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First round of mass drug administration in Haiti successful
A mass drug administration to eliminate lymphatic filariasis in Port-au-Prince, Haiti, was successful, with 71% taking the medication, according to recent data.
“WHO defines adequate mass drug administration coverage as 65% or better,” the researchers wrote in the Morbidity and Mortality Weekly Report. “The first mass drug administration in Port-au-Prince was conducted from November 2011 through 2012. In all, 71% of persons swallowed the tablets.”
WHO estimated that 120 million people globally were infected with lymphatic filariasis in 2010, and Haiti was one of four countries still endemic. In 2000, WHO called for the elimination of the disease by 2020, leading to annual mass drug administration. By 2011, at least one round of mass drug administration of albendazole (Albenza, Amedra Pharmaceuticals) and diethylcarbamazine (Hetrazan, Lederle) had been issued to all endemic areas in Haiti except for Port-au-Prince.
The researchers evaluated coverage in Port-au-Prince by conducting a stratified, three-stage cluster-sample survey in seven strata: internally displaced person (IDP) camps in six communes comprised one stratum, and non-IDP camp households in each of the six communes comprised six strata. A total of 6,345 adults answered for themselves and/or others in the household about taking the tablets, and 71% (95% CI, 69-74) had taken the drugs.
Another 1,976 completed a knowledge, attitudes and practices survey. The researchers found that 88% of the respondents knew about the mass drug administration before it began. Only half of the people who did not hear about it in advance took the tablets, compared with 74% of people who did hear about it in advance.
“[The coverage] demonstrates that despite substantial obstacles posed by recent natural disasters and public health emergencies, Haiti has taken an important step toward meeting the challenge of lymphatic filariasis elimination,” the researchers wrote. “Future mass drug administration efforts should incorporate strategies that were identified in this analysis as potentially important to increase coverage and sustain program success.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Lymphatic filariasisis (LF) a parasitic infection associated with lymphedema and hydrocele; 90% of the cases are caused by a worm caused by Wuchereria bancrofti. It’s been a huge problem globally for thousands of years. The first country to eliminate it was the People’s Republic of China. In the 1970s and 1980s, they began to scale up the concept of mass drug administration. The idea is that you can interrupt the transmission of the disease, and eliminate it as a public health problem, by treating everybody around the same time. The concept worked, and WHO, in collaboration with public and private partnerships such as the Global Alliance to Eliminate Lymphatic Filariasis, worked to apply this concept to other areas. Now the disease has been eliminated in more than 20 countries, including several countries in the Americas, such as Costa Rica, Trinidad, Tobago, Suriname, all countries in the Americas.
Applying this concept to Haiti — one of the four remaining LF-endemic countries in the Americas — has been challenging. Among the reasons for the persistent LF problem in Haiti is the country’s extreme poverty and depleted health system infrastructure, as well as periodic social unrest and associated low compliance rates. Then, just as progress was being made, the earthquake struck in 2010, which further disrupted the health system, ultimately leading to a vicious cholera outbreak. This paper gives us some cause for optimism. It indicates that now there is a level of coverage that could one day reach levels required to eliminate LF when done over a period of 4 to 5 years. These data suggest that if Haiti’s national program to eliminate LF continues to improve its level of coverage, we might eventually eliminate the disease in Haiti, just like we have in other countries in the Americas.