M. Gyapong et al., Community-directed treatment: the way forward to eliminating lymphatic filariasis as a public-health problem in Ghana, ANN TROP M, 95(1), 2001, pp. 77-86
Citations number
15
Categorie Soggetti
Envirnomentale Medicine & Public Health","Medical Research General Topics
The elimination of lymphatic filariasis as a public-health problem is curre
ntly dependent on the delivery of annual drug treatments to at least 80% of
the eligible members of endemic populations for at least 5 years. However,
for various reasons, this goal may not be achievable by the health systems
of most endemic countries in sub-Saharan Africa, particularly if treatment
is not community-directed.
In Ghana, community-directed ivermectin treatment involving the regular pub
lic-health services at the implementation level (ComDT/HS) has recently bee
n compared with mass-treatment in which only the health services participat
ed (HST). Health staff and the target communities appreciated the ComDT/HS
approach more than the HST approach and were more willing to participate in
the community-directed scheme. The treatment coverage achieved by ComDT/HS
(74.5%) was not only much higher than that of HST (43.5%) but also probabl
y adequate for filariasis elimination, HST coverage was particularly poor i
n villages located > 5 km from a health facility, but distance from such a
facility had no significant effect on treatment coverage in the ComDT/HS ar
m. As virtually all the subjects who received drugs swallowed them, complia
nce with treatment was not a problem. The ComDT/HS approach is therefore re
commended, especially for areas where access to health facilities is poor a
nd the health workers are over-stretched. The implications of these finding
s for the global programme for filariasis elimination are discussed.