A Success Story: Togo Is Moving toward Becoming the First Sub-Saharan African Nation to Eliminate Lymphatic Filariasis through Mass Drug Administration and Countrywide Morbidity Alleviation

• Type of Material: Article
• Authors: Yao Sodahlon, Emory University; Ameyo Monique Dorkenoo, Université de Lomé, Lomé, Togo; Kodjo Morgah, Ministère de la Sante, Lomé, Togo; Komlan Nabiliou, Ministère de la Sante, Lomé, Togo; Kossivi Agbo, Université de Lomé, Lomé, Togo; Rebecca Miller, Emory University; Michel Datagni, Ministère de la Sante, Lomé, Togo; Anders Seim, HDI (Health & Development International), Fjellstrand, Norway; Els Mathieu, Centers for Disease Control and Prevention
• Language: English
• Date: 2013-04-11
• Publisher: Public Library Sciences
• Publication Version: Final Published Version
• Copyright Statement: This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
• License: Creative Commons Universal : Public Domain Dedication
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pntd.0002080
• Title of Journal or Parent Work: PLoS Neglected Tropical Diseases
• Volume: 7
• Issue: 4
• Start Page: e2080
• End Page: e2080
• Grant/Funding Information: This article's authors did not receive any specific funding.; The achievements of the NPELF in Togo were made possible through generous funding from Health & Development International (HDI), the GFATM, CNTD of Liverpool School of Tropical Medicine, the Centers for Disease Control (CDC), USAID, the World Health Organization, and IMA World Health; as well as through generous drug donations from GlaxoSmithKline (GSK), Merck & Co., Inc., and the Mectizan Donation Program (MDP).
• Keywords: Mass drug administration; WHO; Togo; Transmission; Lymphatic filariasis; Infection; Morbidity alleviation; Tropical disease
• Research Categories: Health Sciences, Public Health; Health Sciences, Pharmacy; Biology, Virology; Health Sciences, Epidemiology

Abstract

Lymphatic filariasis (LF) is a debilitating vector-borne disease predominantly caused by the helminths Wuchereria bancrofti and Brugia malayi [1], [2]. Endemic in 72 countries, LF is responsible for 5.9 million DALYs lost and is implicated as the second leading cause of disability worldwide by the World Health Organization (WHO) [3]–[5]. Although 70% of those infected do not exhibit symptoms, almost all persons infected have subclinical damage to the lymphatic vessels [6], [7]. An estimated 40 million people are symptomatic with the predominant morbidities associated with LF: lymphedema and/or hydrocele [8]. In recognition of the worldwide burden of LF, in 1997, the World Health Assembly passed the resolution WHA 50.29 calling for collaborative efforts by member states to eliminate the disease as a public health problem [9]. In 2000, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) was formed in response to the WHA resolution and aimed to eliminate the disease by 2020. The program adopted a two-pronged strategy: (1) to interrupt transmission of the causal parasite and (2) to alleviate morbidities associated with the disease [10]. The two pillars of the GPELF's strategy form the basic framework for any successful LF program. Togo is one of the 34 African countries endemic for lymphatic filariasis and is surrounded by the endemic countries of Benin, Ghana, and Burkina Faso [11]. The National Program to Eliminate Lymphatic Filariasis (NPELF) was founded in 2000 and is one of the few LF programs that address the dual goals of the global elimination program on a national scale. Togo is the first sub-Saharan country to achieve probable interruption of transmission and to move to the post-MDA surveillance phase as defined by the WHO [12]. Here we describe the elements that proved successful in the national strategy to address LF in Togo.