Togo En Route To Lymphatic Filariasis Elimination

May 8, 2013 | Katharina Schwan | Research & Policy

Togo, a small country in West Africa sandwiched between Ghana and Benin, may become the first Sub-Saharan African country to eliminate lymphatic filariasis (LF), a neglected tropical disease (NTD) that can cause extreme pain and disfigurement.

According to the Global Network for Neglected Tropical Diseases, LF is one of seven of the most common and disabling NTDs affecting the world’s poorest populations. Those infected with LF suffer not only from excruciating pain, but also from economic instability and social stigma due to the physical deformities often caused by the infection.

Lymphatic filariasis is caused by thread-like parasitic worms, or helminthes. These helminthes are transmitted to humans as larvae, through the bite of a mosquito. Over the course of years, the larvae develop into adult worms in the human lymphatic system. Asymptomatic individuals will not show external signs of infection, but still suffer from damage to the lymphatic system and the kidneys, which may affect the body’s immune response. Acute and chronic patients usually suffer from the disfiguring symptoms that gave rise to LF’s more commonly known name: elephantiasis. The parasitic worms can cause swelling in the legs, arms, and breasts, as well as the genital regions of men, usually resulting in chronic pain and permanent disfigurement.

LF patients with physical deformities are often shunned by their community, are unable to continue working, and have increased medical expenses. Thus, the socioeconomic hardships resulting from this disease are immense.

Treatment for LF does exist and costs less than 0.50 USD per person to administer. A single dose of two anthelmintic drugs will clear the microscopic worms from the bloodstream. However, development of the physical malformations is irreversible.

Togo’s imminent success was announced in a landmark paper published in PLoS Neglected Tropical Diseases this April.  The progress is largely due to the establishment of the National Program to Eliminate Lymphatic Filariasis (NPELF) in 2000. The small country utilized mass drug administration (MDA), a strategy that administers the anthelminitic drugs to at-risk communities, thus interrupting LF transmission. The WHO recommends that MDA continue for 4-6 years to fully interrupt the transmission cycle. In 2010, Togo moved to a 5-year post-MDA surveillance phase, after which the elimination of LF from the country will be official.

Togo’s campaign mirrors the WHO Global Programme to Eliminate Lymphatic Filariasis, also launched in 2000. The WHO set the lofty, yet attainable goal of eliminating LF globally by 2020. If successful, the full economic benefit of the program could exceed 55 billion USD.

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