Progress towards lymphatic filariasis elimination in Ghana from 2000-2016: Analysis of microfilaria prevalence data from 430 communities

Background Ghana started its national programme to eliminate lymphatic filariasis (LF) in 2000, with mass drug administration (MDA) with ivermectin and albendazole as main strategy. We review the progress towards elimination that was made by 2016 for all endemic districts of Ghana and analyze mf prevalence from sentinel and spot-check sites in endemic districts. Methods We reviewed district level data on the history of MDA and outcomes of transmission assessment surveys (TAS). We further collated and analyzed microfilaria (mf) prevalence data from sentinel and spot-check sites. Results MDA was initiated in 2001-2006 in all 98 endemic districts; by the end of 2016, 81 had stopped MDA after passing TAS and after an average of 11 rounds of treatment (range 8 – 14 rounds). The median reported coverage for the communities was 77-80%. Mf prevalence survey data were available for 430 communities from 78/98 endemic districts. Baseline mf prevalence data were available for 53 communities, with an average mf prevalence of 8.7% (0 - 45.7%). Repeated measurements were available for 78 communities, showing a steep decrease in mean mf prevalence in the first few years of MDA, followed by a gradual further decline. In the 2013 and 2014 surveys, 7 and 10 communities respectively were identified with mf prevalence still above 1% (maximum 5.6%). Two stopped MDA in 2015 and 2016 respectively, while the rest of the 15 communities above threshold are all within 13/17 districts where MDA is still ongoing. Conclusions The MDA programme of the Ghana Health Services has reduced mf prevalence in sentinel sites below the 1% threshold in 81/98 endemic districts in Ghana, yet 15 communities within 13 districts (MDA ongoing) had higher prevalence than this threshold during the surveys in 2013 and 2014. These districts may need to intensify interventions to achieve the WHO 2020 target. Author summary Lymphatic filariasis (LF) control in Ghana has relied on ivermectin and albendazole since the year 2000 when the Ghana Filariasis Elimination Programme started. We analyzed trends in microfilaraemia prevalence during MDA, reported coverage, and transmission assessment survey using data obtained from the Ghana Health Services (GHS). The median reported treatment coverage varied between 77-80% over the years. Our results show that the treatment in Ghana made a significant impact in reducing infections <1% in majority of sentinel sites in endemic districts (81/98) by 2016. In the remaining 17 districts, extra efforts may be needed to achieve the same goal. Some of the challenges could be low coverage in some communities, high baseline endemicity, programme logistical challenges etc. The required average rounds of MDA needed for elimination was 11, higher than that proposed by the Global Filariasis Elimination Programme. This article is relevant to LF control programmes in assessing the impact of MDA. It is important for programmes to monitor infections especially within communities where mf prevalence is still above the 1% threshold to ensure that the WHO 2020 elimination target is achieved.