For more information on research and collaboration related to this topic in Uganda, please contact the officer responsible at;
Mr. Gabriel Matwale,
Vector Control Division (MoH),
Plot 15 Bombo Road,
P.O Box 1661, Kampala, Uganda
MINISTRY OF HEALTH
Press Statement on Programme to Eliminate Lymphatic Filariasis (PELF).
Uganda has moved closer to its goal of eliminating Lymphatic Filariais commonly known as Elephantiasis nationwide by the year 2020. Lymphatic filariasis (LF), resulting from infection with the mosquito –borne parasitic nematode Wuchereria bancrofti is endemic in Uganda. It results in considerable suffering and debilitating clinical disease. It is one the diseases targeted for elimination by World Health Organization (WHO).
The commitment to eliminate LF is enshrined in World Health Assembly (WHA) resolution WHA 50.29 (May 1997) urging member states to strengthen activities towards eliminating LF as a public health problem” and “requests the Director –General of WHO to mobilize support for global and national elimination activities” Armed with this resolution, Global Alliance to eliminate lymphatic filariasis (GAELF) was formed in May 2000 during a meeting held in Spain to support GPELF based in WHO in fundraising, advocacy, communications and technical assistance. Another meeting held in May 2002 in India focused on National ownership of elimination programme, with spot light on poverty alleviation and sustainable development.
In Uganda most reports on LF were based on clinical cases seen in hospitals, until in 1998 when epidemiological surveys were conducted by Vector Control Division in the districts of Lira, Soroti and Katakwi. This provided insights on the infection characteristics, clinical spectrum, transmission dynamics (including vectors) and some socio–economic impact. The communities were found to be highly endemic to LF with high prevalence of microfilaria (9-20%), specific circulating filarial antigenaemia-CFA (18-30%), hydroceles (Men>20 years 7-28%) and elephantiasis (adults 4-10%). This survey found significant association between the causative agents with chronic manifestation of LF
Epidemiological mapping of the distribution of LF in Uganda was done using CFA between October 2000 and April 2003 as a pre-requisite for initiating treatment control interventions. CFA prevalence ranged from 0.4 % in the districts of Hoima and Kibaale to 30% in Yumbe. These result in addition to earlier surveillance helped to provide information about the geographical magnitude of the disease with currently more than 146 million people at risk of infection. The results from this mapping lead to the creation of the program to Eliminate Lymphatic Filariasis.
The major goals of the program include; elimination of LF as a public health problem by 2020 and alleviation of physical, social and economic hardship in individuals who have LF-induced disability. These goals have been achieved through the following strategies; interruption of transmission by treating all at risk eligible populations with Albendazole and Invermectin once a year for 4-6 years and disability management to reduce suffering of patients having chronic manifestation through home-based long-term care, increasing access to hydrocelectomy and community care, inclusion and counseling.
Uganda launched its LF Elimination (LFE) program in 2002, in line with World Health Assembly resolution of 1997. The strategy adopted for elimination was Mass Drug Administration (MDA) once a year to all at risk populations using Ivermectin and Albendazole, co-administered. The first MDA covered 2 highly endemic districts in northern and Eastern Uganda, with an eligible population of about one million. A coverage of about 75% was achieved. Plans to scale up MDA to 8 districts in 2003 did not materialize due to civil war, instability due to cattle rustling in the north and Eastern regions and also lack of funds. In 2004, MDA covered 5 districts and this expanded to a total of 10 districts in 2005. In 2006, there was no MDA because of lack of funds. However in 2007, LFE joined other vertical MoH Programs in an integrated program under the umbrella of Neglected Tropical Disease (NTD) Control Program. The NTD Control Program, funded by USAID, commenced in 2007. As a result of this funding, in 2007/2008 LFE completed mapping and later scaled up to 38 districts. In 2010, all the 54 LF endemic districts were covered under MDA and to date all endemic districts have had 3 or more MDAs. However, maintenance of effective coverage of 65% is still a challenge especially in the Post conflict districts in the north.
Map of Uganda showing the current distribution of Lymphatic Filariasis in Uganda
This greatest achievements made so far in the fight against LF; country-wide mapping done with 54 out of 112 districts endemic for LF, treatment programme which was launched in 2002 in then Katakwi and Lira districts and later scaled-up in the country with is now having all the endemic district under treatment. Evaluations show promising results of decline in microfilariae prevalence of below 1% in all sentinel sites. Sixteen districts passed Transmission Assessment surveys (TAS) and requested to stop MDA and start surveillance. Seventeen districts are in the process of organizing TAS.
This success story has been through the effort of the Ministry of Health’s Programme to Eliminate Lymphatic Filariasis (PELF) with support of the implementing partners including: RTI/ENVISION Merck Co. Inc., Danish Bilharziasis Laboratory, GlaxoSmithKline and Taskforce for Global Health. We also acknowledge the support of the District Local Governments; the district NTD Focal Persons and community medicine distributors; and the communities for their support and cooperation that allowed this to be achieved.
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