Lymphatic Filariasis Elimination Programme Research Articles

Factors associated with the motivation of community drug distributors in the lymphatic Filariasis Elimination Programme in Kenya

Annual mass drug administration (MDA) is the main strategy for elimination of lymphatic flariasis (LF), globally. In Kenya, community drug distributors (CDDs) are used to deliver drugs to household members. To determine factors infuencing CDDs’ motivation, a retrospective cross-sectional study based on qualitative data was conducted in Kwale and Malindi districts after the 2008 MDA. In Kwale, Tsimba location represented high and Gadini low compliance while in Malindi, Goshi and Gongoni locations represented high and low compliance areas, respectively. Fifteen CDDs, 80 opinion leaders, 80 LF patients, fve health personnel, four LF coordinators and the National Programme Manager were purposively selected and interviewed. Sixteen focus group discussions (FGDs) were conducted with single-sex adult and youth male and female groups. The factors that possibly had a positive infuence on CDDs’ motivation were: higher education level, trust and familiarity with community members. All CDDs reported that getting reco...

Prevalence Of Lymphatic Filariasis In Three Villages In Kano State, Nigeria

The Nigeria Lymphatic Filariasis Elimination Programme (NLFEP) has set 2015 to eliminate the disease in the country. The success of this programme depends on identifying and treating endemic communities. Unfortunately, information on the distribution and nature of the disease from many parts of the country is lacking. This study aims at determining the distribution and nature of the disease in three selected villages in Kano State, Nigeria. Based on the results of an earlier survey of elephantiasis in 44 local government areas (LGAs) of Kano State, three villages; Marke, Gunduwa and Buda from DawakinTofa, Gabasawa and Garko LGAs respectively were selected for this study. A house-to-house census was undertaken to obtain the demographic information of the selected villages. The prevalence of the disease was determined by clinical and parasitological examinations. The clinical examination identified symptoms of adenolymphangitis (ADL), hydrocoeles and elephantiasis among the population of three villages. The Thick Blood Film (TBF) method was used to screen volunteers for the presence of Wuchereria bancrofti. The results showed that 43(1.5%) of the 2790 males examined had hydrocoele. The prevalence increased with age reaching a peak in the 60 69 year age group before it drops at 70+ year age group. However, the difference in prevalence between the age groups at P 0.05) between hydrocoele and the presence of W. bancrofti microfilaria in the villages. The overall prevalence for the three villages is 58(1.1%). Lymphatic filariasis is endemic in the three villages which is above the 1% level of endemicity recommended for selecting endemic communities for the mass drug administration (MDA) to eradicate the disease.

Hydrocelectomy As An Indicator For The Occurrence And Spread Of Lymphatic Filariasis In Kano State, Nigeria

Lymphatic filariasis is endemic in Nigeria, but the level of endemicity is unknown because many areas in the country remain unstudied. The Nigeria Lymphatic Filariasis Elimination Program (NLFEP) has set an ambitious target of 2015 to eliminate this disease. The success of this program depends on the use of an inexpensive, easy, and simple method to both identify and treat endemic communities. Hydrocoele is one of the chronic symptoms of lymphatic filariasis that is surgically treated in major hospitals in areas where the disease is endemic. Hydrocelectomy has been used as an index to determine the prevalence of lymphatic filariasis in certain endemic communities. The aim of this work is to determine the prevalence of hydrocelectomy in hospitals to assess the occurrence and spread of lymphatic filariasis in Kano State, Nigeria. To accomplish this goal, the prevalence of hydrocelectomy was investigated from 1994–2003 in 20 hospitals spread across eight of the nine Zonal Health Centers (ZHCs) in Kano State. The data obtained were analyzed using simple frequencies and percentages with respect to the specific hospital examined, patient age and type of hydrocoele on which hydrocelectomy was performed. Of 54,943 surgeries performed in 20 hospitals, 1,271 (2.31%) were hydrocelectomies. The prevalence of hydrocelectomy among the hospitals and ZHC cases ranged from 59 (0.16%) to 121 (29.4%) and from 59 (0.16%) to 325 (12.9%), respectively. The frequency of hydrocelectomy cases showed an initial rise with patient age, reaching a peak at the older age groups and then dropping thereafter. Although the overall prevalence of hydrocelectomy is generally low, its prevalence in all the hospitals surveyed strongly suggests that lymphatic filariasis may be prevalent and widespread throughout the state. However, none reflection of the domicile of the patients coupled with poor record taking/keeping and storage made it impossible to use the results in selecting villages for further epidemiological studies. Therefore there is need to develop a standard and sustainable system of taking and keeping records; and storage in Kano State hospitals for effective planning and research.

Prevalence Of Lymphatic Filariasis In Three Villages In Kano State, Nigeria

The Nigeria Lymphatic Filariasis Elimination Programme (NLFEP) has set 2015 to eliminate the disease in the country. The success of this programme depends on identifying and treating endemic communities. Unfortunately, information on the distribution and nature of the disease from many parts of the country is lacking. This study aims at determining the distribution and nature of the disease in three selected villages in Kano State, Nigeria. Based on the results of an earlier survey of elephantiasis in 44 local government areas (LGAs) of Kano State, three villages; Marke, Gunduwa and Buda from DawakinTofa, Gabasawa and Garko LGAs respectively were selected for this study. A house-to-house census was undertaken to obtain the demographic information of the selected villages. The prevalence of the disease was determined by clinical and parasitological examinations. The clinical examination identified symptoms of adenolymphangitis (ADL), hydrocoeles and elephantiasis among the population of three villages. The Thick Blood Film (TBF) method was used to screen volunteers for the presence of Wuchereria bancrofti. The results showed that 43(1.5%) of the 2790 males examined had hydrocoele. The prevalence increased with age reaching a peak in the 60 69 year age group before it drops at 70+ year age group. However, the difference in prevalence between the age groups at P 0.05) between hydrocoele and the presence of W. bancrofti microfilaria in the villages. The overall prevalence for the three villages is 58(1.1%). Lymphatic filariasis is endemic in the three villages which is above the 1% level of endemicity recommended for selecting endemic communities for the mass drug administration (MDA) to eradicate the disease.

Lymphatic filariasis in the Democratic Republic of Congo; micro-stratification overlap mapping (MOM) as a prerequisite for control and surveillance

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.

Monitoring lymphatic filariasis control in Tanzania: effect of repeated mass drug administration on circulating filarial antigen prevalence in young schoolchildren

In most countries of Sub-Saharan Africa the control of lymphatic filariasis (LF) is based on annual mass drug administration (MDA) with a combination of ivermectin and albendazole, in order to interrupt transmission. We monitored the effect of four repeated MDAs with this combination, as implemented by the Tanzanian National Lymphatic Filariasis Elimination Programme (NLFEP), on the circulating filarial antigen (CFA) status of young schoolchildren. A new batch of Standard 1 pupils from 10 rural primary schools in Tanga Municipality were examined for CFA each year in September/October (691-848 children per survey; mean age of 7.5-8.1 years), from immediately before the first MDA until eight months after the fourth MDA. The overall pre-MDA prevalence of CFA was 25.2%. Only minor and non-significant change in prevalence was seen after the first two MDAs. However, this was followed by substantial and statistically significant decreases in subsequent surveys, and eight months after the fourth MDA the prevalence was only 6.4%. Continuous entomological surveillance in a village accommodating one of the schools showed progressive decrease in transmission right from the first MDA. The usefulness of screening young schoolchildren for CFA as a tool for monitoring the impact of MDA on LF transmission is discussed.

Sustained reduction in prevalence of lymphatic filariasis infection in spite of missed rounds of mass drug administration in an area under mosquito nets for malaria control

BackgroundThe Global Programme to Eliminate Lymphatic Filariasis (GPELF) was established by the World Health Organisation (WHO) in 2000 with the goal of eliminating lymphatic filariasis (LF) as a public health problem globally by 2020. Mass drug administration (MDA) of antifilarial drugs is the principal strategy recommended for global elimination. Kenya launched a National Programme for Elimination of Lymphatic Filariasis (NPELF) in Coast Region in 2002. During the same year a longitudinal research project to monitor trends of LF infection during MDA started in a highly endemic area in Malindi District. High coverage of insecticide treated nets (ITNs) in the coastal region has been associated with dramatic decline in hospital admissions due to malaria; high usage of ITNs is also expected to have an impact on LF infection, also transmitted by mosquitoes.ResultsFour rounds of MDA with diethylcarbamazine citrate (DEC) and albendazole were given to 8 study villages over an 8-year period. Although annual MDA was not administered for several years the overall prevalence of microfilariae declined significantly from 20.9% in 2002 to 0.9% in 2009. Similarly, the prevalence of filarial antigenaemia declined from 34.6% in 2002 to 10.8% in 2009. All the examined children born since the start of the programme were negative for filarial antigen in 2009.ConclusionsDespite the fact that the study villages missed MDA in some of the years, significant reductions in infection prevalence and intensity were observed at each survey. More importantly, there were no rebounds in infection prevalence between treatment rounds. However, because of confounding variables such as insecticide-treated bed nets (ITNs), it is difficult to attribute the reduction to MDA alone as ITNs can lead to a significant reduction in exposure to filariasis vectors. The results indicate that national LF elimination programmes should be encouraged to continue provision of MDA albeit constraints that may lead to missing of MDA in some years.

Clinical epidemiology of lymphatic filariasis and community practices and preceptions amongst the Ado People of Benue State, Nigeria

As part of efforts to initiate lymphatic filariasis elimination activities in Benue State, this study employed the use of lymphatic filariasis-related clinical signs as rapid diagnostic features, immunochromatographic card test (ICT) to detect circulating filarial antigen (CFA) and questionnaire to investigate community perceptions and beliefs. 81 (32.6%) out of the 248 persons were positive for circulating filarial antigen (CFA). Infection rates denoted by CFA ranged from 41 (46.1%) in Uffia to 1(6.6%) in Ijigbam districts. Distribution of community ICT prevalence showed a significant variation (X(2), P < 0.05). The prevalence of clinical signs and/or symptoms in the communities also showed significant variations (X(2), P < 0.05). Community hydrocoele prevalence ranged from 8 (9.0%) in Uffia to 1(6.6%) in Ijigbam. The overall hydrocoele prevalence was 21 (8.5%), while the overall lymphoedema prevalence was 16 (6.4%) and women accounted for 14 (87.5%) of persons with swollen limbs. Only about 14 (15.9%) of unaffected respondents knew that lymphatic filariasis is transmitted through mosquito bites, this differ significantly from affected respondents 10 (66.6%) (X(2), P < 0.05). The communities' capacity to protect themselves is hindered by a lack of understanding of the true cause, symptoms, transmission route and prevention of the disease. Our study demonstrates the need for the development of health education programmes that will enable people to protect themselves against mosquito bites. As Nigeria commence her lymphatic filariasis elimination programmes, there is an urgent need to develop morbidity management activities that will alleviate the burden of patients.

Rapid community identification, pain and distress associated with lymphoedema and adenolymphangitis due to lymphatic filariasis in resource-limited communities of North-eastern Nigeria

Identification of communities with people that could benefit from adenolymphangitis (ADL) and lymphoedema morbidity management within Lymphatic Filariasis Elimination Programmes (NLFEP) in many African countries is a major challenge to programme managers. Another challenge is advocating for proportionate allocation of funds to alleviating the suffering that afflicted people bear. In this study we developed a rapid qualitative technique of identifying communities where morbidity management programme could be situated and documenting the pain and distress that afflicted persons endure. Estimates given by health personnel and by community resource persons were compared with systematic household surveys for the number of persons with lymphoedema of the lower limb. Communities in Northeastern Nigeria, with the largest number of lymphoedema cases were selected and a study of local knowledge, physical, psychosocial burden and intervention-seeking activities associated with the disease documented using an array of techniques (including household surveys, key informant interviews, group discussions and informal conversations). Health personnel gave a more accurate estimate of the number of lymphoedema patients in their communities than either the community leader or the community directed ivermectin distributor (CDD). Community members with lymphoedema preferred to confide in health personnel from other communities. The people had a well developed local vocabulary for lymphoedema and are well aware of the indigenous transmission theories. Although the people associated the episodic ADL attacks with the rains which were more frequent at that period they did not associate the episodes with gross lymphoedema. There were diverse theories about lymphoedema causation with heredity, accidental stepping on charmed objects and organisms, breaking taboos. The most popular belief about causation, however, is witchcraft (60.9%). The episodic attacks are dreaded by the afflicted, since they are accompanied by severe pain (18%). The emotional trauma included rejection (27.5%) by family, friends and other community members to the extent that divorce and isolation are common. Holistic approach to lymphoedema morbidity management should necessarily be an integral component of the ongoing transmission elimination programme. Any transmission prevention effort that ignores the physical and psychological pain and distress that those already afflicted suffer is unethical and should not be promoted.

High coverage of mass drug administration for lymphatic filariasis in rural and non-rural settings in the Western Area, Sierra Leone

BackgroundLymphatic filariasis elimination programs are based upon preventative chemotherapy annually in populations with prevalence more than or equal to 1%. The goal is to treat 80% of the eligible, at risk population yearly, for at least 5 years, in order to interrupt transmission and prevent children from becoming infected. This level of coverage has been a challenge in urban settings. Assessing the coverage in a rapidly growing urban/non-rural setting with inadequate population data is also problematic. In Sierra Leone, a 5-day preventative chemotherapy campaign was carried out in the Western Area including the capital: Freetown. An intensive, social mobilization strategy combined traditional and modern communication channels. To aid dissemination of appropriate information Frequently Asked Questions were developed and widely circulated. The population of the Western Area has grown faster than projected by the 2004 National Census due to the post-war settlement of internally displaced persons. As a reliable denominator was not available, independent monitoring was adapted and performed "in process" to aid program performance and "end process" to assess final coverage.ResultsIn 5 days 1,104,407 eligible persons were treated. Using the projected population from the 2004 census this figure represented coverage of 116% in the Urban Western Area and 129% in the Rural Western Area. Independent monitors interviewed a total of 9,253 persons during the 2 End Process days representing 1% of the projected population. Of these, 85.8% recalled taking both ivermectin and albendazole (Urban: 85.2%, Rural: 87.1%). No serious adverse drug reactions were reported.ConclusionThe paper presents the key elements of success of the social mobilization and implementation strategy and describes the independent monitoring used to estimate final coverage in this urban/non-rural setting where the current population size is uncertain. This implementation strategy and Independent Monitoring tool could be useful in similar, rapidly growing cities implementing lymphatic filariasis elimination programs.

Evaluation of synthetic peptides of WbSXP-1 for the diagnosis of human lymphatic filariasis

Parasitic nematodes infect nearly half of the world's human population, resulting in significant morbidity and mortality. Though filariasis is not fatal, it is the second leading cause of permanent and long-term disability worldwide. Filariasis has a spectrum of disease manifestation and infectivity found among the infected individuals and also goes unnoticed for years. Furthermore, there are ample reports emerging on the genetic variation among the parasites population. Hence, it is necessary to develop diagnostics for early detection of the disease. Synthetic peptides that mimic the immunogenic regions and a conserved region similar to that of recombinant antigen will be more useful in developing diagnostics, vaccines, or therapeutics. WbSXP-1 was earlier proven as a good diagnostic antigen; B-cell epitopic analysis showed 4 potent immunodominant regions spanning the whole antigen. These synthetic peptides (N, N1, N2, and N3) were produced and used as a diagnostic candidate to detect anti-SXP antibody and conversely to detect the infected individuals. The monomeric peptides showed good reactivity against microfilareamic (MF) sera. Among them, the peptides N, N1, and N2 were found to be more reactive. Furthermore, multiple chimeric peptides in linear combinations of 2 peptides were tested for its efficacy to detect anti-SXP antibody in infected MF sera. The peptides N:N1 and N1:N2 were synthesized and tested against human clinical sera. This chimeric peptides constructed based on WbSXP-1 were found to be reactive, specifically with MF sera by ELISA. These peptide-based diagnostic method can serve as a standard better tool without cross-reactivity in lymphatic filariasis elimination program.

Sentinel surveillance of lymphatic filariasis, schistosomiasis soil transmitted helminths and malaria in rural southern Malawi.

Baseline prevalence and knowledge, attitude and perception (KAP) survey is a prerequisite for mass drug administration for the control of Lymphatic filariasis (LF) and other neglected tropical diseases. In preparation for the first mass drug administration for LF elimination, a baseline survey was conducted in six sentinel sites in the southern Malawi, amongst participants aged five years or more. A standard questionnaire was used to obtain data on socio-demographic factors, ownership and use of bed nets, previous ingestion of ivermectin and KAP toward hydrocele and lymphoedema. Finger prick blood samples were collected from 22:00 to 01:00 hours for LF microscopy, malaria and haemoglobin examination. Stool and urine samples were collected for internal helminths and schistosomiasis respectively. A total of 1, 903 participants were enrolled. Knowledge on the cause of hydrocele and lymphoedema was low in all the sentinel sites (16%-42%, 10%-24% (respectively). Sexual intercourse with a menstruating woman, bad weather and HIV/AIDS were perceived causes of hydrocele. Microfilaraemia prevalence was 1.5% and varied little between sentinel sites (1.0%-2.1%). Childhood urinary schistosomiasis was common in Phalombe (94.9%) and Blantyre (26.9%). Integrated approach and understanding of the community KAP is vital or successful implementation of LF elimination programme.

Lymphatic Filariasis Control in Tanzania: Effect of Repeated Mass Drug Administration with Ivermectin and Albendazole on Infection and Transmission

BackgroundIn most countries of sub-Saharan Africa the control of lymphatic filariasis (LF) is based on annual mass drug administration (MDA) with a combination of ivermectin and albendazole, in order to interrupt transmission. Here we present the first detailed study on the effect of 3 repeated MDAs with this drug combination, as implemented by the Tanzanian National Lymphatic Filariasis Elimination Programme (NLFEP).Methodology/Principal FindingsInfection and transmission was monitored during a five-year period (one pre-intervention and four post-intervention years) in a highly endemic community (Kirare village) in north-eastern Tanzania. The vectors were Anopheles gambiae, An. funestus and Cx. quinquefasciatus. After start of intervention, human microfilaraemia initially decreased rapidly and statistically significant (prevalence by 21.2% and 40.4%, and mean intensity by 48.4% and 73.7%, compared to pre-treatment values after the first and second MDA, respectively), but thereafter the effect levelled off. The initial decrease in microfilaraemia led to significant decreases in vector infection and vector infectivity rates and thus to a considerable reduction in transmission (by 74.3% and 91.3% compared to pre-treatment level after first and second MDA, respectively). However, the decrease in infection and infectivity rates subsequently also levelled off, and low-level transmission was still noted after the third MDA. The MDAs had limited effect on circulating filarial antigens and antibody response to Bm14.Conclusion/SignificanceCritical issues that may potentially explain the observed waning effect of the MDAs in the later study period include the long intervals between MDAs and a lower than optimal treatment coverage. The findings highlight the importance of ongoing surveillance for monitoring the progress of LF control programmes, and it calls for more research into the long-term effect of repeated ivermectin/albendazole MDAs (including the significance of treatment intervals and compliance), in order to optimize efforts to control LF in sub-Saharan Africa.

The 6th Meeting of the Global Alliance to Eliminate Lymphatic Filariasis: A half-time review of lymphatic filariasis elimination and its integration with the control of other neglected tropical diseases

The 6th Meeting of the Global Alliance to Eliminate Lymphatic Filariasis (GAELF6) was held 1-3 June, 2010 in Seoul, Korea, with 150 participants from 38 countries. The year 2010 marks the midpoint between the first GAELF meeting, in 2000, and the World Health Organization (WHO) 2020 goal of global elimination of lymphatic filariasis (LF) as a public health problem. The theme of the meeting, "Half-time in LF Elimination: Teaming Up with Neglected Tropical Diseases (NTDs)," reflected significant integration of LF elimination programmes into a comprehensive initiative to control NTDs. Presentations on LF epidemiology, treatment, research, and programmes highlighted both accomplishments and remaining challenges.The WHO strategy to interrupt LF transmission is based on annual mass drug administration (MDA) using two-drug combinations. After mapping the geographic distribution of LF, MDA is implemented for ≥ 5 years, followed by a period of post-MDA surveillance, and, ultimately, verification of LF elimination. Morbidity management further reduces disease burden.Of 81 countries considered LF-endemic in 2000, 52 (64.2%) have begun MDA; 10 (12.3%) others with low-level transmission are unlikely to require MDA. In 2008, ~695 million people were offered treatment (51.7% of the at-risk population); ~496 million participated. Approximately 22 million people have been protected from LF infection and disease, with savings of ~US $24.2 billion. Morbidity management programmes have been implemented in 27 (33.3%) countries.Significant challenges to LF elimination remain. These include: initiating MDA in the remaining 19 countries that require it; achieving full geographic coverage in countries where MDA has started; finding alternative strategies to address the problem of Loa loa co-endemicity in Central Africa; developing strategies to treat urban populations; initiating and sustaining MDA in settings of armed conflict; developing refined guidelines and procedures for stopping MDA, for post-MDA surveillance, and for verifying the elimination of LF; and integrating morbidity management into all LF elimination programmes. Scientific research and enhanced advocacy for NTDs remain critical for addressing these challenges.GAELF6 was characterized by enthusiasm and recognition that "teaming up with NTDs" offers opportunities for new partnerships, fresh perspectives, enhanced advocacy, and greater programmatic integration in a rapidly changing global health environment.

Lymphatic filariasis: patients and the global elimination programme

The defining images of lymphatic filariasis are the horrendous disfigurements of lymphoedema, elephantiasis and hydrocele. These clinical presentations, although obviously important and life changing, are not, however, the only outcomes of this wide-spread filarial infection. The other effects of the disease range from severe, acute but short-term bouts of sickness to psychological impairment, poverty and family hardship. It is important to support cases of the disease through all means available, such as reparative hydrocelectomy, hygiene training and facilitation, and the provision of adequate chemotherapy. Although only a minority of the residents in any endemic community is affected with the severe clinical manifestations of this parasitic infection, these cases are central to, and important advocates for, the current global effort to eliminate the infection through mass drug administrations (MDA). Their clinical improvement acts as an important catalyst for the general population and encourages high compliance in the MDA. This communication discusses the central role that filariasis patients have played in the Tanzania Lymphatic Filariasis Elimination Programme to date, and covers some of the clinical successes achieved in the past 10 years. The abolition of the clinical manifestations of filarial infection remains the ultimate goal of the Global Programme to Eliminate Lymphatic Filariasis, and maintaining a focus on the affected individuals and their clinical condition is vital to that programme's overall success.

Marriage, Sex, and Hydrocele: An Ethnographic Study on the Effect of Filarial Hydrocele on Conjugal Life and Marriageability from Orissa, India

BackgroundLymphatic filariasis (LF), a leading cause of permanent and long-term disability, affects 120 million people globally. Hydrocele, one of the chronic manifestations of LF among 27 million people worldwide, causes economic and psychological burdens on patients and their families. The present study explores and describes the impact of hydrocele on sexual and marital life as well as on marriageability of hydrocele patients from rural areas of Orissa, an eastern state of India.Methodology/Principal FindingsThis paper is based on ethnographic data collected through focus group discussions and in-depth interviews with hydrocele patients, wives of hydrocele patients, and other participants from the community. The most worrisome effect of hydrocele for patients and their wives was the inability to have a satisfactory sexual life. The majority of patients (94%) expressed their incapacity during sexual intercourse, and some (87%) reported pain in the scrotum during intercourse. A majority of hydrocele patients' wives (94%) reported dissatisfaction in their sexual life. As a result of sexual dissatisfaction and physical/economic burden, communication has deteriorated between the couples and they are not living happily. This study also highlights the impact on marriageability. The wives of hydrocele patients said that a hydrocele patient is the “last choice” and that girls show reluctance to marry hydrocele patients. In some cases, the patients were persuaded by their wives to remove hydrocele by surgery (hydrocelectomy).Conclusions/SignificanceThe objective of the morbidity management arm of the Global Programme to Eliminate LF should be to increase access to hydrocelectomy, as hydrocelectomy is the recommended intervention. Though the study area is covered by the programme, like in other endemic areas, hydrocelectomy has not been emphasised by the national LF elimination programme. The policy makers and programme managers should be sensitised by utilising this type of research finding.

Integration of irradiation with cytoplasmic incompatibility to facilitate a lymphatic filariasis vector elimination approach

BackgroundMass drug administration (MDA) is the emphasis of an ongoing global lymphatic filariasis (LF) elimination program by the World Health Organization, in which the entire 'at risk' human population is treated annually with anti-filarial drugs. However, there is evidence that the MDA strategy may not be equally appropriate in all areas of LF transmission, leading to calls for the augmentation of MDA with anti-vector interventions. One potential augmentative intervention is the elimination of vectors via repeated inundative releases of male mosquitoes made cytoplasmically incompatible via an infection with Wolbachia bacteria. However, with a reduction in the vector population size, there is the risk that an accidental female release would permit the establishment of the incompatible Wolbachia infection type, resulting in population replacement instead of population elimination. To avoid the release of fertile females, we propose the exposure of release individuals to low doses of radiation to sterilize any accidentally released females, reducing the risk of population replacement.ResultsAedes polynesiensis pupae of differing ages were irradiated to determine a radiation dose that results in sterility but that does not affect the survival and competitiveness of males. Laboratory assays demonstrate that males irradiated at a female sterilizing dosage of 40 Gy are equally competitive with un-irradiated males. No effect of irradiation on the ability of Wolbachia to affect egg hatch was observed.ConclusionAn irradiation dose of 40 Gy is sufficient to cause female sterility, but has no observed negative effect on male fitness. The results support further development of this approach as a preventative measure against accidental population replacement.

Lymphatic filariasis elimination programme in India: progress and challenges

Nearly a decade ago, the World Health Assembly called upon its member states to pursue the goal of lymphatic filariasis (LF) elimination. In 1996–1997, India, which carries 40% of the global LF burden, initiated an ambitious programme to eliminate LF. The programme envisages the yearly mass anti-filarial treatment of 590 million people living in ∼300 000 villages and 1450 urban areas in 250 districts (see the National Vector Borne Disease Control Programme website at www.nvbdcp.gov.in). This requires 1.4 billion diethylcarbamazine (DEC) tablets and 0.51 billon albendazole tablets, 1.1 million drug distributors, the treatment of side-effects and an effective information, education and communication (IEC) campaign.

The combined effect of the Lymphatic Filariasis Elimination Programme and the Schistosomiasis and Soil-transmitted Helminthiasis Control Programme on soil-transmitted helminthiasis in schoolchildren in Tanzania

The combined effect of the Lymphatic Filariasis Elimination Programme (LFEP) and the National Schistosomiasis and Soil-transmitted Helminthiasis Control Programme (NSSCP) on soil-transmitted helminthiasis (STH) was evaluated. In September 2004, before mass drug administration (MDA) with ivermectin and albendazole by the LFEP in October, the prevalence and intensity of STH were recorded in 228 pupils in one primary school. After 8 months, all available pupils were re-examined, and the prevalence of Ascaris lumbricoides, Trichuris trichiura and hookworm had decreased from 0.9 to 0.7% (P=0.84), from 4.8 to 0.7% (P=0.004) and from 45.6 to 11.9% (P<0.001), respectively. Overall, 81.2% of the schoolchildren stated that they were treated by the LFEP in October 2004. After the 8 months follow-up, pupils were treated with praziquantel and albendazole by the present project (substitute for the NSSCP). After another 4 months (at 12 months follow-up), the prevalence of hookworm infection was reduced to 4.8% (P=0.003), while the prevalence of T. trichiura was reduced to 0.3% (P=0.54) and the prevalence of A. lumbricoides remained unchanged. Mass co-administration of ivermectin and albendazole by the LFEP had a significant effect on STH, which was further amplified by treatment with praziquantel and albendazole 4 months later.

Genetic heterogeneity of Wuchereria bancrofti populations at spatially hierarchical levels in Pondicherry and surrounding areas, south India

Lymphatic filariasis (LF), caused by Wuchereria bancrofti is widely distributed in areas of India with variable geoclimatic factors. These factors, coupled with chemotherapeutic pressure exerted for past half a century may have influenced the genetic structure of the parasite populations. A complex genetic structure of parasite populations will have major consequences to the on-going global LF elimination programme. Hence, it is of interest to understand the genetic heterogeneity of W. bancrofti parasite populations. We studied the genetic heterogeneity of populations of W. bancrofti populations from mf carriers residing in an urban area of Pondicherry and surrounding villages through molecular (RAPD) fingerprinting. The analysis showed that W. bancrofti populations of an urban area were mostly highly heterogeneous, while those of rural areas were homogenous. The urban parasite populations appeared to be a pool of parasite population originating from surrounding rural areas. At least two genotypes, exhibiting high genetic differentiation and minimum gene flow between them, existed in Pondicherry urban areas. There was a minimum gene flow between parasite populations of villages. The genetic heterogeneity of parasite population in an adult microfilariae carrier was significantly high, possibly due to accumulation of different genotypes of the parasite with increasing age. The genetic heterogeneity of W. bancrofti populations in an individual mf carrier, in urban and rural areas, within an endemic area at large, and in different geographical regions of India may have far reaching implications to the epidemiology and strategies of chemotherapy control being adopted for LF elimination programme launched on a global scale.