Impact of mass drug administration for elimination of lymphatic filariasis in Nepal
Identifieur interne : 000244 ( Pmc/Checkpoint ); précédent : 000243; suivant : 000245Impact of mass drug administration for elimination of lymphatic filariasis in Nepal
Auteurs : Chet Raj Ojha [États-Unis] ; Basant Joshi [Népal] ; Khagendra Prakash Kc [Népal] ; Shyam Prakash Dumre [Japon] ; Keshav Kumar Yogi [Népal] ; Bandana Bhatta [Népal] ; Tulasi Adhikari [Népal] ; Kathryn Crowley [États-Unis] ; Babu Ram Marasini [Népal]Source :
- PLoS Neglected Tropical Diseases [ 1935-2727 ] ; 2017.
Abstract
Lymphatic filariasis (LF) is a neglected tropical disease transmitted by mosquitoes. Nepal has implemented a national effort to eliminate LF by 2020 through mass drug administration (MDA) using diethylcarbamazine (DEC) and albendazole (ALB). We assessed the impact of MDAs on LF in selected districts of Nepal after the recommended six MDA rounds had been completed.
Baseline surveys were conducted in seven districts and mapping data were used as baseline in the other three districts before starting MDA in 2009. LF antigen (Ag) prevalence ranged from 1.06% to 20% among districts included in the baseline and mapping study. The number of people who received DEC and ALB were recorded during each MDA round and population-based cluster surveys were conducted at least once in each district during the life of the program. The reported MDA coverage in five districts was consistently at least 65%. Two districts achieved the targeted coverage in four out of five rounds and the rest three districts achieved the target only in the first round. A pre-transmission assessment survey (pre-TAS) was conducted in one sentinel site and at least one spot check site in each of the districts after five MDA rounds. In pre-TAS, all the sites of five districts (Pyuthan, Arghakhanchi, Kaski, Bhaktapur, and Kathmandu) and all but one spot check site of Lalitpur district had LF Ag < 2% (ranging from 0.0% to 1.99%). Transmission assessment survey (TAS) was conducted in six evaluation units (EUs) consisting of six districts qualified on pre-TAS. Though MDA coverage of 65% was not achieved in three districts (Kathmandu, Lalitpur and Bhaktapur), Nepal government in consultation with World Health Organization (WHO) decided to conduct TAS. All six EUs achieved the LF Ag threshold required to stop MDA in TAS, despite the low reported MDA coverage in those three districts.
Although Nepal has achieved significant progress towards LF elimination, five rounds of MDA were not sufficient to disrupt the transmission cycle in all districts, probably because of high baseline prevalence.
Url:
DOI: 10.1371/journal.pntd.0005788
PubMed: 28723904
PubMed Central: 5536438
Affiliations:
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Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Immunogenetics, Institute of Tropical Medicine, Nagasaki University, Nagasaki</wicri:regionArea><wicri:noRegion>Nagasaki</wicri:noRegion></affiliation></author><author><name sortKey="Yogi, Keshav Kumar" sort="Yogi, Keshav Kumar" uniqKey="Yogi K" first="Keshav Kumar" last="Yogi">Keshav Kumar Yogi</name><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>World Health Organization, Lalitpur, Nepal</addr-line></nlm:aff><country xml:lang="fr">Népal</country><wicri:regionArea>World Health Organization, Lalitpur</wicri:regionArea><wicri:noRegion>Lalitpur</wicri:noRegion></affiliation></author><author><name sortKey="Bhatta, Bandana" sort="Bhatta, Bandana" uniqKey="Bhatta B" first="Bandana" last="Bhatta">Bandana Bhatta</name><affiliation wicri:level="1"><nlm:aff id="aff005"><addr-line>Save the Children International, Kathmandu, 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id="aff001"><addr-line>Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida</wicri:regionArea><placeName><region type="state">Floride</region></placeName></affiliation></author><author><name sortKey="Joshi, Basant" sort="Joshi, Basant" uniqKey="Joshi B" first="Basant" last="Joshi">Basant Joshi</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Leadership for Environment and Development Nepal, Kathmandu, Nepal</addr-line></nlm:aff><country xml:lang="fr">Népal</country><wicri:regionArea>Leadership for Environment and Development Nepal, Kathmandu</wicri:regionArea><wicri:noRegion>Kathmandu</wicri:noRegion></affiliation></author><author><name sortKey="Kc, Khagendra Prakash" sort="Kc, Khagendra Prakash" uniqKey="Kc K" first="Khagendra Prakash" last="Kc">Khagendra Prakash Kc</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Leadership for Environment and Development Nepal, Kathmandu, Nepal</addr-line></nlm:aff><country xml:lang="fr">Népal</country><wicri:regionArea>Leadership for Environment and Development Nepal, Kathmandu</wicri:regionArea><wicri:noRegion>Kathmandu</wicri:noRegion></affiliation></author><author><name sortKey="Dumre, Shyam Prakash" sort="Dumre, Shyam Prakash" uniqKey="Dumre S" first="Shyam Prakash" last="Dumre">Shyam Prakash Dumre</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Department of Immunogenetics, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan</addr-line></nlm:aff><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Immunogenetics, Institute of Tropical Medicine, Nagasaki University, Nagasaki</wicri:regionArea><wicri:noRegion>Nagasaki</wicri:noRegion></affiliation></author><author><name sortKey="Yogi, Keshav Kumar" sort="Yogi, Keshav Kumar" uniqKey="Yogi K" first="Keshav Kumar" last="Yogi">Keshav Kumar Yogi</name><affiliation wicri:level="1"><nlm:aff id="aff004"><addr-line>World Health Organization, Lalitpur, Nepal</addr-line></nlm:aff><country xml:lang="fr">Népal</country><wicri:regionArea>World Health Organization, Lalitpur</wicri:regionArea><wicri:noRegion>Lalitpur</wicri:noRegion></affiliation></author><author><name sortKey="Bhatta, Bandana" sort="Bhatta, Bandana" uniqKey="Bhatta B" first="Bandana" last="Bhatta">Bandana Bhatta</name><affiliation wicri:level="1"><nlm:aff id="aff005"><addr-line>Save the Children International, Kathmandu, Nepal</addr-line></nlm:aff><country xml:lang="fr">Népal</country><wicri:regionArea>Save the Children International, Kathmandu</wicri:regionArea><wicri:noRegion>Kathmandu</wicri:noRegion></affiliation></author><author><name sortKey="Adhikari, Tulasi" sort="Adhikari, Tulasi" uniqKey="Adhikari T" first="Tulasi" last="Adhikari">Tulasi Adhikari</name><affiliation wicri:level="1"><nlm:aff id="aff006"><addr-line>Epidemiology and Disease Control Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal</addr-line></nlm:aff><country xml:lang="fr">Népal</country><wicri:regionArea>Epidemiology and Disease Control Division, Ministry of Health and Population, Government of Nepal, Kathmandu</wicri:regionArea><wicri:noRegion>Kathmandu</wicri:noRegion></affiliation></author><author><name sortKey="Crowley, Kathryn" sort="Crowley, Kathryn" uniqKey="Crowley K" first="Kathryn" last="Crowley">Kathryn Crowley</name><affiliation wicri:level="1"><nlm:aff id="aff007"><addr-line>RTI International, Washington, District of Columbia, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>RTI International, Washington, District of Columbia</wicri:regionArea><wicri:noRegion>District of Columbia</wicri:noRegion></affiliation></author><author><name sortKey="Marasini, Babu Ram" sort="Marasini, Babu Ram" uniqKey="Marasini B" first="Babu Ram" last="Marasini">Babu Ram Marasini</name><affiliation wicri:level="1"><nlm:aff id="aff006"><addr-line>Epidemiology and Disease Control Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal</addr-line></nlm:aff><country xml:lang="fr">Népal</country><wicri:regionArea>Epidemiology and Disease Control Division, Ministry of Health and Population, Government of Nepal, Kathmandu</wicri:regionArea><wicri:noRegion>Kathmandu</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS Neglected Tropical Diseases</title><idno type="ISSN">1935-2727</idno><idno type="eISSN">1935-2735</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title><p>Lymphatic filariasis (LF) is a neglected tropical disease transmitted by mosquitoes. Nepal has implemented a national effort to eliminate LF by 2020 through mass drug administration (MDA) using diethylcarbamazine (DEC) and albendazole (ALB). We assessed the impact of MDAs on LF in selected districts of Nepal after the recommended six MDA rounds had been completed.</p></sec><sec id="sec002"><title>Methodology and principal findings</title><p>Baseline surveys were conducted in seven districts and mapping data were used as baseline in the other three districts before starting MDA in 2009. LF antigen (Ag) prevalence ranged from 1.06% to 20% among districts included in the baseline and mapping study. The number of people who received DEC and ALB were recorded during each MDA round and population-based cluster surveys were conducted at least once in each district during the life of the program. The reported MDA coverage in five districts was consistently at least 65%. Two districts achieved the targeted coverage in four out of five rounds and the rest three districts achieved the target only in the first round. A pre-transmission assessment survey (pre-TAS) was conducted in one sentinel site and at least one spot check site in each of the districts after five MDA rounds. In pre-TAS, all the sites of five districts (Pyuthan, Arghakhanchi, Kaski, Bhaktapur, and Kathmandu) and all but one spot check site of Lalitpur district had LF Ag < 2% (ranging from 0.0% to 1.99%). Transmission assessment survey (TAS) was conducted in six evaluation units (EUs) consisting of six districts qualified on pre-TAS. Though MDA coverage of 65% was not achieved in three districts (Kathmandu, Lalitpur and Bhaktapur), Nepal government in consultation with World Health Organization (WHO) decided to conduct TAS. All six EUs achieved the LF Ag threshold required to stop MDA in TAS, despite the low reported MDA coverage in those three districts.</p></sec><sec id="sec003"><title>Conclusions</title><p>Although Nepal has achieved significant progress towards LF elimination, five rounds of MDA were not sufficient to disrupt the transmission cycle in all districts, probably because of high baseline prevalence.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Nutman, Tb" uniqKey="Nutman T">TB Nutman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Storey, Dm" uniqKey="Storey D">DM Storey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Adhikari, R" uniqKey="Adhikari R">R Adhikari</name></author><author><name sortKey="Bhusal, K" uniqKey="Bhusal K">K Bhusal</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ottesen, 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Negl Trop Dis</journal-id><journal-id journal-id-type="iso-abbrev">PLoS Negl Trop Dis</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosntds</journal-id><journal-title-group><journal-title>PLoS Neglected Tropical Diseases</journal-title></journal-title-group><issn pub-type="ppub">1935-2727</issn><issn pub-type="epub">1935-2735</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28723904</article-id><article-id pub-id-type="pmc">5536438</article-id><article-id pub-id-type="doi">10.1371/journal.pntd.0005788</article-id><article-id pub-id-type="publisher-id">PNTD-D-16-01403</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject><subj-group><subject>Geographical Locations</subject><subj-group><subject>Asia</subject><subj-group><subject>Nepal</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Social Sciences</subject><subj-group><subject>Sociology</subject><subj-group><subject>Education</subject><subj-group><subject>Schools</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Parasitic Diseases</subject><subj-group><subject>Helminth Infections</subject><subj-group><subject>Filariasis</subject><subj-group><subject>Lymphatic Filariasis</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Tropical Diseases</subject><subj-group><subject>Neglected Tropical Diseases</subject><subj-group><subject>Lymphatic Filariasis</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Disease Vectors</subject><subj-group><subject>Insect Vectors</subject><subj-group><subject>Mosquitoes</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Species Interactions</subject><subj-group><subject>Disease Vectors</subject><subj-group><subject>Insect Vectors</subject><subj-group><subject>Mosquitoes</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Animals</subject><subj-group><subject>Invertebrates</subject><subj-group><subject>Arthropoda</subject><subj-group><subject>Insects</subject><subj-group><subject>Mosquitoes</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Body Fluids</subject><subj-group><subject>Blood</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Body Fluids</subject><subj-group><subject>Blood</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Physiology</subject><subj-group><subject>Body Fluids</subject><subj-group><subject>Blood</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Physiology</subject><subj-group><subject>Body Fluids</subject><subj-group><subject>Blood</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pharmaceutics</subject><subj-group><subject>Drug Therapy</subject><subj-group><subject>Drug Administration</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Organisms</subject><subj-group><subject>Animals</subject><subj-group><subject>Invertebrates</subject><subj-group><subject>Nematoda</subject><subj-group><subject>Filarial Worms</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Epidemiology</subject></subj-group></subj-group></article-categories><title-group><article-title>Impact of mass drug administration for elimination of lymphatic filariasis in Nepal</article-title><alt-title alt-title-type="running-head">Impact of MDA in Nepal</alt-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0002-6816-8892</contrib-id><name><surname>Ojha</surname><given-names>Chet Raj</given-names></name><role content-type="http://credit.casrai.org/">Conceptualization</role><role content-type="http://credit.casrai.org/">Data curation</role><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Funding acquisition</role><role content-type="http://credit.casrai.org/">Investigation</role><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Project administration</role><role content-type="http://credit.casrai.org/">Resources</role><role content-type="http://credit.casrai.org/">Software</role><role content-type="http://credit.casrai.org/">Validation</role><role content-type="http://credit.casrai.org/">Writing – original draft</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib><contrib contrib-type="author"><name><surname>Joshi</surname><given-names>Basant</given-names></name><role content-type="http://credit.casrai.org/">Data curation</role><role content-type="http://credit.casrai.org/">Investigation</role><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Resources</role><role content-type="http://credit.casrai.org/">Validation</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="author-notes" rid="currentaff001"><sup>¤</sup></xref></contrib><contrib contrib-type="author"><name><surname>KC</surname><given-names>Khagendra Prakash</given-names></name><role content-type="http://credit.casrai.org/">Conceptualization</role><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Software</role><role content-type="http://credit.casrai.org/">Validation</role><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Dumre</surname><given-names>Shyam Prakash</given-names></name><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Software</role><role content-type="http://credit.casrai.org/">Supervision</role><role content-type="http://credit.casrai.org/">Validation</role><role content-type="http://credit.casrai.org/">Visualization</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff003"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Yogi</surname><given-names>Keshav Kumar</given-names></name><role content-type="http://credit.casrai.org/">Methodology</role><role content-type="http://credit.casrai.org/">Software</role><role content-type="http://credit.casrai.org/">Supervision</role><xref ref-type="aff" rid="aff004"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Bhatta</surname><given-names>Bandana</given-names></name><role content-type="http://credit.casrai.org/">Investigation</role><role content-type="http://credit.casrai.org/">Resources</role><role content-type="http://credit.casrai.org/">Software</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff005"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Adhikari</surname><given-names>Tulasi</given-names></name><role content-type="http://credit.casrai.org/">Resources</role><xref ref-type="aff" rid="aff006"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Crowley</surname><given-names>Kathryn</given-names></name><role content-type="http://credit.casrai.org/">Formal analysis</role><role content-type="http://credit.casrai.org/">Writing – review & editing</role><xref ref-type="aff" rid="aff007"><sup>7</sup></xref></contrib><contrib contrib-type="author"><name><surname>Marasini</surname><given-names>Babu Ram</given-names></name><role content-type="http://credit.casrai.org/">Conceptualization</role><role content-type="http://credit.casrai.org/">Resources</role><role content-type="http://credit.casrai.org/">Supervision</role><role content-type="http://credit.casrai.org/">Validation</role><role content-type="http://credit.casrai.org/">Visualization</role><xref ref-type="aff" rid="aff006"><sup>6</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>Department of Immunology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America</addr-line></aff><aff id="aff002"><label>2</label><addr-line>Leadership for Environment and Development Nepal, Kathmandu, Nepal</addr-line></aff><aff id="aff003"><label>3</label><addr-line>Department of Immunogenetics, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan</addr-line></aff><aff id="aff004"><label>4</label><addr-line>World Health Organization, Lalitpur, Nepal</addr-line></aff><aff id="aff005"><label>5</label><addr-line>Save the Children International, Kathmandu, Nepal</addr-line></aff><aff id="aff006"><label>6</label><addr-line>Epidemiology and Disease Control Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal</addr-line></aff><aff id="aff007"><label>7</label><addr-line>RTI International, Washington, District of Columbia, United States of America</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Reithinger</surname><given-names>Richard</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>RTI International, UNITED STATES</addr-line></aff><author-notes><fn fn-type="COI-statement" id="coi001"><p>The authors have declared that no competing interests exist.</p></fn><fn fn-type="current-aff" id="currentaff001"><label>¤</label><p>Current address: Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia</p></fn><corresp id="cor001">* E-mail: <email>cojha001@fiu.edu</email></corresp></author-notes><pub-date pub-type="epub"><day>19</day><month>7</month><year>2017</year></pub-date><pub-date pub-type="collection"><month>7</month><year>2017</year></pub-date><volume>11</volume><issue>7</issue><elocation-id>e0005788</elocation-id><history><date date-type="received"><day>2</day><month>8</month><year>2016</year></date><date date-type="accepted"><day>6</day><month>7</month><year>2017</year></date></history><permissions><copyright-statement>© 2017 Ojha et al</copyright-statement><copyright-year>2017</copyright-year><copyright-holder>Ojha et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:href="pntd.0005788.pdf"></self-uri><abstract><sec id="sec001"><title>Background</title><p>Lymphatic filariasis (LF) is a neglected tropical disease transmitted by mosquitoes. Nepal has implemented a national effort to eliminate LF by 2020 through mass drug administration (MDA) using diethylcarbamazine (DEC) and albendazole (ALB). We assessed the impact of MDAs on LF in selected districts of Nepal after the recommended six MDA rounds had been completed.</p></sec><sec id="sec002"><title>Methodology and principal findings</title><p>Baseline surveys were conducted in seven districts and mapping data were used as baseline in the other three districts before starting MDA in 2009. LF antigen (Ag) prevalence ranged from 1.06% to 20% among districts included in the baseline and mapping study. The number of people who received DEC and ALB were recorded during each MDA round and population-based cluster surveys were conducted at least once in each district during the life of the program. The reported MDA coverage in five districts was consistently at least 65%. Two districts achieved the targeted coverage in four out of five rounds and the rest three districts achieved the target only in the first round. A pre-transmission assessment survey (pre-TAS) was conducted in one sentinel site and at least one spot check site in each of the districts after five MDA rounds. In pre-TAS, all the sites of five districts (Pyuthan, Arghakhanchi, Kaski, Bhaktapur, and Kathmandu) and all but one spot check site of Lalitpur district had LF Ag < 2% (ranging from 0.0% to 1.99%). Transmission assessment survey (TAS) was conducted in six evaluation units (EUs) consisting of six districts qualified on pre-TAS. Though MDA coverage of 65% was not achieved in three districts (Kathmandu, Lalitpur and Bhaktapur), Nepal government in consultation with World Health Organization (WHO) decided to conduct TAS. All six EUs achieved the LF Ag threshold required to stop MDA in TAS, despite the low reported MDA coverage in those three districts.</p></sec><sec id="sec003"><title>Conclusions</title><p>Although Nepal has achieved significant progress towards LF elimination, five rounds of MDA were not sufficient to disrupt the transmission cycle in all districts, probably because of high baseline prevalence.</p></sec></abstract><abstract abstract-type="summary"><title>Author summary</title><p>Lymphatic filariasis (LF) is a deforming and disabling infectious disease manifested in the form of elephantiasis and hydroceles. Based on mapping data, 61 out of 75 districts of Nepal were found to be endemic for LF and mass drug administration (MDA) of diethylcarbamazine and albendazole has been already started in 56 districts. The objective of MDA is to interrupt transmission of <italic>Wuchereria bancrofti</italic> in LF endemic districts. In 2015, ten districts had completed six MDA rounds. In this study we reported the impact of the national LF elimination effort in these ten districts of Nepal. The reported coverage rate in each MDA round was consistently above 65% in five districts. Compared to the baseline surveys, pre-transmission assessment surveys (pre-TAS) conducted after completion of five MDA rounds showed reductions in LF antigenemia (Ag) in most districts. Six out of ten districts (formed into six evaluation units) were eligible for TAS, which showed LF Ag below the cutoff point in all six EUs, suggesting successful interruption of LF transmission in six out of ten districts after six MDA rounds.</p></abstract><funding-group><award-group id="award001"><funding-source><institution>RTI International Nepal</institution></funding-source><principal-award-recipient><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0002-6816-8892</contrib-id><name><surname>Ojha</surname><given-names>Chet Raj</given-names></name></principal-award-recipient></award-group><funding-statement>The research leading to these results received funding from RTI International (Nepal). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><fig-count count="1"></fig-count><table-count count="4"></table-count><page-count count="12"></page-count></counts><custom-meta-group><custom-meta><meta-name>PLOS Publication Stage</meta-name><meta-value>vor-update-to-uncorrected-proof</meta-value></custom-meta><custom-meta><meta-name>Publication Update</meta-name><meta-value>2017-07-31</meta-value></custom-meta><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>All relevant data are within the paper.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>All relevant data are within the paper.</p></notes></front></pmc><affiliations><list><country><li>Japon</li><li>Népal</li><li>États-Unis</li></country><region><li>Floride</li></region></list><tree><country name="États-Unis"><region name="Floride"><name sortKey="Ojha, Chet Raj" sort="Ojha, Chet Raj" uniqKey="Ojha C" first="Chet Raj" last="Ojha">Chet Raj Ojha</name></region><name sortKey="Crowley, Kathryn" sort="Crowley, Kathryn" uniqKey="Crowley K" first="Kathryn" last="Crowley">Kathryn Crowley</name></country><country name="Népal"><noRegion><name sortKey="Joshi, Basant" sort="Joshi, Basant" uniqKey="Joshi B" first="Basant" last="Joshi">Basant Joshi</name></noRegion><name sortKey="Adhikari, Tulasi" sort="Adhikari, Tulasi" uniqKey="Adhikari T" first="Tulasi" last="Adhikari">Tulasi Adhikari</name><name sortKey="Bhatta, Bandana" sort="Bhatta, Bandana" uniqKey="Bhatta B" first="Bandana" last="Bhatta">Bandana Bhatta</name><name sortKey="Kc, Khagendra Prakash" sort="Kc, Khagendra Prakash" uniqKey="Kc K" first="Khagendra Prakash" last="Kc">Khagendra Prakash Kc</name><name sortKey="Marasini, Babu Ram" sort="Marasini, Babu Ram" uniqKey="Marasini B" first="Babu Ram" last="Marasini">Babu Ram Marasini</name><name sortKey="Yogi, Keshav Kumar" sort="Yogi, Keshav Kumar" uniqKey="Yogi K" first="Keshav Kumar" last="Yogi">Keshav Kumar Yogi</name></country><country name="Japon"><noRegion><name sortKey="Dumre, Shyam Prakash" sort="Dumre, Shyam Prakash" uniqKey="Dumre S" first="Shyam Prakash" last="Dumre">Shyam Prakash Dumre</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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