Improving drug delivery strategies for lymphatic filariasis elimination in urban areas in Ghana
Identifieur interne : 004307 ( Pmc/Curation ); précédent : 004306; suivant : 004308Improving drug delivery strategies for lymphatic filariasis elimination in urban areas in Ghana
Auteurs : Nana-Kwadwo Biritwum [Ghana] ; Bertha Garshong [Ghana] ; Bright Alomatu [Ghana] ; Dziedzom K. De Souza [Ghana] ; Margaret Gyapong [Ghana] ; Dominique Kyelem [États-Unis]Source :
- PLoS Neglected Tropical Diseases [ 1935-2727 ] ; 2017.
Abstract
The Global Program to Eliminate Lymphatic Filariasis (GPELF) advocates for the treatment of entire endemic communities, in order to achieve its elimination targets. LF is predominantly a rural disease, and achieving the required treatment coverage in these areas is much easier compared to urban areas that are more complex. In Ghana, parts of the Greater Accra Region with Accra as the capital city are also endemic for LF. Mass Drug Administration (MDA) in Accra started in 2006. However, after four years of treatment, the coverage has always been far below the 65% epidemiologic coverage for interrupting transmission. As such, there was a need to identify the reasons for poor treatment coverage and design specific strategies to improve the delivery of MDA. This study therefore set out to identify the opportunities and barriers for implementing MDA in urban settings, and to develop appropriate strategies for MDA in these settings. An experimental, exploratory study was undertaken in three districts in the Greater Accra region. The study identified various types of non-rural settings, the social structures, stakeholders and resources that could be employed for MDA. Qualitative assessment such as in-depth interviews (IDIs) and focus group discussions (FGDs) with community leaders, community members, health providers, NGOs and other stakeholders in the community was undertaken. The study was carried out in three phases: pre-intervention, intervention and post-intervention phases, to assess the profile of the urban areas and identify reasons for poor treatment coverage using both qualitative and quantitative research methods. The outcomes from the study revealed that, knowledge, attitudes and practices of community members to MDA improved slightly from the pre-intervention phase to the post-intervention phase, in the districts where the interventions were readily implemented by health workers. Many factors such as adequate leadership, funding, planning and community involvement, were identified as being important in improving implementation and coverage of MDA in the study districts. Implementing MDA in urban areas therefore needs to be given significant consideration and planning, if the required coverage rates are to be achieved. This paper, presents the recommendations and strategies for undertaking MDA in urban areas.
Url:
DOI: 10.1371/journal.pntd.0005619
PubMed: 28493966
PubMed Central: 5441634
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<front><div type="abstract" xml:lang="en"><p>The Global Program to Eliminate Lymphatic Filariasis (GPELF) advocates for the treatment of entire endemic communities, in order to achieve its elimination targets. LF is predominantly a rural disease, and achieving the required treatment coverage in these areas is much easier compared to urban areas that are more complex. In Ghana, parts of the Greater Accra Region with Accra as the capital city are also endemic for LF. Mass Drug Administration (MDA) in Accra started in 2006. However, after four years of treatment, the coverage has always been far below the 65% epidemiologic coverage for interrupting transmission. As such, there was a need to identify the reasons for poor treatment coverage and design specific strategies to improve the delivery of MDA. This study therefore set out to identify the opportunities and barriers for implementing MDA in urban settings, and to develop appropriate strategies for MDA in these settings. An experimental, exploratory study was undertaken in three districts in the Greater Accra region. The study identified various types of non-rural settings, the social structures, stakeholders and resources that could be employed for MDA. Qualitative assessment such as in-depth interviews (IDIs) and focus group discussions (FGDs) with community leaders, community members, health providers, NGOs and other stakeholders in the community was undertaken. The study was carried out in three phases: pre-intervention, intervention and post-intervention phases, to assess the profile of the urban areas and identify reasons for poor treatment coverage using both qualitative and quantitative research methods. The outcomes from the study revealed that, knowledge, attitudes and practices of community members to MDA improved slightly from the pre-intervention phase to the post-intervention phase, in the districts where the interventions were readily implemented by health workers. Many factors such as adequate leadership, funding, planning and community involvement, were identified as being important in improving implementation and coverage of MDA in the study districts. Implementing MDA in urban areas therefore needs to be given significant consideration and planning, if the required coverage rates are to be achieved. This paper, presents the recommendations and strategies for undertaking MDA in urban areas.</p>
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</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>Research and Analysis Methods</subject>
<subj-group><subject>Research Design</subject>
<subj-group><subject>Survey Research</subject>
<subj-group><subject>Surveys</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>Public and Occupational Health</subject>
<subj-group><subject>Physical Activity</subject>
<subj-group><subject>Physical Fitness</subject>
<subj-group><subject>Exercise</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>Sports and Exercise Medicine</subject>
<subj-group><subject>Exercise</subject>
</subj-group>
</subj-group>
</subj-group>
<subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject>
<subj-group><subject>Sports Science</subject>
<subj-group><subject>Sports and Exercise Medicine</subject>
<subj-group><subject>Exercise</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>Health Care</subject>
<subj-group><subject>Health Education and Awareness</subject>
</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>
</subj-group>
</subj-group>
</article-categories>
<title-group><article-title>Improving drug delivery strategies for lymphatic filariasis elimination in urban areas in Ghana</article-title>
<alt-title alt-title-type="running-head">Mass drug administration for elephantiasis control in urban areas in Ghana</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0001-5967-5676</contrib-id>
<name><surname>Biritwum</surname>
<given-names>Nana-Kwadwo</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="corresp" rid="cor001">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Garshong</surname>
<given-names>Bertha</given-names>
</name>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Alomatu</surname>
<given-names>Bright</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>de Souza</surname>
<given-names>Dziedzom K.</given-names>
</name>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gyapong</surname>
<given-names>Margaret</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author" deceased="yes"><name><surname>Kyelem</surname>
<given-names>Dominique</given-names>
</name>
<xref ref-type="aff" rid="aff005"><sup>5</sup>
</xref>
</contrib>
</contrib-group>
<aff id="aff001"><label>1</label>
<addr-line>Neglected Tropical Diseases Program, Ghana Health Service, Accra, Ghana</addr-line>
</aff>
<aff id="aff002"><label>2</label>
<addr-line>Research and Development Division, Ghana Health Service, Accra, Ghana</addr-line>
</aff>
<aff id="aff003"><label>3</label>
<addr-line>Noguchi Memorial Institute for Medical Research, University of Ghana, Legon-Accra, Ghana</addr-line>
</aff>
<aff id="aff004"><label>4</label>
<addr-line>Dodowa Health Research Center, Dodowa, Ghana</addr-line>
</aff>
<aff id="aff005"><label>5</label>
<addr-line>Taskforce for Global Health, Decatur-Atlanta, Georgia, United States of America</addr-line>
</aff>
<contrib-group><contrib contrib-type="editor"><name><surname>Lammie</surname>
<given-names>Patrick J.</given-names>
</name>
<role>Editor</role>
<xref ref-type="aff" rid="edit1"></xref>
</contrib>
</contrib-group>
<aff id="edit1"><addr-line>Task Force for Child Survival and Developmentorce for Global Health, 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="con"><p><list list-type="simple"><list-item><p><bold>Conceptualization:</bold>
NKB BG BA MG DK.</p>
</list-item>
<list-item><p><bold>Data curation:</bold>
BG BA MG.</p>
</list-item>
<list-item><p><bold>Formal analysis:</bold>
NKB BG BA DKdS MG.</p>
</list-item>
<list-item><p><bold>Funding acquisition:</bold>
NKB DK.</p>
</list-item>
<list-item><p><bold>Investigation:</bold>
NKB BA.</p>
</list-item>
<list-item><p><bold>Methodology:</bold>
BG MG.</p>
</list-item>
<list-item><p><bold>Project administration:</bold>
NKB BA.</p>
</list-item>
<list-item><p><bold>Resources:</bold>
NKB DK.</p>
</list-item>
<list-item><p><bold>Software:</bold>
BG MG.</p>
</list-item>
<list-item><p><bold>Supervision:</bold>
NKB.</p>
</list-item>
<list-item><p><bold>Validation:</bold>
BG BA MG.</p>
</list-item>
<list-item><p><bold>Visualization:</bold>
NKB BG BA DKdS MG.</p>
</list-item>
<list-item><p><bold>Writing – original draft:</bold>
DKdS NKB.</p>
</list-item>
<list-item><p><bold>Writing – review & editing:</bold>
NKB BG BA DKdS MG.</p>
</list-item>
</list>
</p>
</fn>
<corresp id="cor001">* E-mail: <email>nkadbiritwum@gmail.com</email>
</corresp>
</author-notes>
<pub-date pub-type="epub"><day>11</day>
<month>5</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="collection"><month>5</month>
<year>2017</year>
</pub-date>
<volume>11</volume>
<issue>5</issue>
<elocation-id>e0005619</elocation-id>
<history><date date-type="received"><day>21</day>
<month>10</month>
<year>2016</year>
</date>
<date date-type="accepted"><day>2</day>
<month>5</month>
<year>2017</year>
</date>
</history>
<permissions><copyright-statement>© 2017 Biritwum et al</copyright-statement>
<copyright-year>2017</copyright-year>
<copyright-holder>Biritwum 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.0005619.pdf"></self-uri>
<abstract><p>The Global Program to Eliminate Lymphatic Filariasis (GPELF) advocates for the treatment of entire endemic communities, in order to achieve its elimination targets. LF is predominantly a rural disease, and achieving the required treatment coverage in these areas is much easier compared to urban areas that are more complex. In Ghana, parts of the Greater Accra Region with Accra as the capital city are also endemic for LF. Mass Drug Administration (MDA) in Accra started in 2006. However, after four years of treatment, the coverage has always been far below the 65% epidemiologic coverage for interrupting transmission. As such, there was a need to identify the reasons for poor treatment coverage and design specific strategies to improve the delivery of MDA. This study therefore set out to identify the opportunities and barriers for implementing MDA in urban settings, and to develop appropriate strategies for MDA in these settings. An experimental, exploratory study was undertaken in three districts in the Greater Accra region. The study identified various types of non-rural settings, the social structures, stakeholders and resources that could be employed for MDA. Qualitative assessment such as in-depth interviews (IDIs) and focus group discussions (FGDs) with community leaders, community members, health providers, NGOs and other stakeholders in the community was undertaken. The study was carried out in three phases: pre-intervention, intervention and post-intervention phases, to assess the profile of the urban areas and identify reasons for poor treatment coverage using both qualitative and quantitative research methods. The outcomes from the study revealed that, knowledge, attitudes and practices of community members to MDA improved slightly from the pre-intervention phase to the post-intervention phase, in the districts where the interventions were readily implemented by health workers. Many factors such as adequate leadership, funding, planning and community involvement, were identified as being important in improving implementation and coverage of MDA in the study districts. Implementing MDA in urban areas therefore needs to be given significant consideration and planning, if the required coverage rates are to be achieved. This paper, presents the recommendations and strategies for undertaking MDA in urban areas.</p>
</abstract>
<abstract abstract-type="summary"><title>Author summary</title>
<p>The control of lymphatic filariasis depends on the treatment of entire endemic communities, ensuring that a greater proportion of the population is treated. In urban areas, this can be very difficult to achieve. In Ghana, parts of the Greater Accra Region, where the capital city is located, are also endemic for lymphatic filariasis. Treatment in these areas started in 2006, but the proportion of people treated has continuously been below the required programmatic coverage levels. To understand the reasons behind this, a study was undertaken in three endemic districts. The study was carried out in three stages; pre-treatment, treatment and post-treatment. Individuals and groups of people were interviewed in the pre-treatment phase, following which their concerns were used to plan and execute treatment activities. After treatment, some individuals were again interviewed to assess the effectiveness of the interventions. The results showed that the knowledge and behavior of community members towards the disease and treatment activities improved from the pre-treatment to the post-treatment reviews. Many factors were identified including, financial, management and leadership issues that should be considered when planning treatment activities in urban areas.</p>
</abstract>
<funding-group><award-group id="award001"><funding-source><institution>Task Force for Global Health</institution>
</funding-source>
<award-id>43922</award-id>
<principal-award-recipient><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0001-5967-5676</contrib-id>
<name><surname>Biritwum</surname>
<given-names>Nana-Kwadwo</given-names>
</name>
</principal-award-recipient>
</award-group>
<funding-statement>This study was supported under Grant Number 43922, administered by the Task Force for Global Health (<ext-link ext-link-type="uri" xlink:href="http://www.taskforce.org/">http://www.taskforce.org/</ext-link>
), to NKB. 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="16"></table-count>
<page-count count="23"></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>2017-05-23</meta-value>
</custom-meta>
<custom-meta id="data-availability"><meta-name>Data Availability</meta-name>
<meta-value>All relevant data are within the paper and its Supporting Information files.</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
<notes><title>Data Availability</title>
<p>All relevant data are within the paper and its Supporting Information files.</p>
</notes>
</front>
</pmc>
</record>
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