Dr Chen Ken, WHO Representative in the South Pacific, gave the following address at the 2008 launch of the National Mass Drug Administration programme for lymphatic filariasis at the Ministry of Health, Fiji:
Lymphatic filariasis is a threat to 1 billion people in 80 countries with over 120 million affected and 40 million severely disfigured and incapacitated. It is considered as the second leading cause of disability worldwide.
In the Pacific WHO estimates that 7.9 million are still at risk of infection in sixteen Pacific countries and areas. The social and economic burden as well as the suffering of affected individuals is enormous. Even when no clinical symptoms are present, hidden lymphatic pathology and kidney damage exist. The visible and disfiguring consequences of the disease, such as elephantiasis and hydrocele will often drag entire families into poverty.
The Pacific Programme to Eliminate Lymphatic Filariasis was launched in 2000 under the auspices of WHO following the World Health Assembly resolution WHA50.29 which calls for the elimination of lymphatic filariasis as a public health problem. Several countries and areas in the Pacific such as Cook Islands, Fiji, French Polynesia, Samoa and Wallis and Futuna already had a long history of fighting the disease and its resurgences when the WHA resolution came into effect. In Fiji, Dr Mataika is well known for his contribution and work on the control of Lymphatic Filariasis.
Significant efforts have been made by the Member States to eliminate lymphatic filariasis in the Pacific area in partnership with the Government of Japan and other stakeholders. Good progress has been achieved. Among the endemic countries in the Pacific, all but Papua New Guinea have completed at least five rounds of mass drug administration (MDA). Since 2000, about 1.5 million people have been reached by mass drug administration. However, much remains to be done. Among the critical challenges is the need for endemic countries to achieve treatment coverage rates above 85% if elimination is to succeed.
The prevalence surveys implemented in several countries in 2007 helped us to get a better understanding of the current epidemiological situation in the Pacific and to develop country-tailored strategies.
Fiji is the second largest endemic country in the Pacific Program to Eliminate Lymphatic Filariasis and the entire population is considered at risk of filariasis. The whole population is therefore targeted for MDA. In 2002 Fiji launched the mass drug administration programme to eliminate Lymphatic Filariasis (LF) and completed the fifth MDA with DEC and albendazole in the year 2006. A prevalence survey was implemented in 2007 and based on the results the epidemiological situation was reviewed by a team of experts in early June 2008. Following this review, recommendations were made to the Fiji programme manager on the future course of action.
In 2007 the prevalence was lower in all the geographic regions than that observed prior to the 1st MDA. The Ag prevalence was lowest in Western division with 0.9% and highest in Central division with 15.4% and in Rotuma island with 18.5%. From pre-MDA to post -5th MDA, the overall antigen prevalence declined from 15.0% to 9.5% and the microfilaremia prevalence from 5.2% to 1.4% .
These results were achieved with relatively low coverage during the past five rounds of MDA. The average treatment coverage for Fiji ranged from 58% to 66% over the years. Mostly, drugs have been handed over to the people who were expected to consume them, and treatment was not directly observed by the drug distributors. As a result, in 2007 the national antigenemia prevalence was found to be 9.5%, still far above the target of below 1%. The same survey also found that the prevalence was higher in males than in females in almost all age-groups. Among men, the prevalence was higher in 30-60 year age group.
In June 2007 a team of international experts visited Fiji to review the data and to draw the strategy for the next few years with the national team. The strategy was tailored to each division but it was clear that to achieve the target the following must be achieved:
- At least 85% of the population must swallow the tablets during the MDA
- Directly Observed Treatment should be the foundation of the MDA strategy and should be implemented during each MDA, meaning that the people should swallow the tablets in front of the distributors.
- A special effort should be made to target groups that were under-represented in previous MDAs including men, breast-feeding women and medically excluded persons.
- Coverage should be verified by a post-MDA coverage survey.
In the Pacific, four countries (Cook islands, Niue, Tonga and Vanuatu) have achieved the target of below 1% antigenemia prevalence. Among the common factors of success is the fact that all these countries have always ensured a true coverage of above 85% of their population. If this is not reached then the elimination is not going to be met in Fiji.
Conscious of the challenge that this represents for Fiji, the WHO has tremendously increased its support to the MOH this year by making $US 60,000 available for this campaign (compared to 5000 to 10,000 $US in the past) in addition to its continuous technical support.
Elimination of lymphatic filariasis in Fiji is feasible but it will require a high level of commitment from all stakeholders and an extremely active follow up to make sure that as close as possible to 100% of the population has swallowed the medicines in 2008.
I wish you a successful campaign and I am looking forward for the highest coverage Fiji has ever reached for a MDA with above 85% of the population swallowing the tablets!
