RESUMO
Lymphatic filariasis (LF), also commonly known as elephantiasis, is a neglected tropical disease (NTD) caused by filarial parasites. The disease is transmitted via a bite from infected mosquitoes. The bites of these infected mosquitoes deposit filarial parasites, Wuchereria or Brugia, whose predilection site is the lymphatic system. The damage to the lymph system causes swelling in the legs, arms, and genitalia. A mapping survey conducted between 2003 and 2011 determined LF as being endemic in Zambia in 96 out of 116 districts. Elimination of LF is known to be possible by stopping the spread of the infection through large-scale preventive chemotherapy. Therefore, mass drug administration (MDA) with diethylcarbamazine citrate (DEC) (6 mg/kg) and Albendazole (400 mg) for Zambia has been conducted and implemented in all endemic districts with five effective rounds. In order to determine whether LF prevalence has been sufficiently reduced to levels less than 2% antigenemia and less than 1% microfilaremia, a pre-transmission assessment survey (pre-TAS) was conducted. Therefore, post-MDA pre-TAS was conducted between 2021 and 2022 in 80 districts to determine the LF prevalence. We conducted a cross-sectional seroprevalence study involving 600 participants in each evaluation unit (EU) or each district. The study sites (sentinel and spot-check sites) were from districts that were the implementation units (IUs) of the LF MDA. These included 80 districts from the 9 provinces. A total of 47,235 people from sentinel and spot-check locations were tested. Of these, valid tests were 47,052, of which 27,762 (59%) were females and 19,290 (41%) were males. The survey revealed in the 79/80 endemic districts a prevalence of Wb antigens of 0.14% and 0.0% prevalence of microfilariae. All the surveyed districts had an optimum prevalence of less than 2% for antigenaemia, except for Chibombo district. The majority of participants that tested positive for Wuchereria bancrofti (Wb) Antigens (Ag) were those that had 2, 3, and 4 rounds of MDA. Surprisingly, individuals that had 1 round of MDA were not found to have circulating antigens of Wb. The study showed that all the surveyed districts, except for Chibombo, passed pre-TAS. This further implies that there is a need to conduct transmission assessment surveys (TASs) in these districts.
RESUMO
BACKGROUND: Surgery for hydrocele is commonly promoted as part of morbidity management and disability prevention (MMDP) services for lymphatic filariasis (LF). However, uptake of these surgeries has been suboptimal owing to several community level barriers that have triggered mistrust in such services. This study aimed at documenting mechanisms of unlocking trust in community health systems (CHSs) in the context of a LF hydrocele management project that was implemented in Luangwa District, Zambia. METHODS: Qualitative data was collected through in-depth interviews (IDIs) and focus group discussions (FGDs) (n=45) in February 2020 in Luangwa District. Thirty-one IDIs were conducted with hydrocele patients, community health workers (CHWs), health workers, traditional leaders and traditional healers. Two FGDs were also conducted with CHWs who had been involved in project implementation with seven participants per group. Data was analyzed using a thematic analysis approach. RESULTS: The use of locally appropriate communication strategies, development of community driven referral systems, working with credible community intermediaries as well as strengthening health systems capacity through providing technical and logistical support enhanced trust in surgery for hydrocele and uptake of the surgeries. CONCLUSION: Implementation of community led communication and referral systems as well as strengthening health services are vital in unlocking trust in health systems as such mechanisms trigger authentic partnerships, including mutual respect and recognition in the CHS. The mechanisms also enhance confidence in health services among community members.
