ABSTRACT
BACKGROUND: Lymphatic filariasis (LF) is targeted for global elimination through treatment of entire at-risk populations with repeated annual mass drug administration (MDA). Essential for program success is defining and confirming the appropriate endpoint for MDA when transmission is presumed to have reached a level low enough that it cannot be sustained even in the absence of drug intervention. Guidelines advanced by WHO call for a transmission assessment survey (TAS) to determine if MDA can be stopped within an LF evaluation unit (EU) after at least five effective rounds of annual treatment. To test the value and practicality of these guidelines, a multicenter operational research trial was undertaken in 11 countries covering various geographic and epidemiological settings. METHODOLOGY: The TAS was conducted twice in each EU with TAS-1 and TAS-2 approximately 24 months apart. Lot quality assurance sampling (LQAS) formed the basis of the TAS survey design but specific EU characteristics defined the survey site (school or community), eligible population (6-7 year olds or 1(st)-2(nd) graders), survey type (systematic or cluster-sampling), target sample size, and critical cutoff (a statistically powered threshold below which transmission is expected to be no longer sustainable). The primary diagnostic tools were the immunochromatographic (ICT) test for W. bancrofti EUs and the BmR1 test (Brugia Rapid or PanLF) for Brugia spp. EUs. PRINCIPAL FINDINGS/CONCLUSIONS: In 10 of 11 EUs, the number of TAS-1 positive cases was below the critical cutoff, indicating that MDA could be stopped. The same results were found in the follow-up TAS-2, therefore, confirming the previous decision outcome. Sample sizes were highly sex and age-representative and closely matched the target value after factoring in estimates of non-participation. The TAS was determined to be a practical and effective evaluation tool for stopping MDA although its validity for longer-term post-MDA surveillance requires further investigation.
Subject(s)
Disease Transmission, Infectious/prevention & control , Elephantiasis, Filarial/drug therapy , Elephantiasis, Filarial/transmission , Filaricides/therapeutic use , Animals , Brugia/isolation & purification , Child , Elephantiasis, Filarial/epidemiology , Elephantiasis, Filarial/prevention & control , Epidemiological Monitoring , Female , Humans , Male , Wolbachia/isolation & purificationABSTRACT
Se realizó una primera aproximación al diagnóstico de la situación de la población de Sabana Grande de Boyá con la participación de la comunidad organizada, encontrándose condiciones deplorables de existencia producto del modelo económico que sustenta su economía: el cultivo monopólico del azúcar, expresadas en altas tasas de mortalidad y morbilidad general, observándose una distribución diferencial de los procesos mórbidos y siendo los grupos más afectados aquellos sometidos al sistema de explotación propio del modelo económico mencionado. Frente a esta situación, encontramos un sector de salud estatal debilitado, incapaz de dar respuesta a la demanda real de la población, exhibiendo una gran subutilización de sus recursos, con muy bajos niveles de eficiencia evidenciados por una baja productividad y cobertura, y funcionando totalmente aislados de la población destinataria de dichos servicios
Subject(s)
Humans , Health Status , Health Status Indicators , Health Services , Dominican RepublicABSTRACT
Describe un proyecto que contempla la generación del conocimiento de la magnitud, distribución y factores asociados a la transmisión de las enfermedades tropicales en el país, con el objeto de orientar el desarrollo infraestructural acorde con las necesidades reales. Plantea el fortalecimiento y ampliación de las estructuras necesarias para la vigilancia epidemiológica con cobertura nacional, orientado al manejo integral y automatizado de la información referente a las enfermedades tropicales. Los componentes del proyecto son: investigación, vigilancia y control epidemiológico, capacitación de recursos humanos, asesorías e intercambio tecnico y evaluación sistemática y permanente