The Africa Region Neglected Tropical Diseases (NTD) Programme includes lymphatic filariasis providing technical orientation, support and guidance to Member States in the WHO African Region in order to contribute to the accelerated prevention, control, elimination and eradication of Neglected Tropical Diseases (NTDs) and Zoonoses.
Vision: An African Region free of Neglected Tropical Diseases.
Goal: To accelerate the reduction of the disease burden through the control, elimination and eradication of targeted NTDs and contribute to poverty alleviation, increased productivity and better quality of life of the affected people in the African Region— lymphatic filariasis and trachoma by 2020, advanced control of schistosomiasis and soil-transmitted helminthiasis by 2020 and onchocerciasis by 2025.Achievements, constraints, challenges and lessons learnt.
According to the 2017 WHO Weekly Epidemiological Report, based on data reported from 24 countries, 211.1 million persons were reported covered in MDA for a regional coverage of 56.9%. This marks a continuing increase in coverage for the past 5 years with 104.7 million more people treated than in 2012. Angola and Chad initiated MDA in 2016. Côte d’Ivoire, Mozambique and Zambia scaled MDA to all endemic IUs for the first time. Not only did Zimbabwe start MDA in 2016, the programme also achieved 100% geographical coverage. Despite the notable progress, the most immediate challenge to overcome in the region is starting MDA in all endemic areas. The following countries increased MDA treatments in 2016 but have not yet implemented MDA in all endemic IUs: Democratic Republic of Congo, Ethiopia, Guinea, Madagascar, and Nigeria. MDA needs to start urgently in Equatorial Guinea, Sao Tome and Principe and South Sudan. Comoros needs to restart MDA after unsuccessful TAS in 2012. A report from Guinea Bissau is awaited. Because only few infections were identified across Gabon and in only 2 districts of Eritrea, these programmes are undergoing remapping to determine whether MDA for LF is warranted.
Togo is the first country in the region to eliminate LF as a public health problem establishing the proof of concept for the 33 other endemic countries. Malawi stopped MDA nationwide and MDA is scaling down rapidly across 9 other countries (Benin, Burkina Faso, Cameroon, Ghana, Mali, Niger, Sierra Leone, Uganda and United Republic of Tanzania) as TAS are passed. In the region, 95.8 million persons no longer require MDA. In 2016, 371.2 million persons were currently considered to require MDA in 32 countries.
A total of 64.2 million treatments were delivered in IUs co-endemic for LF and onchocerciasis in 19 countries. The number of countries delivering ivermectin alone for onchocerciasis in LF co-endemic IUs decreased from 5 to 2 indicating improved coordination between LF and onchocerciasis elimination programmes in 2016. Chad (5 IUs) and Democratic Republic of Congo (69 IUs) treated 7.3 million persons for onchocerciasis only in LF co-endemic areas. None of the 7 loiasis co-endemic countries implementing MDA in 2016 reported albendazole alone MDA in applicable IUs (Angola, Cameroon, Central Africa Republic, Chad, Congo, Democratic Republic of Congo, Nigeria). Equatorial Guinea, Gabon and South Sudan have not started MDA. A great achievement of the African Regional Programme Review Group (RPRG - which reviews national programmes, applications for drug donations, provides technical guidance and identifies operational research issues) is obtaining the enthusiasm of endemic countries to join the programme. The demand from them for assistance is far greater than the means available and this, although improving, has resulted in a prolonged period of disease mapping in those countries that are already implementing MDA; a slow rate of scaling up of national programmes to cover all the at-risk populations; and stagnation in the number of active programmes.
Insufficient funding is a major constraint. At this stage, the need for good evaluation data is critical and all efforts need to be carried out to obtain them. The major lesson learnt is that, for sustainability of the Global Programme, country ownership of the programmes, partnership-building at local, regional and global levels, as well as creation of synergies between disease control programmes, need to be highly encouraged.
The treatment regime in AFRO endemic countries is albendazole plus Mectizan in areas where LF is co-endemic with onchocerciasis and elsewhere with albendazole plus DEC (diethylcarbamazine).
The Africa Regional Programme Review Group (RPRG) is chaired by:
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