scholarly journals A community survey of coverage and adverse events following country-wide triple-drug mass drug administration for lymphatic filariasis elimination, Samoa 2018

2020 ◽  
Vol 14 (11) ◽  
pp. e0008854
Author(s):  
Gabriela A. Willis ◽  
Helen J. Mayfield ◽  
Therese Kearns ◽  
Take Naseri ◽  
Robert Thomsen ◽  
...  
Keyword(s):  
Adverse Events ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Total Population ◽  
Community Survey ◽  
World Health ◽  
Cross Sectional ◽  
Eligible Population ◽  
Health Organization

The Global Programme to Eliminate Lymphatic Filariasis has made considerable progress but is experiencing challenges in meeting targets in some countries. Recent World Health Organization guidelines have recommended two rounds of triple-drug therapy with ivermectin, diethylcarbamazine (DEC), and albendazole (IDA), in areas where mass drug administration (MDA) results with two drugs (DEC and albendazole) have been suboptimal, as is the case in Samoa. In August 2018, Samoa was the first country in the world to implement countrywide triple-drug MDA. This paper aims to describe Samoa’s experience with program coverage and adverse events (AEs) in the first round of triple-drug MDA. We conducted a large cross-sectional community survey to assess MDA awareness, reach, compliance, coverage and AEs in September/October 2018, 7–11 weeks after the first round of triple-drug MDA. In our sample of 4420 people aged ≥2 years (2.2% of the population), age-adjusted estimates indicated that 89.0% of the eligible population were offered MDA, 83.9% of the eligible population took MDA (program coverage), and 80.2% of the total population took MDA (epidemiological coverage). Overall, 83.8% (2986/3563) reported that they did not feel unwell at all after taking MDA. Mild AEs (feeling unwell but able to do normal everyday things) were reported by 13.3% (476/3563) and moderate or severe AEs (feeling unwell and being unable to do normal everyday activities such as going to work or school) by 2.9% (103/3563) of participants. This study following the 2018 triple-drug MDA in Samoa demonstrated a high reported program awareness and reach of 90.8% and 89.0%, respectively. Age-adjusted program coverage of 83.9% of the total population showed that MDA was well accepted and well tolerated by the community.

scholarly journals An assessment of coverage and adverse events following country-wide triple-therapy mass drug administration for lymphatic filariasis elimination, Samoa 2018

2020 ◽  
Author(s):  
Gabriela A. Willis ◽  
Helen Mayfield ◽  
Therese Kearns ◽  
Take Naseri ◽  
Robert Thomsen ◽  
...  
Keyword(s):  
Adverse Events ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Total Population ◽  
Public Health Problem ◽  
Community Survey ◽  
World Health ◽  
Ministry Of Health ◽  
The World

AbstractBackgroundThe Global Programme to Eliminate Lymphatic Filariasis is making considerable progress but has experienced challenges in meeting targets in some countries. Recent World Health Organization guidelines have recommended two rounds of triple-drug therapy with ivermectin, diethylcarbamazine (DEC), and albendazole (IDA), in areas where mass drug administration (MDA) results with two drugs (DEC and albendazole) have been suboptimal, as is the case in Samoa. In August 2018, Samoa was the first in the world to implement countrywide triple-drug MDA. This paper aims to describe Samoa’s experience with program coverage and adverse events (AEs) in the first round of triple-drug MDA.Methodology/Principal findingsWe assessed MDA awareness, reach, compliance, coverage and AEs from three different data sources: a Supervisor’s Coverage Tool (SCT) in three villages; a large cross-sectional community survey in September/October 2018, 7-11 weeks after the first round of triple-drug MDA; and AE surveillance conducted by the Ministry of Health, Samoa. Participants aged ≥5 years had a fingerprick blood sample tested for circulating filarial antigen using the Alere Filariasis Test Strip. Data were analysed descriptively. In our sample of 4420 people (2.2% of the population), age-adjusted estimates indicated that 89.0% of the eligible population were offered MDA and 80.2% of the total population took MDA. Mild AEs were reported by 13.3% and moderate/severe AEs by 2.9% of participants.Conclusions/SignificanceThis study following the 2018 triple-drug MDA in Samoa demonstrated a high reported program awareness and reach of 90.8% and 89.0%, respectively. Coverage of 80.2% of the total population showed that MDA was well accepted and well tolerated by the community.Author summaryLymphatic filariasis is a mosquito transmitted worm disease. A global program underway aims to eliminate lymphatic filariasis as a public health problem by distributing deworming drugs to the whole population once a year for at least five years. In some countries, including Samoa, this strategy has not been sufficient to eliminate transmission. A new drug has been added, and in 2018, Samoa was the first country in the world to apply triple drug mass drug administration using ivermectin, diethylcarbamazine, and albendazole. This study reports on the coverage achieved (percentage of people who reported taking the drugs) and adverse events after taking the drugs. Data were obtained from three different sources. A large community survey of over 4000 people, done 7-11 weeks after the distribution of the first round, found that the program reached and offered MDA to approximately 90% of the whole population, and approximately 80% of the whole population swallowed the drugs. Findings from the community survey on participation in the MDA program were consistent with those from the WHO recommended Supervisor’s Coverage Tool, a smaller survey which was undertaken in three villages by the Samoan Ministry of Health. Data on AEs related to MDA were collected during the community survey, and also through a system set up by the Ministry of Health to enable community members to report any problems related to MDA and receive advice on managing problems. There were relatively few adverse events reported and most of them were mild and of short duration.

scholarly journals Potential use of antibodies to provide an earlier indication of lymphatic filariasis resurgence in post-mass drug administration surveillance, American Samoa

2021 ◽  
Author(s):  
Angela M. Cadavid Restrepo ◽  
Katherine Gass ◽  
Kimberly Y. Won ◽  
Meru Sheel ◽  
Keri Robinson ◽  
...  
Keyword(s):  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
American Samoa ◽  
School Level ◽  
World Health ◽  
Chi Squared ◽  
Health Organization ◽  
Potential Use

AbstractObjectivesUnder the Global Programme to Eliminate Lymphatic Filariasis (LF), American Samoa conducted seven rounds of mass drug administration between 2000 and 2006. The territory passed transmission assessment surveys (TAS) in 2011 (TAS-1) and 2015 (TAS-2) based on World Health Organization guidelines. In 2016, the territory failed TAS-3, indicating resurgence. This study aims to determine if antibodies (Ab) may have provided a timelier indication of LF resurgence in American Samoa.MethodsWe examined school-level Ag and Ab status (presence/absence of Ag- and Ab- positive children) and prevalence of single and combined Ab responses to Wb123, Bm14, Bm33 Ags at each TAS. Pearson’s chi-squared tests and logistic regression were used to examine associations between school-level Ab prevalence in TAS-1 and TAS-2 and school-level Ag status in TAS-3.ResultsSchools with higher prevalence of Wb123 Ab in TAS-2 had higher odds of being Ag-positive in TAS-3 (odds ratio [OR] 24.5, 95% CI:1.2-512.7). Schools that were Ab-positive for WB123 plus Bm14, Bm33 or both Bm14 and Bm33 in TAS-2 had higher odds of being Ag-positive in TAS-3 (OR 16.0-24.5).ConclusionAnti-filarial Abs could provide earlier signals of resurgence and enable a timelier response. The promising role of Abs in post-MDA surveillance and decision making should be further investigated in other settings.

scholarly journals Potential strategies for strengthening surveillance of lymphatic filariasis in American Samoa after mass drug administration: targeting older age groups, hotspots, and household members of infected persons

2020 ◽  
Author(s):  
Colleen Lau ◽  
Meru Sheel ◽  
Katie Gass ◽  
Saipale Fuimaono ◽  
Michael David ◽  
...  
Keyword(s):  
High Risk ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Disease Transmission ◽  
Parasitic Infection ◽  
American Samoa ◽  
Community Survey ◽  
World Health ◽  
Surveillance Strategy

ABSTRACTBackgroundUnder the Global Programme to Eliminate Lymphatic Filariasis (LF), American Samoa conducted mass drug administration (MDA) from 2000-2006. Despite passing Transmission Assessment Surveys (TAS) in 2011/2012 and 2015, American Samoa failed TAS-3 in 2016, with antigen (Ag) prevalence of 0.7% (95%CI 0.3-1.8%) in 6-7 year-olds. A 2016 community survey (Ag prevalence 6.2% (95%CI 4.4-8.5%) in age ≥8 years) confirmed resurgence. Here, we explore the potential of targeted strategies to strengthen post-MDA surveillance.Methodology/Principal FindingsUsing Ag data plus new antibody data (Wb123, Bm14, Bm33) from the 2016 surveys, we identified risk factors for seropositivity using multivariable logistic regression. We compared TAS with strategies that targeted high-risk subpopulations (older ages, householders of Ag-positive TAS children [index children]) and/or known hotspots, and used NNTestav (average number needed to test to identify one positive) to compare sampling efficiency.Antibody prevalence in TAS-3 (n=1143) were 1.6% for Bm14 (95%CI 0.9-2.9%), 7.9% for Wb123 (95%CI 6.4-9.6%), and 20.2% for Bm33 (95%CI 16.7-24.3%); and in the community survey (n=2507), 13.9% for Bm14 (95%CI 11.2-17.2%), 27.9% for Wb123 (95%CI 24.6-31.4%), and 47.3% for Bm33 (95%CI 42.1-52.6%). Ag prevalence was 20.7% (95%CI 9.7-53.5%) in households of index children. Higher Ag prevalence was found in males (adjusted odds ratio [aOR] 3.01), age ≥18 years (aOR 2.18), residents of Fagali’i (aOR 15.81), and outdoor workers (aOR 2.61). Using Ag, NNTestav ranged from 142.5 for TAS, to <5 for households of index children. NNTestav was lower in older ages, and highest for Ag, followed by Bm14, Wb123 and Bm33 antibodies.Conclusions/SignificanceWe propose a multi-stage surveillance strategy, starting with population-representative sampling (e.g. TAS), followed by targeted strategies in subgroups and locations with low NNTestav. This approach could potentially improve the efficiency of identifying remaining infected persons and residual hotspots. The utility of antibodies in surveillance should also be explored.AUTHOR SUMMARYLymphatic filariasis (LF) is a parasitic infection transmitted by mosquito bites. Globally, tens of millions are infected, with many disfigured and disabled by severe damage to their lymphatic systems, such as severe swelling of the legs (elephantiasis) or scrotum (hydrocele). The Global Programme to Eliminate LF (GPELF) aims to interrupt disease transmission through mass drug administration (MDA), and to control illness and suffering in affected persons. The World Health Organization recommends conducting Transmission Assessment Surveys (TAS) in school children aged 6 to 7 years, to determine if infection rates have dropped to levels where disease transmission is no longer sustainable. From 2000-2006, American Samoa conducted MDA and made significant progress towards eliminating LF. However, despite passing TAS in 2011/2012 and 2015, surveys in 2016 showed evidence of resurgence. Our study explored alternative surveillance strategies and compared their efficiency with TAS. Based on our findings, we recommended that in addition to TAS, strategies that target high-risk populations and hotspots would strengthen surveillance and help countries achieve their goals of LF elimination.

scholarly journals Coverage evaluation surveys following soil-transmitted helminthiasis and schistosomiasis mass drug administration in Wolaita Zone of Ethiopia—The Geshiyaro project

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260722
Author(s):  
Ewnetu Firdawek Liyew ◽  
Melkie Chernet ◽  
Habtamu Belay ◽  
Rosie Maddren ◽  
Toby Landeryou ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Cross Sectional Study ◽  
World Health ◽  
Size Analysis ◽  
Preventive Chemotherapy ◽  
Cross Sectional ◽  
Change Communication ◽  
Sanitation And Hygiene ◽  
Health Organization

Introduction The Geshiyaro project aims to break transmission of soil-transmitted helminths and schistosomiasis in the Wolaita Zone of Ethiopia through a combination of two interventions: behavior change communication (BCC) for increased water, sanitation and hygiene (WaSH) infrastructure use alongside preventive chemotherapy (PC) using albendazole (ALB) and praziquantel (PZQ), targeted to reach 90% treatment coverage. Coverage evaluation surveys (CES) were conducted post-treatment, and the resultant survey coverage was compared to reported administrative coverage. This provided a secondary confirmation of the Geshiyaro project coverages, and is used to monitor the success of each Mass Drug Administration (MDA) round. Methods A community-based cross-sectional study was conducted in 13 woredas (districts) of the Wolaita Zone. All eligible individuals from the selected households were invited for an interview. The study design, sample size, analysis and report writing were conducted according to the World Health Organization (WHO) CES guidelines for PC. Results The study interviewed a total of 3,568 households and 18,875 individuals across 13 woredas in the Wolaita Zone. Overall, the survey coverage across all studied woredas was 81.5% (95% CI; 80.9–82.0%) for both ALB and PZQ. Reported administrative coverage across all studied woredas was higher than survey coverage, 92.7% and 91.2% for ALB and PZQ, respectively. A significant portion of individuals (17.6%) were not offered PC. The predominant reason for not achieving the target coverage of 90% was beneficiary absenteeism during MDA (6.6% ALB, 6.8% PZQ), followed by drug distributors failing to reach all households (4.7% ALB, 4.8% PZQ), and beneficiaries not informed of the program (1.3% ALB, 1.7% PZQ). Conclusion Programmatic actions will need to be taken during the next MDA campaign to achieve the targeted Geshiyaro project coverage threshold across data collection and program engagement. Adequate training and supervision on recording and reporting administrative coverage should be provided, alongside improved social mobilization of treated communities to increase participation, and strengthened institutional partnerships and communication.

Non-compliance to Mass Drug Administration Associated with the Low Perception of the Community Members About their Susceptibility to Lymphatic Filariasis in Ankobra, Ghana

2020 ◽  
Vol 20 (2) ◽  
pp. 167-174
Author(s):  
Ilo Dicko ◽  
Yaya Ibrahim Coulibaly ◽  
Modibo Sangaré ◽  
Bismark Sarfo ◽  
Priscillia Awo Nortey
Keyword(s):  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Health Workers ◽  
Compliance Rate ◽  
Cross Sectional Study ◽  
Cluster Sampling ◽  
Cross Sectional ◽  
Improve Compliance ◽  
Degree Of Association

Background: Lymphatic filariasis (LF) is a parasitic disease that has been targeted for elimination through the Mass Drug Administration (MDA.) Although the MDA started in the Ankobra community in Ghana in 2000, LF prevalence as reported in 2014 was relatively high (4.5%). Non-compliance to the MDA has been associated with the persistent LF prevalence in endemic regions. Objective: This study determined the factors associated with the non-compliance to the MDA among patients living in the Ankobra community, Ghana. Methods: A cross-sectional study using a one-stage cluster sampling method was used to collect data between June and July, 2017 in Ankobra. Questionnaires were used to collect data from health workers, the MDA drug distributors and study participants in Ankobra. Data analysis was performed using STATA 14. Logistic regression was used to measure the degree of association between the dependent (non-compliance) and independent variables. Non-compliance rate was defined as the percentage of individuals who self-reported that they did not actually swallow the drugs provided during the MDA. Results: The MDA coverage and non-compliance rates were 73.5% (147/200) and 33.33% (49/147) respectively. The main reason for non-compliance was fear of drug adverse events (75.51%, 37/49). Thought of “not being susceptible to LF” was significantly associated with the non-compliance (aOR= 2.83, [CI= 1.15, 6.98]). Conclusion: Health education about the susceptibility of residents getting LF disease in endemic community must be intensified to improve compliance to MDA medication ingestion and thus meet the Global Elimination of Lymphatic Filariasis by 2020.

scholarly journals Potential strategies for strengthening surveillance of lymphatic filariasis in American Samoa after mass drug administration: Reducing ‘number needed to test’ by targeting older age groups, hotspots, and household members of infected persons

2020 ◽  
Vol 14 (12) ◽  
pp. e0008916
Author(s):  
Colleen L. Lau ◽  
Meru Sheel ◽  
Katherine Gass ◽  
Saipale Fuimaono ◽  
Michael C. David ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Age Groups ◽  
American Samoa ◽  
Community Survey ◽  
Older Age ◽  
Antibody Prevalence ◽  
Surveillance Strategy

Under the Global Programme to Eliminate Lymphatic Filariasis (LF), American Samoa conducted mass drug administration (MDA) from 2000–2006. Despite passing Transmission Assessment Surveys (TAS) in 2011/2012 and 2015, American Samoa failed TAS-3 in 2016, with antigen (Ag) prevalence of 0.7% (95%CI 0.3–1.8%) in 6–7 year-olds. A 2016 community survey (Ag prevalence 6.2% (95%CI 4.4–8.5%) in age ≥8 years) confirmed resurgence. Using data from the 2016 survey, this study aims to i) investigate antibody prevalence in TAS-3 and the community survey, ii) identify risk factors associated with being seropositive for Ag and anti-filarial antibodies, and iii) compare the efficiency of different sampling strategies for identifying seropositive persons in the post-MDA setting. Antibody prevalence in TAS-3 (n = 1143) were 1.6% for Bm14 (95%CI 0.9–2.9%), 7.9% for Wb123 (95%CI 6.4–9.6%), and 20.2% for Bm33 (95%CI 16.7–24.3%); and in the community survey (n = 2507), 13.9% for Bm14 (95%CI 11.2–17.2%), 27.9% for Wb123 (95%CI 24.6–31.4%), and 47.3% for Bm33 (95%CI 42.1–52.6%). Multivariable logistic regression was used to identify risk factors for being seropositive for Ag and antibodies. Higher Ag prevalence was found in males (adjusted odds ratio [aOR] 3.01), age ≥18 years (aOR 2.18), residents of Fagali’i (aOR 15.81), and outdoor workers (aOR 2.61). Ag prevalence was 20.7% (95%CI 9.7–53.5%) in households of Ag-positive children identified in TAS-3. We used NNTestav (average number needed to test to identify one positive) to compare the efficiency of the following strategies for identifying persons who were seropositive for Ag and each antibody: i) TAS of 6–7 year-old children, ii) population representative surveys of older age groups, and iii) targeted surveillance of subpopulations at higher risk of being seropositive (older ages, householders of Ag-positive TAS children, and known hotspots). For Ag, NNTestav ranged from 142.5 for TAS, to <5 for households of index children. NNTestav was lower in older ages, and highest for Ag, followed by Bm14, Wb123 and Bm33 antibodies. We propose a multi-stage surveillance strategy, starting with population-representative sampling (e.g. TAS or population representative survey of older ages), followed by strategies that target subpopulations and/or locations with low NNTestav. This approach could potentially improve the efficiency of identifying remaining infected persons and residual hotspots. Surveillance programs should also explore the utility of antibodies as indicators of transmission.

Awareness and Coverage of Mass Drug Administration for Elimination of Lymphatic Filariasis: A Community Based Cross Sectional Study in Nepal

2014 ◽  
Vol 40 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Ram Kumar Adhikari ◽  
Jeevan Bahadur Sherchand ◽  
Shiva Raj Mishra ◽  
Kamal Ranabhat ◽  
Rajendra Raj Wagle
Keyword(s):  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Community Based ◽  
Cross Sectional

scholarly journals From Informed Consent to Adherence: Factors Influencing Involvement in Mass Drug Administration With Ivermectin for Malaria Elimination in The Gambia

2020 ◽  
Author(s):  
Alexandra E. Fehr ◽  
Claudia Nieto-Sanchez ◽  
Joan Muela ◽  
Fatou Jaiteh ◽  
Omar Ceesay ◽  
...  
Keyword(s):  
Decision Making ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Social Dynamics ◽  
The Gambia ◽  
World Health ◽  
Cross Sectional Survey ◽  
Enabling Factors ◽  
Cross Sectional ◽  
Medication Costs

Abstract Background: The World Health Organization (WHO) recommends consideration of mass drug administration (MDA) for malaria control in low-endemic settings approaching elimination. However, MDA remains a controversial strategy, as multiple individual, social, and operational factors have shown to affect its acceptability at local levels. This is further complicated by inconsistent definitions of key indicators derived from individual and community involvement — coverage, adherence, and compliance— that cast doubts about the actual and potential epidemiological impact of MDA on disease control. This study aimed to identify limitations and enabling factors impacting involvement at different stages of a large cluster-randomized trial assessing the effect of combining dihydroartemisinin-piperaquine (DP) and ivermectin (IVM) in malaria transmission in The Gambia. Methods: This social science study used a mixed-methods approach. Qualitative data were collected in intervention and control villages through ethnographic methods, including in-depth interviews (IDIs), focus group discussions (FGDs), and participant observation conducted with trial participants and decliners, community leaders, and field staff. A cross-sectional survey was conducted in the intervention villages after the first year of MDA. Both strands of the study explored malaria knowledge and opinions, social dynamics influencing decision-making, as well as perceived risks, burdens, and benefits associated with this MDA.Results: 157 IDIs and 11 FGDs were conducted, and 864 respondents were included in the survey. Barriers and enabling factors to involvement were differentially influential at the various stages of the MDA. Issues of social influence, concerns regarding secondary effects of the medication, costs associated with malaria, and acceptability of the implementing organization, among other factors, differently affected the decision-making processes throughout the trial. Rather than a linear trajectory, involvement in this MDA trial was subjected to multiple revaluations from enrolment and consent to medicine intake and adherence to treatment. Conclusions: Our study went beyond the individual factors often associated with coverage and adherence, and found that nuanced social dynamics greatly influence the decision-making process at all phases of the trial. These issues need to be consider for MDA implementation strategies and inform discussions about more accurate ways of reporting on critical effectiveness indicators.

scholarly journals A Step Toward Eradication of Human Filariases in Areas Where Loa Is Endemic

mBio ◽  
2016 ◽  
Vol 7 (2) ◽  
Author(s):  
Timothy G. Geary
Keyword(s):  
Adverse Events ◽  
Drug Treatment ◽  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Diagnostic Method ◽  
Parasitic Infections ◽  
Loa Loa ◽  
Risk Threshold ◽  
Rapid Diagnostic Method

ABSTRACT Mass drug administration (MDA) programs have achieved remarkable success in limiting the pathology and transmission of the human parasitic infections onchocerciasis and lymphatic filariasis. The full implementation of MDA campaigns for filariasis elimination has been stymied by the unacceptable incidence of severe adverse events observed following drug treatment of a subset of individuals who harbor high loads of Loa loa microfilaria. Extending MDA strategies to regions where loiasis is coendemic could be done confidently if a simple, inexpensive, and rapid diagnostic method was available that could accurately identify individuals who have L. loa microfilarial loads above the risk threshold and could thus be excluded from treatment. A recent paper in mBio reports the discovery of an antigen unique to L. loa microfilaria that can be detected in blood and urine and may form the basis for such an assay. Further work will reveal whether this discovery will smooth the path to achieve filariasis eradication.

A Hospital Based Cross Sectional Study to assess Knowledge Regarding Lymphatic Filariasis & Mass Drug Administration

2013 ◽  
Vol 4 (4) ◽  
pp. 45
Author(s):  
Gouri Ku Padhy ◽  
Rajib Kumar Ray ◽  
Sangeeta Das ◽  
Manas Ranjan Pani
Keyword(s):  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional
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