Assessing the impact of Mass Drug Administration (MDA) in the Global Programme to Eliminate Lymphatic Filariasis (GPELF) on Patients with Filarial Disease Public

Strahm, Melanie R (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/f4752h555?locale=fr
Published

Abstract


Background: Lymphatic filariasis (LF) is a chronically disabling and debilitating
mosquito-borne parasitic infection that infects an estimated 120 million persons
worldwide. LF is endemic in 81 countries with approximately more than 1.3 billion
people at risk of infection worldwide. The Global Programme for the Elimination of
Lymphatic Filariasis (GPELF) was launched in 2000, and as of 2009 scaled up to
introduce MDA in 53 endemic countries. The GPELF focuses on the interruption of
transmission through mass drug administration and managing and preventing disability,
such as ADL, lymphedema, and hydrocele, for infected individuals.
Objective: The objective of this analysis was to evaluate studies assessing the impact of
mass drug administration on filarial morbidity.
Methods: Studies were included from a Pubmed search via criteria established a priori.
Analysis was performed on studies that met the standards based on the Grading of
Recommendations Assessment, Development and Evaluation (GRADE) system for rating
evidence.
Results: Data from 25 studies met the criteria for inclusion. Of these, ten evaluated
ADL events, 15 assessed lymphedema, and 15 assessed hydrocele outcomes. Study
design included 14 clinical trials and eleven prospective cohort, case study, or cross
sectional evaluations. Of the included studies, 15 studies were considered to be of
sufficient quality for in depth analysis. Five studies reported a decrease in ADL events
over the course of the study period. Improvement was noted in five studies, and a lack of
improvement was found in four studies assessing lymphedema and/or elephantiasis.
Hydrocele was found to improve in five studies, whereas no improvement was recorded
in four.
Conclusion: The data suggests inconclusive results derived from studies assessing the
impact of MDA on LF morbidity. Studies on MDA and clinical disease demonstrate
numerous inconsistencies related to methodology. The mixed results of this review stress
the need to adopt and employ more rigorous and standardized case definitions, study
design, and outcome measurements to better understand and respond to the course of
clinical disease after MDA employment.

Table of Contents

TABLE OF CONTENTS

I. INTRODUCTION........................................................................................................................ 9
II. LITERATURE REVIEW.......................................................................................................... 13
Lymphatic filariasis (LF) ........................................................................................................... 13
Global Programme to Eliminate Lymphatic Filariasis (GPELF)............................................... 15
Mass Drug Administration......................................................................................................... 16
Morbidity ................................................................................................................................... 18
Acute Inflammatory Episodes (ADL)....................................................................................19
Lymphedema..........................................................................................................................22
Hydrocele...............................................................................................................................23
MDA and Filarial Morbidity Research ...................................................................................... 24
III. METHODOLOGY .................................................................................................................. 25
Search strategy........................................................................................................................... 25
Study selection........................................................................................................................... 26
Inclusion criteria ........................................................................................................................ 26
Assessment of methodological quality ...................................................................................... 26
Data extraction........................................................................................................................... 28
Data synthesis ............................................................................................................................ 28
IV. RESULTS................................................................................................................................ 30
Eligible Studies .......................................................................................................................... 30
Description of Eligible Studies .................................................................................................. 32
Methodological quality .............................................................................................................. 32
ADL Results............................................................................................................................... 33
Lymphedema Results................................................................................................................. 35
Hydrocele Results ...................................................................................................................... 38
V. DISCUSSION........................................................................................................................... 41
Issues with Study Design ........................................................................................................... 41
Issues with Clinical Definitions ................................................................................................. 41
Issues with Confounding............................................................................................................ 43
Issues with Clinical Assessment ................................................................................................ 44
Issues with clinical follow up..................................................................................................... 45
Summary of effect of DEC on filarial morbidity....................................................................... 46
Summary of effect of ivermectin and albendazole on filarial morbidity ................................... 48
V. RECOMMENDATIONS.......................................................................................................... 50
VI. CONCLUSION........................................................................................................................ 53

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