الفهرس 
HISTORY OF BANCROFTIAN FILARIASISOnly 14 pages are availabe for public view
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Abstract
Lymphatic filariaisis is a major health problem in tropical and subtropical regions with at least 120 million people are infected with the parasite in 80 countries and over 40 million people have overt clinical disease. Bancroftian filariasis has been endemic in Egypt for centuries with all the clinical manifestations. An estimated 250.000 people infected and 3.5 million people at risk in 9 governorates in the Delta region.
Improved therapies and diagnostic methods have led to a new thinking about lymphatic filariasis. It should be possible to interrupt transmission and eliminate the major public health problem by repeated annual cycles of mass treatment with new single dose combination drug regimens.
This study aimed at testing the hypothesis that Bancroftian filariasis can be eliminated from an Egyptian village namely Azizia village by four annual cycles of mass treatment with Albendazole and DEC.
The study design was a Repeated Survey which consisted of 3 cross sectional studies conducted within the same dynamic target population in Azizia village (both sectors Kafr Bahari KB and Kafr Kebli KK). It consisted of three parts village survey, school survey and a KAP study of the population as regards mass drug administration.
In the village survey Immunochromatographic test ICT card was done for all study subjects and in those proved positive (antigen positive) a venous sample collected between 9PM and 2 AM for a membrane filteration test which detect microfilaraemia (MF). A thick smear blood film was also done for all subjects after the fourth dose of MDA. The school students of Azizia village were subjected to BmM14 antibody testing (ELISA testing) to measure the prevalence rates of filarial antibodies in school children and ICT card testing for first grade students. An interview questionnaire was used in the KAP study about MDA this was done only in 2003.
The village survey included 1067 subjects pretreatment year 2000, 1005 subjects after the 3rd dose of MDA year 2003 and 1116 subjects after the 4th dose of MDA year 2004. The school survey included primary school students 539 first grade students pretreatment, 1352 students after the 3rd dose and also 1347 students after the fourth dose in the first, second and fifth grades. The KAP study included a sample of 1001 subjects living in Azizia village.
The village survey revealed that the MF level decreased from 11.7% to 0.3% in the Whole village and antigenaemia level decreased from 19.2% to 2.4% which could be transformed to clearance rate of 87.5% for antigaenmia compared to pretreatment level and 97.5% for microfilaraemia compared to pretreatment level.
Community Microfilarial load which is a measure to detect the level of transmission of microfilarial level in a community has decreased from 20.6 pretreatment level to 0.73 after the third dose and 0.02 after the fourth dose of MDA.
Among those who had no history of taking any dose of the four doses of MDA 5.1% had still positive Antigenaemia and 2.5% had microfilaraemia and this was significant levels compared to those who took doses of MDA.
The school survey showed that the decrease of the level of antigenaemia of first grade students was from 10% positivity pretreatment to 0.4% after the fourth dose. Also the level of filarial antibodies decreased from 18.4% pre MDA to 2.2% after the third dose and 1.5% after the fourth dose.
Also the study revealed that KB has reached two out of the three set criterias for elimination of lymphatic filariasis which are MF <0.1% (one in 1000), BM14 antibodies less than 1% in first grade students and mosquito pools <1% while KK has not yet reached any of those three set criterias which indicates a better achievement towards elimination in KB compared to KK and a great advance in both sectors compared to pretreatment high infection rates.
The Knowledge Attitude and Practice study showed that 87.0% of the subjects took the MDA in year 2002, 87.6% in KB and 86.4% in KK.
Being abroad or out of the house, pregnancy and lactation was among the causes of not taking the MDA drugs. Also 16.2% of those who didn’t take the drug were rejecters of the drug and 14.6% feared of the adverse events of the drugs and 10.8% reported that the distributing team didn’t come to their houses.
Only 19.6% of those who took the drug reported the occurrence of adverse events which were mostly dizziness and fatigue.
It is concluded from the study that Azizia village with its two sectors nearly reached elimination of Fialariasis. KB has better results than KK which still need more efforts to reach elimination of Filariasis hopefully after the fifth round of MDA.
Both sectors has reached a marked decline compared to Pre Mass Drug Administration levels which proves the success of the Elimination programme in controlling Lymphatic filariasis in one of the heavily infested villages all around the country.
It is recommended that further assessment of the level of infection in both sectors of Azizia in Giza governorate should be made after the fifth round of MDA which was given in September 2004 to compare the levels of infection with the results after the fourth round of MDA and to confirm the complete elimination of Lymphatic Fialriasis in both sectors .Based on the results of this study the health authorities should take the decision of both sectors of Azizia village as well as similar villages with similar situation if they need a sixth round of MDA or not. Active surveillance of Lymphatic Filariasis should be implemented in Azizia village and other selected implementation units or sentinel sites for at least three years after the stoppage of MDA. Surveillance should be done in selected villages (IUs) that had a high level of microfilaraemia as Azizia village or had a low coverage of MDA. It is recommended also that more emphasis and studies should be done on the vector and vector control in Azizia village and other areas endemic for lymphatic filariasis to document the interruption of transmission of LF. The tools of this study should be implemented in the detection of the level of infection and community diagnosis in any village in Egypt. It is also recommended that the antibody testing that was used in school to be made in the future as a rapid card test for detection of antibody levels in school children which is a good indicator of the level of transmission. This will lead to easy implementation and interpretation by the MOH.