Impact of mass drug administration of ivermectin and albendazole on the prevalence of lymphatic filariasis in the Nzema East and Ahanta West Districts

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Lymphatic filariasis (LF) is considered a public health problem by WHO. The Global Programme to Eliminate Lymphatic Filariasis (GPELF) targets <1% prevalence by 2020. After more than a decade of implementing the annual mass administration of ivermectin and albendazole in Ghana, this study was conducted to assess its impact on LF prevalence in the Ahanta West and Nzema East Districts of the Western Region. A total of 2,626 adults living in the endemic communities were recruited and tested for microfilaraemia (mf) and circulating filarial antigen (CFA). The study participants were also interviewed to determine the number of rounds of ivermectin and albendazole received. The survey revealed 15.6% of the study participants tested positive for mf whilst 39.2% were positive for antigenaemia. Prevalence rates of mf and antigenaemia among the males were 20.9% and 44.4% respectively, higher than in females who recorded mf and antigenaemia prevalence of 5.8% and 29.7% respectively. The prevalence of lymphedema was 10.1% and that of hydrocele was 40.3%. The prevalence rates were generally higher in younger age groups between 18 and 40 years but declined as the ages increased. The prevalence rates of mf, antigenaemia, hydrocele and lymphedema decreased as the number of MDA rounds increased. After more than ten years of the MDA programme, 97% of study participants had received less than 6 rounds of ivermectin. Non-compliance was higher in males than females and the age group with the highest level of non-compliance was 18-30 years. Prevalence rates among participants who had received at least 7 rounds of ivermectin were <1%. The MDA programme is therefore an effective way of reducing the prevalence of LF and its pathologies. High non-compliance by people living in endemic areas contributes to the persistently high prevalence rates. This poses a threat to the target to eliminate lymphatic filariasis by 2020 and hence a strategy must be employed to ensure a sustained success.
A thesis submitted to the Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology in partial fulfillment of the requirements for the degree of Master of Philosophy