title: Shrinking the Lymphatic Filariasis Map of Ethiopia: Reassessing the Population at Risk through Nationwide Mapping.
abstract: BACKGROUND
  Mapping of lymphatic filariasis (LF) is essential for the delineation of endemic implementation units and determining the population at risk that will be targeted for mass drug administration (MDA). Prior to the current study, only 116 of the 832 woredas (districts) in Ethiopia had been mapped for LF. The aim of this study was to perform a nationwide mapping exercise to determine the number of people that should be targeted for MDA in 2016 when national coverage was anticipated.
  
  
  RESULTS
  A two-stage cluster purposive sampling was used to conduct a community-based cross-sectional survey for an integrated mapping of LF and podoconiosis, in seven regional states and two city administrations. Two communities in each woreda were purposely selected using the World Health Organization (WHO) mapping strategy for LF based on sampling 100 individuals per community and two purposely selected communities per woreda. Overall, 130 166 people were examined in 1315 communities in 658 woredas. In total, 140 people were found to be positive for circulating LF antigen by immunochromatographic card test (ICT) in 89 communities. Based on WHO guidelines, 75 of the 658 woredas surveyed in the nine regions were found to be endemic for LF with a 2016 projected population of 9 267 410 residing in areas of active disease transmission. Combining these results with other data it is estimated that 11 580 010 people in 112 woredas will be exposed to infection in 2016.
  
  
  CONCLUSIONS
  We have conducted nationwide mapping of LF in Ethiopia and demonstrated that the number of people living in LF endemic areas is 60% lower than current estimates. We also showed that integrated mapping of multiple NTDs is feasible and cost effective and if properly planned, can be quickly achieved at national scale.
authors.affiliation: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom.
authors.forename: Maria P
authors.initials: MP
authors.lastname: Rebollo
authors.affiliation: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
authors.forename: Heven
authors.initials: H
authors.lastname: Sime
authors.affiliation: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
authors.forename: Ashenafi
authors.initials: A
authors.lastname: Assefa
authors.affiliation: London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Jorge
authors.initials: J
authors.lastname: Cano
authors.affiliation: Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom.|School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Kebede
authors.initials: K
authors.lastname: Deribe
authors.affiliation: Faculty of Infectious and Tropical Diseases, Rey Juan Carlos University, Madrid, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Gonzalez-Escalada
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Oumer
authors.initials: O
authors.lastname: Shafi
authors.affiliation: Brighton and Sussex Medical School, Falmer, Brighton, United Kingdom.
authors.forename: Gail
authors.initials: G
authors.lastname: Davey
authors.affiliation: London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Brooker
authors.affiliation: Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
authors.forename: Amha
authors.initials: A
authors.lastname: Kebede
authors.affiliation: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom.
authors.forename: Moses J
authors.initials: MJ
authors.lastname: Bockarie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004605:Elephantiasis, Filarial / Q000453:epidemiology*; D019353:Endemic Diseases; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D019371:Topography, Medical; D055815:Young Adult