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Open Access Research article

Lessons from the Pacific programme to eliminate lymphatic filariasis: a case study of 5 countries

Clare Huppatz12, Corinne Capuano3, Kevin Palmer4, Paul M Kelly2 and David N Durrheim15*

Author Affiliations

1 Hunter New England Population Health Unit, New South Wales Health, Locked Bag 10, Wallsend, Australia

2 National Centre for Epidemiology and Population Health, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia

3 Pacific Programme to Eliminate Lymphatic Filariasis, Office of the World Health Organization Representative in the South Pacific, Suva, Fiji

4 Country Office, World Health Organization, Apia, Samoa

5 Hunter Medical Research Institute and School of Public Health and Medical Practice, University of Newcastle, Newcastle, New South Wales, Australia

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BMC Infectious Diseases 2009, 9:92  doi:10.1186/1471-2334-9-92

Published: 12 June 2009

Abstract

Background

Lymphatic Filariasis (LF) is an important Neglected Tropical Disease, being a major cause of disability worldwide. The Global Programme to Eliminate Lymphatic Filariasis aims to eliminate LF as a public health problem by the year 2020, primarily through repeated Mass Drug Administration (MDA). The Pacific region programme commenced in 1999. By June 2007, five of the eleven countries classified as endemic had completed five MDA campaigns and post-MDA prevalence surveys to assess their progress. We review available programme data and discuss their implications for other LF elimination programs in developing countries.

Methods

Reported MDA coverage and results from initial surveys and post-MDA surveys of LF using the immunochromatographic test (ICT) from these five Pacific Island countries (Tonga, Niue, Vanuatu, Samoa and Cook Islands) were analysed to provide an understanding of their quality and programme progress towards LF elimination. Denominator data reported by each country programme for 2001 was compared to official sources to assess the accuracy of MDA coverage data.

Results

Initial survey results from these five countries revealed an ICT prevalence of between 2.7 and 8.6 percent in individuals tested prior to commencement of the programme. Country MDA coverage results varied depending on the source of denominator data. Of the five countries in this case study, three countries (Tonga, Niue and Vanuatu) reached the target prevalence of <1% antigenaemia following five rounds of MDA. However, endpoint data could not be reliably compared to baseline data as survey methodology varied.

Conclusion

Accurate and representative baseline and post-campaign prevalence data is crucial for determining program effectiveness and the factors contributing to effectiveness. This is emphasised by the findings of this case study. While three of the five Pacific countries reported achieving the target prevalence of <1% antigenaemia, limitations in the data preclude identification of key determinants of this achievement.