti is the sole documented cause of LF in Myanmar, where it is transmitted by the mosquito Culex quinquefasciatus.[3, 5, 7, 8]
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