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14 years of mass drug administration in Ghana ... Keywords: Lymphatic filariasis, Ghana, Hotspots, Mass drug administrat

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Trans R Soc Trop Med Hyg 2016; 110: 690–695 doi:10.1093/trstmh/trx007

ORIGINAL ARTICLE

Persistent ‘hotspots’ of lymphatic filariasis microfilaraemia despite 14 years of mass drug administration in Ghana Nana-Kwadwo Biritwuma, Paul Yikpoteyb,*, Benjamin K. Marfoa, Samuel Odooma, Ernest O. Mensahb, Odame Asiedua, Bright Alomatua, Edward T. Herviea, Abednego Yeboaha, Serge Adec,d, Sven G. Hinderakere, Anthony Reidf, Kudakwashe C. Takarindad, Benjamin Koudoug and Joseph B. Koromab a

Neglected Tropical Diseases Programme, Ghana; bFamily Health International (FHI360), P.O. Box 4033, Accra, Ghana; cUniversity of Parakou, Benin; dInternational Union Against Tuberculosis and Lung Disease, France; eUniversity of Bergen, Bergen, Norway; f Operational Research Unit (LuxOR), Medical Department, Médecins Sans Frontières, Operational Centre Brussels, Luxembourg; g Liverpool School of Tropical Medicine, Filaria Programme Support Unit, Liverpool, UK *Corresponding author: Tel: +233 209374110; E-mail: [email protected], [email protected]

Received 19 December 2016; revised 29 January 2017; editorial decision 31 January 2017; accepted 1 February 2017 Background: Among the 216 districts in Ghana, 98 were declared endemic for lymphatic filariasis in 1999 after mapping. Pursuing the goal of elimination, WHO recommends annual treatment using mass drugs administration (MDA) for at least 5 years. MDA was started in the country in 2001 and reached national coverage in 2006. By 2014, 69 districts had ‘stopped-MDA’ (after passing the transmission assessment survey) while 29 others remained with persistent microfilaraemia (mf) prevalence (≥1%) despite more than 11 years of MDA and were classified as ‘hotspots’. Methods: An ecological study was carried out to compare baseline mf prevalence and anti-microfilaria interventions between hotspot and stopped-MDA districts. Results: Baseline mf prevalence was significantly higher in hotspots than stopped-MDA districts (p

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