Global Programme to Eliminate Lymphatic Filariasis ... - libdoc.who.int

28Annual Report on Lymphatic Filariasis 2003Chapter 1 Progress of the Global Programme to Eliminate Lymphatic FilariasisRESEARCHIvermectin and albendazoleA randomized, double-blind, placebo-controlled trial ofivermectin plus albendazole versus ivermectin was carriedout in Pemba, United Republic of Tanzania. Thestudy aimed at assessing:• drug reaction levels by day 7 post-administration;• the reappearance of mf by 12 months;• mf clearance at 3 and 6 months;• reduction in the magnitude and intensity of soiltransmittedhelminths on day 21 following MDA.The study has been completed and the evaluation reportis in the process of being prepared. The nationwide MDAundertaken just before completion of the parasitologicalsurvey may have affected the survey results.DEC and albendazoleA randomized, double-blind, placebo-controlled trial ofDEC plus albendazole versus DEC (three rounds) was carriedout in Wardha, India. The study aimed at assessing:• the safety and tolerability of the two drugs administeredtogether;• the efficacy in the clearance of microfilaraemia measuredat pre-treatment at 3 months, 6 months, 1 year,1.25 years, 1.5 years and 2 years.• the clearance of the filaria dance sign (FDS) at pretreatment,then at 3 months, 6 months and 1 yearafter each treatment.The study was successfully completed and the data arebeing evaluated.Development of evidence-based guidelines forelimination strategies using available drugcombinationsThe following transmission studies are being carried out.In Culex-prevalent regions• Pondicherry, India:— a multi-arm study with ivermectin alone, DECalone, ivermectin plus DEC and placebo has beenin place since 1993;— DEC plus albendazole versus DEC since 2001, afterreplacing the placebo arm in the above by DECplus albendazole.• Madurai, India:— comparing DEC plus albendazole versus DEC since2001.In Anopheles-prevalent regionsThree studies are in progress in Africa since 2001: one eachin Ghana and Mali where ivermectin plus albendazole coadministrationis being used, and the third in Kenya whereDEC plus albendazole co-administration is in use.Development of improved drug deliverystrategies, especially in urban settingsA multicentre study on MDA is in progress in urbanareas of Chennai, Varanasi and Orissa, India. The objectivesare to:• identify determinants of low coverage (compliance)in urban areas;• determine principal socioeconomic strata, priorityhealth and development needs, and importance of LF;• determine the potential for involvement of otherstakeholders in MDA;• develop and implement an intervention strategy thatmeets the challenges for MDA in urban areas;• evaluate the impact of this intervention strategy andthe treatment coverage achieved;• determine the cost-effectiveness of this interventionstrategy and the feasibility of its implementationusing existing human resources.The study is being carried out in two phases: the firstphase consists of a situation analysis and baseline survey,which has been completed, and the second comprisesintervention development and testing at scale.Community-based management oflymphoedema and adenolymphangitisMaliThe study showed that community members are of theopinion that:• prevention is a collective activity of the community;• care of the LF sufferer is the province of the family,as follows: