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 currently 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 public-health services at the implementation level (ComDT/HS) has recently been compared with mass-treatment in which only the health services participated (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 probably adequate for filariasis elimination. HST coverage was particularly poor in 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 arm. As virtually all the subjects who received drugs swallowed them, compliance with treatment was not a problem. The ComDT/HS approach is therefore recommended, especially for areas where access to health facilities is poor and the health workers are over-stretched. The implications of these findings for the global programme for filariasis elimination are discussed.
Health Research Unit, Ministry of Health, P.O. Box GP-184, Accra, Ghana.
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Gyapong
J O
JO
Gyapong
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G
Owusu-Banahene
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration; D004605:Elephantiasis, Filarial / Q000188:drug therapy* / Q000453:epidemiology; D019353:Endemic Diseases / Q000517:prevention & control*; D005260:Female; D005369:Filaricides / Q000008:administration & dosage* / Q000600:supply & distribution; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007559:Ivermectin / Q000008:administration & dosage* / Q000600:supply & distribution; D008297:Male; D008509:Medication Systems / Q000458:organization & administration*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance; D010358:Patient Participation
D005369:Filaricides; D007559:Ivermectin