|Community-directed Treatment of Lymphatic Filariasis in Africa - Report of a multi-centre study in Ghana and Kenya (UNDP - WB - WHO, 2000, 44 p.)|
Lymphatic filariasis is an important public health and socio-economic problem affecting over 120 million people worldwide. Although there have been some significant successes in the control of the disease, in most endemic countries the burden of lymphatic filariasis remains unaffected, or is even on the increase. However, the introduction in recent years of new drugs and single-dose treatment regimens with diethylcarbamazine (DEC) and/or ivermectin has been an important breakthrough for filariasis control. In 1997 the World Health Assembly passed a resolution calling for .....the elimination of lymphatic filariasis as a public health problem.... The global control strategy for lymphatic filariasis has been redefined, and the principal strategy is now based on annual, single-dose treatment of all eligible members of endemic communities.
The principal challenge for filariasis elimination is to deliver treatment to the populations of endemic communities, and to sustain annual delivery and a high treatment coverage for a sufficiently long period to bring about the elimination of the disease. In most endemic countries in Africa, sustained drug delivery to all affected communities is difficult to achieve by the health services alone, either because they are overburdened with other responsibilities and short of resources, or because of lack of active participation of the population with the official treatment programme. Recent research on drug delivery for another disease, onchocerciasis, indicates that greater involvement of the endemic communities in the delivery process may be a solution.
TDR has developed the concept of community-directed treatment, in which the community itself has the responsibility for the organisation and execution of the treatment of its members. A large, multi-country study has shown that community-directed treatment is feasible and effective in onchocerciasis control, and it is now the basis for the control strategy of the African Programme for Onchocerciasis Control and the Onchocerciasis Control Programme in West Africa.
A meeting held at the World Health Organization in Geneva concluded that Community-Directed Treatment also appears to be a promising strategy for the delivery of single-dose treatment in the control of lymphatic filariasis. However, the meeting noted several important differences between onchocerciasis and lymphatic filariasis control that require further operational research on drug delivery in lymphatic filariasis. Community-Directed Treatment methods should also be compared with health service based delivery, especially in countries with a highly developed health care system, and hybrids combining the two approaches should be developed and tested.
The TDR Task Force on Community-Directed Treatment of lymphatic filariasis and onchocerciasis selected several multi-disciplinary teams to participate in a multi-country study. The aim was to develop effective and sustainable large-scale treatment methods for lymphatic filariasis that are directed by the endemic communities themselves, and initiated and supported by the health services or other partners. The countries involved were Ghana, India, Kenya, Myanmar and Vietnam. This report presents the results for the two African sites.