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Research calls for new approach to treating neglected tropical diseases in urban areas

February 2018
Hassana.
Hassana is 65 and lives in Lokoja, a city in central Nigeria. She has lymphatic filariasis, which has caused her leg to swell.

New research suggests that distributing medication on a large scale to treat lymphatic filariasis in urban areas may not be the most effective way to tackle the disease.

Research published today in medical journal The Lancet Infectious Diseases says that treating lymphatic filariasis using this approach, known as mass drug administration, is successful in rural areas, but is often challenging and costly to carry out in urban centres.

The research was carried out by the Liverpool School of Tropical Medicine, Sightsavers, Noguchi Memorial Institute for Medical Research at the University of Ghana, the Ghana Health Service, and the Ministries of Health of Burkina Faso and Cote d’Ivoire.

Lymphatic filariasis is transmitted to people via mosquito bite and can cause enlarged body parts, leading to pain, disability and stigma. It is one of a group of preventable and treatable conditions known as neglected tropical diseases (NTDs). Worldwide, 120 million people are infected with lymphatic filariasis, making it the world’s leading cause of physical disability.

At the moment, treatment for the disease in both rural and urban areas focuses on distributing preventive drugs to people irrespective of whether they are infected. However, the research shows that using this approach in urban areas is more expensive, and it can be difficult to ensure at least 65 per cent of the population receive the medication – the level required to make sure the disease is no longer being spread. This  poses a key challenge to the global goal of eliminating the disease as public health problem by 2020.

Professor David Molyneux from the Liverpool School of Tropical Medicine, who co-authored the research, said: “This paper raises questions about the need for mass drug distribution, given the evidence that transmission is limited in urban settings in West Africa. The problems faced by the filariasis community in addressing these challenges reflects a wider problem of how to tackle urban neglected tropical diseases, given the increased rate of rural-urban migration, resource limitations and population diversity.”

The research calls for more detailed studies into the effectiveness of mass drug administration in densely populated towns and cities in Africa. It also argues that greater focus should be placed on vector control: getting rid of the insects that spread the disease to minimise the risk of contracting it from mosquito bites. Solutions can include long-lasting insecticidal nets, mosquito repellents and improved housing structures in African cities.

Sightsavers Director of NTDs Simon Bush, who co-authored the report, said: “The research illustrates that we must continue to analyse our approach to treating neglected tropical diseases. Bringing together experts to review the issues identified, along with the resulting consequences for national programmes, is essential.”

120 million
people worldwide are infected with lymphatic filariasis
A health worker talks to an LF patient.
Hassana discusses her condition with a community health worker.

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