Strategies for the ENdgame: Targeting Infections among Non-compliants in the Elimination of Lymphatic filariasis (SENTINEL), SENTINEL PHASE I
Ghana
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Reference ID
NMIMR_SENTINEL_PHASE_I_2017
Producer(s)
Dziedzom K. de Souza
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Created on
Jun 08, 2023
Last modified
Jul 14, 2023
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389
Identification
Survey ID Number
NMIMR_SENTINEL_PHASE_I_2017
Title
Strategies for the ENdgame: Targeting Infections among Non-compliants in the Elimination of Lymphatic filariasis (SENTINEL), SENTINEL PHASE I
Subtitle
SENTINEL PHASE I
Abbreviation or Acronym
SENTINEL PHASE I
Country
| Name | Country code |
|---|---|
| Ghana | GH |
Kind of Data
sample survey data[ssd]
Version
Version Description
v1
Version Date
2023-06-08
Scope
Notes
Many lymphatic filariasis (LF) endemic countries, including Ghana, have
successfully implemented mass drug administration (MDA) and made
significant progress towards the elimination of the disease as a public health
problem. Unfortunately, the existence of individuals who seldom or never take
part in MDA pose a threat to this success, as they may serve as reservoirs of
infection, re-infecting their communities. In this study we implemented
strategies to identify and treat these individuals, while also assessing their
level of infection, to inform programme actions. The study was undertaken in
the Ahanta West hotspot district in Ghana, which has received more than 17
rounds of MDA. Through the community registers used in recording
participation in MDAs, we identified and offered treatment to individuals who
were ineligible or inadvertently missed the last MDA in April 2021 (Engage and
Treat – E&T), or testing using the filariasis test strip followed by treatment to
community members who for various reasons chose not to participate in the
last MDA (Test and Treat – T&T). During the study, 23,879 individuals ranging
from 5 to 98 years were reached, of whom 78% were not captured in the MDA
register. Among the E&T group, 75.06% willingly received and swallowed the
treatment drugs. The remaining 24.94% were offered testing followed by a reengagement
to receive the drug in the T&T group. Overall, 22,830 (95.61%) of
participants were treated by either strategy. Of the participants in the T&T
group, 516 (8.66%; 95% CI= 7.96 – 9.41) were positive by the FTS. The highest
antigen prevalence was detected among children 5 to 10 years, with 16.59%
(95% CI= 12.02 – 22.06) and 22.54% (95% CI= 17.11 – 28.74) among females
and males, respectively. Mapping of the data revealed that most infections are
in a few select communities. Of the 516 FTS positives, 27.33% reportedly missed
MDA once, 18.41% missed MDA twice and 54.26% missed all of the last three
MDAs. The main reasons for missing MDA included absence (25.49%), travel
(21.24%), being unaware of MDA (20.27%), refusals to take the drug (10.65%),
illnesses (7.07%) and fear of adverse events (6.13%). This study demonstrates
that greater sensitization and engagement strategies, with a test and treat
strategy reserved for the most hesitant individuals, could significantly increase
the number of individuals who receive treatment and therefore help districts
reach their elimination targets by reducing the remaining reservoir or
infection. NTD programmes require new tools to help them identify,
engage and treat these individuals, as part of their overall monitoring and
evaluation strategy.
successfully implemented mass drug administration (MDA) and made
significant progress towards the elimination of the disease as a public health
problem. Unfortunately, the existence of individuals who seldom or never take
part in MDA pose a threat to this success, as they may serve as reservoirs of
infection, re-infecting their communities. In this study we implemented
strategies to identify and treat these individuals, while also assessing their
level of infection, to inform programme actions. The study was undertaken in
the Ahanta West hotspot district in Ghana, which has received more than 17
rounds of MDA. Through the community registers used in recording
participation in MDAs, we identified and offered treatment to individuals who
were ineligible or inadvertently missed the last MDA in April 2021 (Engage and
Treat – E&T), or testing using the filariasis test strip followed by treatment to
community members who for various reasons chose not to participate in the
last MDA (Test and Treat – T&T). During the study, 23,879 individuals ranging
from 5 to 98 years were reached, of whom 78% were not captured in the MDA
register. Among the E&T group, 75.06% willingly received and swallowed the
treatment drugs. The remaining 24.94% were offered testing followed by a reengagement
to receive the drug in the T&T group. Overall, 22,830 (95.61%) of
participants were treated by either strategy. Of the participants in the T&T
group, 516 (8.66%; 95% CI= 7.96 – 9.41) were positive by the FTS. The highest
antigen prevalence was detected among children 5 to 10 years, with 16.59%
(95% CI= 12.02 – 22.06) and 22.54% (95% CI= 17.11 – 28.74) among females
and males, respectively. Mapping of the data revealed that most infections are
in a few select communities. Of the 516 FTS positives, 27.33% reportedly missed
MDA once, 18.41% missed MDA twice and 54.26% missed all of the last three
MDAs. The main reasons for missing MDA included absence (25.49%), travel
(21.24%), being unaware of MDA (20.27%), refusals to take the drug (10.65%),
illnesses (7.07%) and fear of adverse events (6.13%). This study demonstrates
that greater sensitization and engagement strategies, with a test and treat
strategy reserved for the most hesitant individuals, could significantly increase
the number of individuals who receive treatment and therefore help districts
reach their elimination targets by reducing the remaining reservoir or
infection. NTD programmes require new tools to help them identify,
engage and treat these individuals, as part of their overall monitoring and
evaluation strategy.
Coverage
Geographic Coverage
Ahanta West District, Western Region of Ghana
Producers and sponsors
Primary investigators
| Name | Affiliation |
|---|---|
| Dziedzom K. de Souza | Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon-Accra, Ghana |
Funding Agency/Sponsor
| Name |
|---|
| Coalition for Operational Research on Neglected Tropical Diseases, which is funded at The Task Force for Global Health primarily by the Bill & Melinda Gates Foundation, by the United States Agency for International Development through its Neglected Tropical Diseases Program, and with UK aid from the British people |
Other Identifications/Acknowledgments
| Name |
|---|
| We are grateful to the study participants for freely participating in the study to share their invaluable views on the LF, MDA and how to improve participation in MDA activities. We thank the chiefs and people of the study communities for admitting the research team into Trop. Med. Infect. Dis. 2022, 7, 273 18 of 19 their communities and the AhantaWest District health management team for their support during fieldwork. We are also grateful to the research assistants who served as data collectors during fieldwork. |
Data Collection
Data Collection Mode
Review of MDA registers, Community Interviews and testing
Access policy
Contacts
| Name | Affiliation | |
|---|---|---|
| Dziedzom K. de Souza | Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon-Accra, Ghana | DdeSouza@noguchi.ug.edu.gh |
Access authority
| Name | Affiliation | URL | |
|---|---|---|---|
| Dziedzom K. de Souza | Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon-Accra, Ghana | Link | DdeSouza@noguchi.ug.edu.gh |
Disclaimer and copyrights
Copyright
Noguchi Memorial Institute for Medical Research