| Moving Forward
LF elimination is a concerted effort that requires years of cooperation to ultimately achieve success. Not every country has been able to begin LF elimination efforts simultaneously. This section highlights those countries that have been especially successful in moving forward with a national LF elimination programme. Many of these countries began with pilot projects in one or two regions and are now facing the challenges of scaling up the program to cover all areas with LF in the country.
Countries with Current Programmes
The approximately 40 countries that currently have elimination programmes have been particularly successful in creating an environment to set up successful programmes, establishing effective task forces to oversee programme activities, mapping LF to determine where endemic areas within the country are, deciding on mass drug administration strategy and finally, creatively developing ways to help those afflicted with LF.
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Mapping
Twenty years ago, it was extremely difficult to determine whether LF existed in a particular community. Research into LF has led to the development of a simple, finger-prick diagnostic blood test, called an ICT. The ICT is very sensitive and specific to LF, detecting the infection within minutes, at any time of day, without the need for laboratory facilities. In areas where the presence of LF is unknown, a carefully chosen sample of schoolchildren is tested using the ICT cards. The area is classified as endemic if there are positive findings. The ICT, along with spatial analysis, has allowed communities to be mapped more efficiently. This, in turn, helps governments establish areas for targeted elimination activities.
- 52 countries have been totally mapped
- 16 countries are in the process of mapping
- 15 countries have not yet started mapping
Mass drug administration (MDA) for elimination
One of the two principal goals of the Global Programme is to interrupt transmission of infection, achieved by treating the entire at-risk population. Community-wide treatment entails the co-administration of two safe and effective drugs to members of endemic communities, once a year, for at least five years. This combination of drugs is either albendazole and Mectizan® (ivermectin) or albendazole and diethylcarbamazine (DEC). Mectizan® is given in African countries where river blindness and LF are co-endemic; DEC is used in all other locations. DEC can also be administered as DEC-fortified table/cooking salt to endemic communities for two years.
- In 2000, 12 countries covered 3 million people using the two-drug MDA.
- In 2001, 22 countries covered 26 million people using the two-drug MDA.
- In 2002, 32 countries covered 60 million people using the two-drug MDA.
- In 2003, 36 countries covered 86 million people using the two-drug MDA.
- In 2004, 35 countries covered 110 million people using the two-drug MDA.
Disability Management
The other principal goal of the Global Programme is to alleviate hardship in individuals with LF-induced disability. Because of the many different presentations of clinical disease, there is no one drug or treatment that is effective for all cases. However, for all patients, three issues should be considered: (1) anti-parasitic drug therapy, (2) supportive clinical care, and (3) patient education and counselling. Projects to assist individuals with lymphoedema and hydrocele are often implemented in concert with the primary health care system or NGOs established in the area. |
