Rapid assessment procedures to detect hidden endemic foci in areas not subjected to mass drug administration in Sri Lanka.
For the declaration of elimination of lymphatic filariasis, reliable epidemiological data in all parts of a country are required. In Sri Lanka, due to social disturbance, there are 3 provinces whose endemicity has been declared unknown. Further, a recent report revealed an endemic pocket, which is on the border with the district that was not covered by the national elimination program. These facts indicate the necessity of more extensive studies to discover hidden endemic foci. To facilitate such studies, we evaluated 2 methods of Rapid Assessment Procedure (RAP) in Hambantota district, where the filariasis endemicity was low: (1) indirect questioning by mailing a questionnaire to each local leader (IndQ), asking about the presence of clinical cases, and (2) focus group discussion (FGD) by villagers. The information given by people was validated with clinical examination by doctors (CE) and IgG4 ELISA using urine samples. In the results: there was a strong positive correlation between CE and ELISA rates. The hydrocele rates obtained by FGD or IndQ were associated significantly with CE rates. The rates by FGD or Cluster-IndQ ('modified' IndQ) were also associated significantly with ELISA rates. The IndQ was most cost-effective. Based on these findings, we have concluded that screening by IndQ and confirmation by the ELISA would be an effective and practical way in Sri Lanka to locate endemic foci in hitherto unsurveyed districts.
Filariasis Research Training and Service Unit, Department of Parasitology, Faculty of Medicine, University of Ruhuna, P.O. Box 70, Galle, Sri Lanka. Electronic address: tcyahath@yahoo.co.uk.
Thishan C
TC
Yahathugoda
Mirani V
MV
Weerasooriya
Toshihiko
T
Sunahara
Eisaku
E
Kimura
Wilfred A
WA
Samarawickrema
Makoto
M
Itoh
D000293:Adolescent; D002648:Child; D003625:Data Collection / Q000191:economics; D004605:Elephantiasis, Filarial / Q000453:epidemiology* / Q000517:prevention & control*; D019353:Endemic Diseases; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005369:Filaricides / Q000008:administration & dosage* / Q000494:pharmacology*; D040362:Geographic Information Systems; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012306:Risk; D013188:Sri Lanka / Q000453:epidemiology; D011795:Surveys and Questionnaires / Q000191:economics; D055815:Young Adult
D005369:Filaricides
GIS; Hidden endemic foci; Hydrocele; Lymphatic filariasis; Rapid assessment; Urine ELISA