RESUMO
In Nigeria, mass drug administration (MDA) for schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) has often been coordinated with other programs that receive greater external funding. As these programs reach stop MDA milestones, SCH and STH programs will likely need to transition implementation, or "mainstream," to domestic support. A mixed-methods study was conducted in four districts before (2021) and after (2022) mainstreaming to evaluate its impact on MDA coverage. Household surveys were done in 30 villages per district pre- and post-mainstreaming. All selected communities were eligible for STH treatment; around a third were eligible for SCH treatment. Mass drug administration was primarily conducted in schools. A total of 5,441 school-aged children were included in pre-mainstreaming and 5,789 were included in post-mainstreaming. Mass drug administration coverage was heterogeneous, but overall, mebendazole coverage declined nonsignificantly from 81% pre-mainstreaming to 76% post-mainstreaming (P = 0.09); praziquantel coverage declined significantly from 73% to 55% (P = 0.008). Coverage was significantly lower among unenrolled children or those reporting poor school attendance in nearly every survey. For the qualitative component, 173 interviews and 74 focus groups were conducted with diverse stakeholders. Respondents were deeply pessimistic about the future of MDA after mainstreaming and strongly supported a gradual transition to full government ownership. Participants formulated recommendations for effective mainstreaming: clear budget allocation by governments, robust and targeted training, trust building, and comprehensive advocacy. Although participants lacked confidence that SCH and STH programs could be sustained after reductions in external support, initial results indicate that MDA coverage can remain high 1 year into mainstreaming.
RESUMO
Transmission of Onchocerca volvulus (causing "river blindness") was interrupted in two states of Nigeria (Plateau and Nasarawa) in 2017 in accordance with 2016 WHO guidelines. Ivermectin mass drug administration was halted in January 2018, and posttreatment surveillance activities were conducted over a 3-year period. Vector Simulium damnosum s.l. flies were collected during the 2019 (39 sites) and 2020 (42 sites) transmission seasons. Head pools were tested by polymerase chain reaction for the presence of third-stage O. volvulus larvae; 15,585 flies were all negative, demonstrating an infective rate of < 1/2,000 with 95% confidence. In 2021, the Nigerian Federal Ministry of Health declared the two-state area as having eliminated transmission. Plateau and Nasarawa states are the first of 30 endemic states in Nigeria to have met the WHO criteria for onchocerciasis elimination. Post-elimination surveillance will need to continue given the risk of reintroduction of transmission from neighboring states.
Assuntos
Onchocerca volvulus , Oncocercose , Simuliidae , Animais , Humanos , Ivermectina/uso terapêutico , Oncocercose/tratamento farmacológico , Oncocercose/epidemiologia , Oncocercose/prevenção & controle , Administração Massiva de Medicamentos , Insetos VetoresRESUMO
Nigeria changed its goal for onchocerciasis from control to transmission elimination. Under the control program, ivermectin mass drug administration (MDA) focused only on hyper/meso-endemic local government areas (LGAs) identified by Rapid Epidemiological Mapping of Onchocerciasis as having ≥ 20% nodule rates. Because transmission is likely in some LGAs where nodule rates are < 20%, the new elimination paradigm requires MDA expansion. Determining which hypoendemic areas require MDA, termed onchocerciasis elimination mapping, is a major challenge. In 2016, we studied 19 ivermectin-naive hypoendemic LGAs in southern Nigeria that bordered LGAs under MDA. Fifty adults and 50 children (aged 5-10 years) were tested in 110 villages for onchocerciasis IgG4 antibody using an Ov16 rapid diagnostic test (RDT). A 10% subset of subjects provided a blood spot for confirmatory Ov16 ELISA. The mean prevalence of RDT positives was 0.5% in the 5,276 children tested (village range, 0.0-4.0%) versus 3.3% in 5,302 adults (village range, 0.0-58.0%). There was 99.3% agreement between the Ov16 RDT and ELISA. Six different MDA launch thresholds were applied to the RDT results based on different recommendations by the Nigeria Onchocerciasis Elimination Committee and the Onchocerciasis Technical Advisory Subgroup of the WHO. Mass drug administration targets for the same area varied tenfold by threshold chosen, from one LGA (population to be treated 221,935) to 13 LGAs (population 2,426,987). Because the Ov16 threshold selected will have considerable cost and resource implications, the decision to initiate MDA should incorporate entomological data demonstrating onchocerciasis transmission.
Assuntos
Oncocercose/epidemiologia , Adulto , Anticorpos Anti-Helmínticos/imunologia , Antiparasitários/uso terapêutico , Criança , Pré-Escolar , Erradicação de Doenças , Doenças Endêmicas , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Ivermectina/uso terapêutico , Governo Local , Loíase/epidemiologia , Masculino , Administração Massiva de Medicamentos , Pessoa de Meia-Idade , Nigéria/epidemiologia , Oncocercose/tratamento farmacológico , Oncocercose/prevenção & controle , Oncocercose/transmissão , PrevalênciaRESUMO
Following the halt of mass drug administration (MDA) for lymphatic filariasis (LF), the WHO recommends at least 4 years of post-treatment surveillance (PTS) to confirm that transmission recrudescence or importation does not occur. The primary means of evaluation during PTS is repeated transmission assessment surveys (TASs) conducted at 2- to 3-year intervals after TAS-1 stop-MDA surveys. This study reports the results of TAS-2 and TAS-3 surveys in Plateau and Nasarawa states (pop. 6.9 million) of Nigeria divided into a minimum of seven evaluation units (EUs) per TAS. A total of 26,536 first- and second-year primary school children (approximately 6-7 years old) were tested for circulating filarial antigen (CFA) between 2014 and 2017. Of 12,313 children tested in TAS-2 surveys, only five (0.04%) were CFA positive, with no more than two positive samples from any one EU, which was below the critical value of 20 per EU. Of 14,240 children tested in TAS-3 surveys, none (0%) were CFA positive. These results indicate that LF transmission remains below sustainable transmission levels and suggest that elimination of transmission has been achieved in Plateau and Nasarawa, Nigeria.
Assuntos
Albendazol/uso terapêutico , Filariose Linfática/epidemiologia , Filariose Linfática/prevenção & controle , Ivermectina/uso terapêutico , Administração Massiva de Medicamentos , Vigilância da População , Albendazol/administração & dosagem , Anti-Helmínticos/administração & dosagem , Anti-Helmínticos/uso terapêutico , Criança , Pré-Escolar , Feminino , Filaricidas/uso terapêutico , Humanos , Ivermectina/administração & dosagem , Masculino , Nigéria/epidemiologia , Estudos RetrospectivosRESUMO
The western region of Edo state in southern Nigeria is highly endemic for onchocerciasis. Despite years of mass drug administration (MDA) with ivermectin (IVM), reports suggest persistently high prevalence of onchocerciasis, presumably because of poor coverage. In 2016, twice-per-year treatment with IVM (combined with albendazole for lymphatic filariasis in the first round where needed) began in five local government areas (LGAs) of Edo state. We undertook a multistage cluster survey within 3 months after each round of MDA to assess coverage. First-round coverage was poor: among 4,942 people of all ages interviewed from 145 clusters, coverage was 31.1% (95% confidence intervals [CI]: 24.1-38.0%). Most respondents were not offered medicines. To improve coverage in the second round, three LGAs were randomized to receive MDA through a "modified campaign" approach focused on improved supervision and monitoring. The other two LGAs continued with standard MDA as before. A similar survey was conducted after the second round, interviewing 3,362 people in 87 clusters across the five LGAs. Coverage was not statistically different from the first round (40.0% [95% CI: 31.0-49.0%]) and there was no significant difference between the groups (P = 0.7), although the standard MDA group showed improvement over round 1 (P < 0.01). The additional cost per treatment in the modified MDA was 1.6 times that of standard MDA. Compliance was excellent among those offered treatment. We concluded that poor mobilization, medicine distribution, and program penetration led to low coverage. These must be addressed to improve treatment coverage in Edo state.
Assuntos
Filariose Linfática/tratamento farmacológico , Filaricidas/administração & dosagem , Administração Massiva de Medicamentos/estatística & dados numéricos , Oncocercose/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Albendazol/administração & dosagem , Albendazol/economia , Criança , Erradicação de Doenças/estatística & dados numéricos , Esquema de Medicação , Quimioterapia Combinada , Filariose Linfática/epidemiologia , Feminino , Filaricidas/economia , Humanos , Ivermectina/administração & dosagem , Ivermectina/economia , Governo Local , Masculino , Administração Massiva de Medicamentos/economia , Pessoa de Meia-Idade , Nigéria/epidemiologia , Oncocercose/epidemiologia , Prevalência , Inquéritos e Questionários , Resultado do Tratamento , Adulto JovemRESUMO
Stopping interventions is a critical decision for parasite elimination programmes. Quantifying the probability that elimination has occurred due to interventions can be facilitated by combining infection status information from parasitological surveys with extinction thresholds predicted by parasite transmission models. Here we demonstrate how the integrated use of these two pieces of information derived from infection monitoring data can be used to develop an analytic framework for guiding the making of defensible decisions to stop interventions. We present a computational tool to perform these probability calculations and demonstrate its practical utility for supporting intervention cessation decisions by applying the framework to infection data from programmes aiming to eliminate onchocerciasis and lymphatic filariasis in Uganda and Nigeria, respectively. We highlight a possible method for validating the results in the field, and discuss further refinements and extensions required to deploy this predictive tool for guiding decision making by programme managers.
Assuntos
Modelos Biológicos , Doenças Parasitárias/transmissão , Inquéritos e Questionários , Filariose Linfática/diagnóstico , Filariose Linfática/epidemiologia , Filariose Linfática/parasitologia , Filariose Linfática/transmissão , Humanos , Oncocercose/diagnóstico , Oncocercose/epidemiologia , Oncocercose/parasitologia , Oncocercose/transmissão , Doenças Parasitárias/diagnóstico , Doenças Parasitárias/epidemiologia , Doenças Parasitárias/parasitologia , Tamanho da Amostra , Uganda/epidemiologiaRESUMO
Ivermectin treatment can cause central nervous system adverse events (CNS-AEs) in persons with very high-density Loa loa microfilaremia (≥ 30,000 mf/mL blood). Hypoendemic onchocerciasis areas where L. loa is endemic have been excluded from ivermectin mass drug administration programs (MDA) because of the concern for CNS AEs. The rapid assessment procedure for L. loa (RAPLOA) is a questionnaire survey to assess history of eye worm. If ≥ 40% of respondents report eye worm, this correlates with ≥ 2% prevalence of very high-density loiasis microfilaremia, posing an unacceptable risk of CNS-AEs after MDA. In 2016, we conducted a L. loa study in 110 ivermectin-naïve, suspected onchocerciasis hypoendemic villages in southern Nigeria. In previous RAPLOA surveys these villages had prevalences between 10% and 67%. We examined 10,605 residents using the LoaScope, a cell phone-based imaging device for rapidly determining the microfilaria (mf) density of L. loa infections. The mean L. loa village mf prevalence was 6.3% (range 0-29%) and the mean individual mf count among positives was 326 mf/mL. The maximum individual mf count was only 11,429 mf/mL, and among 2,748 persons sampled from the 28 villages with ≥ 40% RAPLOA, the ≥ 2% threshold of very high Loa mf density could be excluded with high statistical confidence (P < 0.01). These findings indicate that ivermectin MDA can be delivered in this area with extremely low risk of L. loa-related CNS-AEs. We also concluded that in Nigeria the RAPLOA survey methodology is not predictive of ≥ 2% prevalence of very high-density L. loa microfilaremia.
Assuntos
Doenças Endêmicas/estatística & dados numéricos , Loa/isolamento & purificação , Loíase/epidemiologia , Carga Parasitária , Adolescente , Adulto , Animais , Criança , Pré-Escolar , Olho , Feminino , Filaricidas/uso terapêutico , Humanos , Ivermectina/uso terapêutico , Loa/patogenicidade , Loíase/diagnóstico , Loíase/parasitologia , Masculino , Administração Massiva de Medicamentos/métodos , Nigéria/epidemiologia , Prevalência , População Rural , Inquéritos e QuestionáriosRESUMO
The original version of this Article contained an error in the spelling of Emily Griswold, which was incorrectly given as Emily Grisworld. This error has now been corrected in both the PDF and HTML versions of the Article.
RESUMO
National onchocerciasis elimination committees (NOECs) serve to help ministries of health complete the pathway to successful verification of elimination of onchocerciasis (river blindness), as outlined in the 2016 World Health Organization guidelines. These guidelines, however, only take effect when the country believes it has reached a point that elimination can be demonstrated, and do not address the preceding milestones. Therefore, NOECs can be of great help with guiding and tailoring earlier planning, programming and assessments to empower national programs to aggressively move toward their countries' elimination goals. In this article, we provide suggestions for organizing NOECs and examples of four such committees that have successfully operated in Africa and the Americas.
Assuntos
Erradicação de Doenças/organização & administração , Internacionalidade , Oncocercose/prevenção & controle , África , América , Países em Desenvolvimento , Erradicação de Doenças/normas , Guias como Assunto , Humanos , Oncocercose Ocular/prevenção & controle , Organização Mundial da SaúdeRESUMO
BACKGROUND: Members of the Anopheles gambiae complex are important vectors of lymphatic filariasis (LF) in sub-Saharan Africa, but little is known about the relative contributions of all mosquitoes to lymphatic filariasis transmission in this area. METHODS: Over a 28 month period, mosquitoes were collected from 13 villages in Plateau and Nasarawa states in central Nigeria and dissected to determine W. bancrofti infection status. Wings and legs from a subset of the mosquitoes visually identified as A. gambiae s.l. were identified by PCR as either A. gambiae s.s. or A. arabiensis. RESULTS: A. gambiae s.s peaked in abundance during the rainy season while A. arabiensis predominated during drier parts of the year. Both species were found equally likely to be infected with the developing stages (L1-L3) of W. bancrofti (9.2% and 11.1%, respectively). Fewer A. funestus (1.1%, p < 0.001) were infected than A. gambiae s.l. CONCLUSION: Understanding the relative contributions of morphologically indistinguishable species to LF transmission is essential if PCR is to be performed on mosquito pools. In the study area, the use of mosquito pools composed of A. gambiae sibling species would not be problematic, as both A. gambiae s.s. and A. arabiensis contribute equally to LF transmission.
RESUMO
Nigeria has the largest population at risk for lymphatic filariasis (LF) in Africa. This study used a transmission assessment survey (TAS) to determine whether mass drug administration (MDA) for LF could stop in 21 districts, divided into four evaluation units (EUs), of Plateau and Nasarawa States, Nigeria, after 8-12 years of annual albendazole-ivermectin treatment. A total of 7,131 first- and second-year primary school children (approximately 6-7 years old) were tested for LF antigen by immunochromatographic test (ICT) from May to June 2012. The target sample size of 1,692 was exceeded in each EU (range = 1,767-1,795). A total of 25 (0.4%) individuals were ICT positive, with the number of positives in each EU (range = 3-11) less than the TAS cutoff of 20, meaning that LF transmission had been reduced below sustainable levels. As a result, 3.5 million annual albendazole-ivermectin treatments were halted in 2013. Combined with the previous halt of MDA for LF in other parts of Plateau and Nasarawa, these are the first Nigerian states to stop LF MDA statewide. Posttreatment surveillance is ongoing to determine if LF transmission has been interrupted.
Assuntos
Albendazol/administração & dosagem , Anti-Helmínticos/administração & dosagem , Filariose Linfática/epidemiologia , Filariose Linfática/prevenção & controle , Ivermectina/administração & dosagem , Vigilância da População , Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Antígenos de Helmintos/sangue , Criança , Cromatografia de Afinidade , Humanos , Ivermectina/uso terapêutico , Nigéria/epidemiologiaRESUMO
We conducted a cohort study on impact of effects of eight years of annual ivermectin mass treatment administered in eight villages in Imo State, Nigeria. Physical and visual acuity examinations carried out in 462 persons in 1995, prior to the launching of mass drug administration with ivermectin, were compared with re-examinations of 411 (89%) of these same individuals in 2002. We found that gross visual impairment decreased from 16% to 1%, nodule prevalence decreased from 59% to 18%, and papular dermatitis was reduced from 15% to 2%. No change was seen in leopard skin rates (14%). The only incident lesions were three subjects from a single community having the appearance of new nodules (e.g., nodules not identified in the 1995 examinations). Differences in community coverage did not appear to influence the benefit from treatment of individual residents.
Assuntos
Ivermectina/uso terapêutico , Oncocercose/tratamento farmacológico , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , NigériaRESUMO
The rapid immunochromatographic card test (ICT) for Wuchereria bancrofti circulating filarial antigen is being used to map areas endemic for lymphatic filariasis. However, the ICT is expensive; thus, surveys based on this test must be relatively limited. Our study was conducted to determine if village-based hydrocele surveys could be used to supplement the ICT surveys in the mapping activities. We compared in 144 Nigerian villages the two assessment methods, ICT and examination for clinical hydrocele, in random samples of 30 adults selected using a procedure that obtained 15 younger males (reported age = 16-39 years old) and 15 older males (> or = 40 years), based on the assumption that hydrocele rates may be more prevalent in older age groups. The men were asked if they had scrotal swelling, then examined and tested by the ICT. We found a weakly positive correlation between village prevalence determined by the ICT and hydrocele (r = 0.041, P < 0.001). Only villages with hydrocele rates of 20% or greater were also consistently classified as having endemic filariasis by the ICT. There was no correlation between an individual's ICT positivity and clinical presence of hydrocele, and questioning about scrotal swelling was not predictive for presence of hydrocele. More research is needed to determine if community level hydrocele prevalence surveys can offer an economical and broadly applicable supplement to the ICT for determining the endemicity of filariasis.
Assuntos
Antígenos de Helmintos/sangue , Filariose Linfática/complicações , Filariose Linfática/epidemiologia , Hidrocele Testicular/diagnóstico , Hidrocele Testicular/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Cromatografia , Filariose Linfática/parasitologia , Doenças Endêmicas , Humanos , Masculino , Microfilárias/isolamento & purificação , Pessoa de Meia-Idade , Nigéria/epidemiologia , Exame Físico , Prevalência , Kit de Reagentes para Diagnóstico , População Rural , Hidrocele Testicular/parasitologia , Fatores de Tempo , Wuchereria bancrofti/isolamento & purificaçãoRESUMO
This paper describes a pilot initiative to incorporate lymphatic filariasis (LF) elimination and urinary schistosomiasis (SH) control into a mature onchocerciasis control program based on community-directed ivermectin treatment in central Nigeria. In the same districts having onchocerciasis we found LF (as determined by blood antigen testing in adult males) in 90% of 149 villages with a mean prevalence of 22.4% (range 0-67%). Similarly, SH, as determined by dipstick reagent testing for blood in urine from school children, was found in 91% of 176 villages with a mean orevalence in school age children of 24.4% (range 0-87%). Health education and treatment interventions for SH resulted in 52,480 cumulative praziquantel treatments, and 159,555 combined onchocerciasis and LF treatments (with ivermectin and albendazole) as of the end of 2000. Treatments for onchocerciasis and LF were separated by at least 1 week from treatments for SH. There was no negative impact on the coverage of the onchocerciasis program by the addition of LF and SH activities.
Assuntos
Filariose Linfática/prevenção & controle , Oncocercose/prevenção & controle , Esquistossomose/prevenção & controle , Anti-Helmínticos/uso terapêutico , Filariose Linfática/epidemiologia , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Nigéria/epidemiologia , Oncocercose/epidemiologia , Praziquantel/uso terapêutico , Esquistossomose/epidemiologiaRESUMO
Lymphatic filariasis (LF) in rural southeastern Nigeria is transmitted mainly by Anopheles spp. mosquitoes. Potential coinfection with Loa loa in this area has prevented use of ivermectin in the mass drug administration (MDA) strategy for LF elimination because of potential severe adverse L. loa-related reactions. This study determined if long-lasting insecticidal net (LLIN) distribution programs for malaria would interrupt LF transmission in such areas, without need for MDA. Monthly entomologic monitoring was conducted in sentinel villages before and after LLIN distribution to all households and all age groups (full coverage) in two districts, and to pregnant women and children less than five years of age in the other two districts. No change in human LF microfilaremia prevalence was observed, but mosquito studies showed a statistically significant decrease in LF infection and infectivity with full-coverage LLIN distribution. We conclude that LF transmission can be halted in southeastern Nigeria by full-coverage LLIN distribution, without MDA.
Assuntos
Filariose Linfática/prevenção & controle , Mosquiteiros Tratados com Inseticida , Controle de Mosquitos/instrumentação , Animais , Anopheles/parasitologia , Pré-Escolar , Características da Família , Feminino , Humanos , Inseticidas , Ivermectina/farmacologia , Estudos Longitudinais , Malária/prevenção & controle , Nigéria , Gravidez , População RuralRESUMO
Nigeria is highly endemic for infection with Schistosoma haematobium, which most commonly manifests itself with blood in urine. To monitor the impact of annual mass drug administration (MDA) with Praziquantel for S. haematobium in Delta State, Nigeria, cross-sectional hematuria surveys of school children were conducted in 8 sentinel villages (SVs) at baseline (n=240) and after two annual doses (n=402). We assessed the comparability of three assessments of hematuria (child's reported history, nurse visual diagnosis (NVD) and dipstick) to determine the need for mass treatment. Dipstick was considered to be the gold standard. Prior to treatment, history and NVD each identified only the 3 most highly prevalent SVs, and overall this represented just 37.5% of the 8 SVs in need of treatment. Following treatment, after dipstick prevalence decreased by 88.5% (p<0.001), and history and NVD identified only one of two villages still needing treatment. The study suggests that dipsticks should be the recommended method for launching and monitoring mass treatment for S. haematobium.
Assuntos
Anti-Helmínticos/administração & dosagem , Monitoramento de Medicamentos/métodos , Heme/análise , Praziquantel/administração & dosagem , Schistosoma haematobium/patogenicidade , Esquistossomose Urinária/tratamento farmacológico , Urina/química , Adolescente , Animais , Criança , Pré-Escolar , Técnicas de Laboratório Clínico/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Nigéria , Prevalência , Schistosoma haematobium/efeitos dos fármacos , Esquistossomose Urinária/parasitologia , Instituições AcadêmicasRESUMO
The current strategy for interrupting transmission of lymphatic filariasis (LF) is annual mass drug administration (MDA), at good coverage, for 6 or more years. We describe our programmatic experience delivering the MDA combination of ivermectin and albendazole in Plateau and Nasarawa states in central Nigeria, where LF is caused by anopheline transmitted Wuchereria bancrofti. Baseline LF mapping using rapid blood antigen detection tests showed mean local government area (LGA) prevalence of 23% (range 4-62%). MDA was launched in 2000 and by 2003 had been scaled up to full geographic coverage in all 30 LGAs in the two states; over 26 million cumulative directly observed treatments were provided by community drug distributors over the intervention period. Reported treatment coverage for each round was ≥85% of the treatment eligible population of 3.7 million, although a population-based coverage survey in 2003 showed lower coverage (72.2%; 95% CI 65.5-79.0%). To determine impact on transmission, we monitored three LF infection parameters (microfilaremia, antigenemia, and mosquito infection) in 10 sentinel villages (SVs) serially. The last monitoring was done in 2009, when SVs had been treated for 7-10 years. Microfilaremia in 2009 decreased by 83% from baseline (from 4.9% to 0.8%); antigenemia by 67% (from 21.6% to 7.2%); mosquito infection rate (all larval stages) by 86% (from 3.1% to 0.4%); and mosquito infectivity rate (L3 stages) by 76% (from 1.3% to 0.3%). All changes were statistically significant. Results suggest that LF transmission has been interrupted in 5 of the 10 SVs, based on 2009 finding of microfilaremia ≥1% and/or L3 stages in mosquitoes. Four of the five SVs where transmission persists had baseline antigenemia prevalence of >25%. Longer or additional interventions (e.g., more frequent MDA treatments, insecticidal bed nets) should be considered for 'hot spots' where transmission is ongoing.
Assuntos
Filariose Linfática/tratamento farmacológico , Filariose Linfática/epidemiologia , Filaricidas/administração & dosagem , Wuchereria bancrofti/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Albendazol/administração & dosagem , Animais , Antígenos de Helmintos/sangue , Criança , Pré-Escolar , Quimioterapia Combinada/métodos , Filariose Linfática/prevenção & controle , Filariose Linfática/transmissão , Feminino , Humanos , Incidência , Ivermectina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Adulto JovemRESUMO
We evaluated the effect of annual ivermectin (IV) distribution for onchocerciasis on the prevalence of soil transmitted helminth (STH) infections in school-aged (SAC) and preschool-aged (PAC) children by comparing children in villages that had received treatment for 13 years to those from socioeconomically similar villages in untreated areas. We enrolled 1,031 SAC and 211 PAC for Kato Katz examinations. Treated areas had a lower prevalence of Ascaris (SAC: 3% versus 12%, P < 0.0001; PAC: 3% versus 10%, P < 0.051) and Trichuris (SAC: 6% versus 10%, P = 0.012; PAC: 1% versus 8%, P = 0.019), but not hookworm (SAC: 38% versus 42%, P = 0.20; PAC: 21% versus 27%, P = 0.30). The prevalence of Ascaris or Trichuris in treated areas was below the WHO threshold for mass antihelminthic treatment (MDA), but not for hookworm. We conclude that benzimidazole MDA in IV treatment areas is indicated to effectively control hookworm.
Assuntos
Antiparasitários/uso terapêutico , Helmintos/isolamento & purificação , Intestinos/parasitologia , Ivermectina/uso terapêutico , Oncocercose/tratamento farmacológico , Adolescente , Animais , Criança , Pré-Escolar , Humanos , Ivermectina/farmacologia , PrevalênciaRESUMO
This report describes how Nigeria, a country that at one time had the highest number of cases of dracunculiasis (Guinea worm disease) in the world, reduced the number of cases from more than 653,000 in 1988 to zero in 2009, despite numerous challenges. Village-based volunteers formed the foundation of the program, which used health education, cloth filters, vector control, advocacy for safe water, voluntary isolation of patients, and monitored program interventions and cases reported monthly. Other factors in the program's success were strong governmental support, advocacy by a former head of state of Nigeria, technical and financial assistance by The Carter Center, the U.S. Centers for Disease Control and Prevention, the United Nations Children's Fund, the World Health Organization, and many other partners and donors. The estimated cost of the Nigerian program during 1988-2009 is $37.5 million, not including funding for water supply projects or salaries of Nigerian governmental workers.
Assuntos
Dracunculíase/epidemiologia , Dracunculíase/prevenção & controle , Programas Nacionais de Saúde/organização & administração , Anti-Helmínticos/uso terapêutico , Controle de Doenças Transmissíveis/métodos , Surtos de Doenças/prevenção & controle , Dracunculíase/tratamento farmacológico , Saúde Ambiental , Filtração , Educação em Saúde , Humanos , Programas Nacionais de Saúde/economia , Nigéria/epidemiologia , Fatores de Tempo , Água/parasitologia , Abastecimento de Água/normasRESUMO
In a pilot program of mass surgery weeks (MSW) to provide hydrocelectomy services to men with filarial scrotal hydrocele, local general practitioners performed 425 surgical repairs in 301 men in five MSW in three rural Nigerian community hospitals between 2002 and 2005. The most common (94%) procedure used was the eversion technique, which was most familiar to the practitioners. Postoperative complications included hematoma (3.7%) and infection (3%), and there was one death from infection in an elderly man with previously unrecognized diabetes. In 115 patients (38%) followed for 1 to 3 years, the hydrocele recurrence rate was 7%. The eversion technique gives an acceptable outcome, and MSW are safe and effective if strict attention is paid to preoperative screening of candidates and asepsis.