Community-directed treatment: the way forward to eliminating lymphatic filariasis as a public-health problem in Ghana

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.