Elimination of lymphatic filariasis as a public health problem in Malawi.

• Published in: PLOS Neglected Tropical Diseases
• Main Authors: John Chiphwanya, Square Mkwanda, Storn Kabuluzi, Themba Mzilahowa, Bagrey Ngwira, Dorothy E Matipula, Limbikani Chaponda, Paul Ndhlova, Prince Katchika, Chawananga Mahebere Chirambo, Philemon Moses, Justin Kumala, Martin Chiumia, Carrie Barrett, Hannah Betts, Joan Fahy, Maria Rebollo Polo, Lisa Reimer, Michelle C Stanton, Brent Thomas, Sian Freer, David H Molyneux, Moses J Bockarie, Charles D Mackenzie, Mark J Taylor, Sarah Martindale, Louise A Kelly-Hope
• Format: Article in Journal/Newspaper
• Language: English
• Published: Public Library of Science (PLoS) 2024
• Subjects: Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic
• Online Access: https://doi.org/10.1371/journal.pntd.0011957; https://doaj.org/article/126240df225f4b70a55ec51cda07b6bf

Background Lymphatic filariasis (LF) is a parasitic disease transmitted by mosquitoes, causing severe pain, disfiguring, and disabling clinical conditions such as lymphoedema and hydrocoele. LF is a global public health problem affecting 72 countries, primarily in Africa and Asia. Since 2000, the World Health Organization (WHO) has led the Global Programme to Eliminate Lymphatic Filariasis (GPELF) to support all endemic regions. This paper focuses on the achievements of the Malawi LF Elimination Programme between 2000 and 2020 to eliminate LF as a public health problem, making it the second sub-Saharan country to receive validation from the WHO. Methodology/principal findings The Malawi LF Programme addressed the widespread prevalence of LF infection and disease across the country, using the recommended WHO GPELF strategies and operational research initiatives in collaboration with key national and international partners. First, to stop the spread of infection (i.e., interrupt transmission) and reduce the circulating filarial antigen prevalence from as high as 74.4% to below the critical threshold of 1-2% prevalence, mass drug administration (MDA) using a two-drug regime was implemented at high coverage rates (>65%) of the total population, with supplementary interventions from other programmes (e.g., malaria vector control). The decline in prevalence was monitored and confirmed over time using several impact assessment and post-treatment surveillance tools including the standard sentinel site, spot check, and transmission assessment surveys and alternative integrated, hotspot, and easy-access group surveys. Second, to alleviate suffering of the affected populations (i.e., control morbidity) the morbidity management and disability prevention (MMDP) package of care was implemented. Specifically, clinical case estimates were obtained via house-to-house patient searching activities; health personnel and patients were trained in self-care protocols for lymphoedema and/or referrals to hospitals for hydrocoele ...