Dear Partners,

The fifth issue of LF News is in itsregular format of six pages. It focuseson two reports from the Chairs of theAfrican and Eastern MediterraneanProgramme Review Groups, while onthe first page you will find an articlewritten by Dr Yankum Dadzie, Chair of the Executive Group.

On page 3 you will find a table of dataconcerning the total population of allimplementation units where mass drugadministration has been carried out in2003, where 70 million people werereported to have ingested the drugcombination of either DEC plusalbendazole or ivermectin plusalbendazole in 36 countries. A secondtable shows the number of endemiccountries that were covered by massdrug administration in 2003 organizedunder their respective RegionalProgramme Review Groups.

LF News, Issue 5 has been printed in 3000 copies and widely distributedin countries and regions. Electroniccopies can be downloaded from the site of the Global Alliance at:www.filariasis.org and the HTMLversion has been e-mailed to severalhundred people throughout the world.

Once again, your suggestions onthemes and articles will be mostwelcome and may be sent via the website by clicking “contact” in the upperright-hand corner on the home page of www.filariasis.org.

The Editor

The frontispiece to LF News Issue 4provided a review of the newstructure of the Global Alliance to

Eliminate Lymphatic Filariasis (GAELF)that was established at the Third Meetingof the Global Alliance held in Cairo,Egypt, on 23–25 March 2004.

Since then, activities have continuedapace. A first aim of the Executive Group(EG) was to consider their role anddevelop an appropriate mission state-ment. The following mission statement,they believe, encompasses their role andthe ethos of the GAELF in its role to assistthe Global Programme to EliminateLymphatic Filariasis (GPELF):“The Executive Group of GAELF worksto support the GPELF by enhancing theeffectiveness of national, regional andglobal fundraising, advocacy, commu-nication and planning for theProgramme.”

Included in this issue are two regionalreports – one from the African Pro-gramme Review Group (PRG) and theother from the Eastern MediterraneanPRG, both of which provide an insightinto their activities. Focus is also on theprogress achieved by the EG and variousother partners.

As indicated previously, the EG iscommitted to ensuring that the GPELF issuccessful. In Cairo and in the creation ofthe Action Plan for the EG, fundraising

was highlighted as being the priorityneed for the Programme.

To achieve success, the EG has instigatedseveral initiatives. North American andEuropean fundraising teams have beenappointed, and approaches to potentialdonor foundations, organizations andbilaterals are under way. The NorthAmerican team is also establishing aNorth American Committee headed byFather Ted Hesburgh, former President of the University of Notre Dame inIndiana, former Chair of the RockefellerFoundation and one of the primaryproponents of the Green Revolution. Heis highly respected and widely consid-ered a luminary in humanitarian circles.The North American Committee will actas advocate for the Global Alliance toraise public awareness and secure addi-tional programmatic and donor partnersfor the Alliance in the United States andCanada.

Also in this issue are articles on thesuccesses already achieved. BurkinaFaso, with training and support, has beensuccessful in raising in-country funds,and Togo has been successful inobtaining the Global Fund to Fight AIDS,TB and Malaria (GFATM) support formalaria with integrated LF activities.Advocacy with the GFATM has alsoresulted in the inclusion of a sectionregarding disease intervention strategyintegration. Workshops are planned to

assist countries prepare applications tothe Global Fund. Dr Bernhard Liese ofthe World Bank generously agreed tolead a task force to investigate the avail-ability of in-country funds related toHIPC/PRSP and debt swap.

To support the advocacy and fundraisingactivities, a brochure, a four-page leafletand a DVD are currently being devel-oped. Copies of these will be availablefrom the EG Secretariat (see contactdetails on back cover).

The Executive summary of the Commu-nication Strategy appears on page 4. Thefull Communication Strategy has beenseparately circulated by e-mail. Commu-nication, not only with our partners butalso globally to achieve a higher diseasefocus, is a complicated and mammothundertaking. To date, two issues of thequarterly e-mail publication Executivegroup update, which provides greaterdetail of the activities of the EG, havebeen circulated. The EG believes thattransparency in information-sharing isessential, and only by frequent commu-nication can it be achieved. Any feed-back on communication and informa-tion sharing to the EG Secretariat wouldbe appreciated.

Yankum Dadzie Chair, Executive Group

Global Alliance to Eliminate Lymphatic Filariasis

Nº5AUTUMN 2004

THE NEWSLETTER This document may be freely reviewed, abstracted,reproduced or translated, in part or in whole, butnot for sale or for use in conjunction withcommercial purposes. The designations employedand the presentation of all material in LF News donot imply the expression of any opinion whatsoeveron the part of the Executive Group of the GlobalAlliance to Eliminate Lymphatic Filariasis concerningthe legal status of any country, territory, city or areaor of its authorities, or concerning the delimitation ofits frontiers or boundaries.

LF News is a publication of GAELF and is publishedquarterly by the Global Alliance Secretariat. Publisheddata reflect information available at the time of print.

The editor welcomes articles of interest on publichealth and lymphatic filariasis for publication andsuggestions of themes or issues that readers would liketo see discussed or written about in LF News.

MEETINGS7–11 November 200453rd Meeting of the American Society of Tropical Medicine Miami, USA

12–13 November 2004WHO Informal Consultation on TechnicalIssues Faced by the GPELF after the first five years Miami, USA

20 December 20044th Regional Programme Review GroupMeeting on Lymphatic FilariasisElimination Cairo, Egypt

8–9 March 2005Intercountry meeting of nationalprogramme managers of the South AsiaProgramme Review GroupBangalore, India

10–11 March 20057th Meeting of the South Asia (formerlyIndian Subcontinent) Programme ReviewGroup Bangalore, India

25–28 January 2005Global Fund Workshop for FrancophoneCountriesLomé, Togo

31 January–3 February 2005Global Fund Workshop for AnglophoneCountriesAccra, Ghana

PARTNERSThe Global Alliance to EliminateLymphatic Filariasis is a coalitionforged among many organizations, eachwith a different mandate but all having acommon goal: to tackle the wide-rangingand complex process of science and practice that will result in theelimination of lymphatic filariasis.Partners of the Global Alliance are:

Ministries of Health of the 80 endemic countries;

World Bank Group; United Nations Children’s

Fund (UNICEF); World Health Organization (WHO);

Binax, Inc., USA; Merck & Co., Inc., USA;

GlaxoSmithKline, UK; Arab Fund for Economic and

Social Development (AFESD), Kuwait; Bill &

Melinda Gates Foundation, USA; Centers for

Disease Control and Prevention (CDC), Atlanta,

USA; Department for International Development

(DFID), UK; Directorate General for Development

Cooperation (DGCS), Italy; Japan International

Cooperation Agency (JICA), Japan; Ministry of

Health, Labour and Welfare, Japan; Ministeral des

Affaires sociales, de la Santé publique et de

l’Environnment, Belgium; Ministerio de Sanidad y

Consumo, Spain; Ministry of Health, Welfare and

Sport, The Netherlands; Amaury Couthino, Brazil;

Fondazione Franco Moschino, Italy; Handicap

International; Health and Development

International (HDI), Norway; Interchurch Medical

Assistance (IMA), USA; International Foundation

for Dermatology, UK; International Skin-Care

Nursing Group, UK; International Volunteers in

Urology, USA; Carter Center, Atlanta, USA; Centres

for Partnerships in Health, Australia; Mectizan®

Donation Program, USA; World Alliance for

Community Health, Canada; Ain Shams University,

Egypt; Bernhard Nocht Institute for Tropical

Medicine, Germany; Chinese Academy of

Preventive Medicine, China; Danish Bilharziasis

Laboratory (DBL), Denmark; Institute for Medical

Research (IMR), Malaysia; James Cook University,

Australia; Lymphatic Filariasis Support Center,

Emory University, USA; Lymphatic Filariasis

Support Centre, Liverpool School of Tropical

Medicine, UK; Michigan State University, USA;

University of Notre Dame, USA; Universidade

Federal de Pernambuco, Brazil; Vector Control

Research Centre (VCRC), Indian Council of

Medical Research, India; Washington University in

St Louis, Barnes-Jewish Hospital, USA.

LF NEWSLF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis6The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis

All comments and feedback on LF News should be sent to the Executive Group of GAELF fax: + 44 (0)151 709 0354 — E-mail: gaelf@liv.ac.uk

EDITORIAL

LF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis5LF elimination in the EasternMediterranean PRGThe Eastern Mediterranean PRGincludes 23 countries. LF is wellknown to be focally endemic inthree countries in the region:Egypt, Sudan and Yemen; whereasthe LF situation in Djibouti, Oman,Pakistan, Saudi Arabia and Somaliais currently uncertain.

In these countries, LF is caused entirely by Wuchereria bancrofti transmitted primarily

by Culex mosquitoes in most rural and semi-urban areas.

A regional PRG for the elimination of LF was as-sembled in 2001 to meet on a yearly basis. TheArab Fund for Economic and Social Develop-ment, located in Kuwait, made a generous con-tribution aimed at helping these countries tostart LF elimination programmes.

Current status of LF elimination programmes in endemic countries

EGYPTThe population of Egypt (administratively con-sisting of 27 governorates) is currently more than70 million people. The disease has a focal distribution in 8 governorates.

Egypt is among the first countries to develop anational programme to eliminate LF (NPELF).The programme is based on MDA of singleannual doses of DEC (6 mg/kg) in combina-tion with albendazole (400 mg). The villagelevel was chosen as the implementation unit(IU) for MDA.

The programme depended on a well-devel-oped infrastructure with a network of ruralhealth centres and good social mobilization.

The NPELF has successfully completed 5rounds. The number of identified endemic vil-lages increased from 161 in 2000 to 181 in2004. The coverage rate was estimated (de-pendently and independently) to be consistentlyover 80%.

Adverse events were rare and mild-to-moderatein severity. Spot surveys in several localities fol-lowing each round of MDA showed a remark-able impact of the drug combination on MFprevalence rates and intensities.

YEMENYemen (approximately 20 million people) is aknown endemic country for onchocerciasis andhas proved to be for LF too. The ozla (subdis-trict) is considered as the IU of the NPELF.

Integration of the NPELF was done with the lep-rosy mission, a unit related to the YemeniMinistry of Public Health (MOPH), which is responsible for onchocerciasis control and pre-vention and has a well-developed network ofclinics distributed throughout the country.

In 2000, questionnaires were distributed to keyinformants and revealed that 13 ozlas (11 laterproved to be endemic by ICT) and 24 ozlas indifferent governorates (none proved to beendemic) were less likely endemic localities.

Training sessions for 634 primary health-careworkers were carried out in addition to socialmobilization activities. In 2002, an initial pilotMDA was implemented in 3 ozlas (42 800inhabitants). Then, the first round of MDA withivermectin (200 µg/kg) and albendazole (400 mg) was carried out house-to-house. Theprogramme estimated an overall 85% MDAcoverage rate. No serious adverse events wereidentified.

In 2003, the second round of MDA was carriedout in the same areas and in 9 additional endemic IUs. Lack of ICT cards and resources hin-dered the completion of LF mapping in Yemen.

SUDANLF is endemic in Sudan. During 2003, a pilotsurvey in 4 states was carried out for rapidassessment of the LF situation using the ques-tionnaire approach and a limited number ofICT cards. The administrative unit (mahaliat)was chosen as the IU.

Currently, LQAS surveys using ICT are beingconducted in highly suspect administrativeunits identified by questionnaire surveys in 2states: Bahr El-Gabal and Bahr El-Ghazal. Forsecurity reasons, mapping of LF in Sudan iscurrently hampered.

Countries with uncertain LF situation

SAUDI ARABIASaudi Arabia, with an estimated population ofapproximately 24 million inhabitants, hasreported a few chronic cases of LF from 3areas: Assir, Jazan and Mekka.

Consequently, 34 laboratory technicians weretrained to perform ICT. However, due to a tech-nical problem encountered at that time withthe Binax ICT cards, the evaluation of thecurrent LF situation in Saudi Arabia was post-poned.

OMANOman has a population of approximately 2.5million inhabitants, of which 26.3% are expa-triates. Many of the expatriates come to workin Oman from LF-endemic countries (e.g.India). Over the past decade, 15 LF cases wereidentified; only 7 were Omani.

In 2002, health authorities in Oman carriedout a rapid assessment of community burdenof the disease using the questionnaireapproach: 23 (3.6%) informants, representing12 districts, reported that they had seen at least1 case of LF and 21 physicians (3.1%) hadobserved cases of lymphoedema and/orhydrocele.

Oman is currently conducting LQAS surveysusing the ICT in high schools in highlysuspected areas.

Maged El Setouhy Chair of the Eastern MediterraneanPRG

EDITORIAL

Lymphatic filariasis (LF) is a majorcause of clinical morbidity and is an impediment to socioeconomicdevelopment in Africa. The diseasehas grave socioeconomic andpsychological consequences.It also imposes a tremendousburden on the health-care systemsin endemic areas.

The goal of the African programme is toeliminate LF as a public health problem

in Africa by the year 2020 and contribute tothe attainment of better health for the under-privileged majority of communities living withthe burden of the disease, in order to promoteproductive life. Improving the health status ofcommunities, especially poor communities,empowers them to improve their socioeco-nomic status, thereby contributing to nationaldevelopment and the attainment of the mil-lennium development goals. The cost ofeliminating LF is, therefore, an investmentleading to attainment of good health for theaffected communities as an immediate bene-fit and, in the long term, an important elementof poverty alleviation. The rationale for theinitiation of this programme is as follows:

� LF elimination, as a public health inter-vention, serves as a vehicle for promotinggeneral health care.

� The reduction and subsequent interrup-tion of transmission by mass drug adminis-tration (MDA) will protect future generationsagainst lymphatic filarial disease.

� Palliative and beneficial treatment of thoseaffected is now feasible using simple inter-ventions, which can be implemented at thecommunity level.

� Working with the malaria control pro-gramme to promote the use of insecticide-treated materials as a vector control strategy willgreatly enhance the elimination programmeand would also be cost effective.

� Programme activities will be backed upwith strong operational research to regularlyreview and confirm that the policies andstrategies followed are the most effective andefficient.

The strategic objectives are therefore:

� To improve the general health status ofendemic populations through increasedaccess to public health interventions, prefer-ably working through existing health struc-tures and programmes.

� To reduce and ultimately interrupt trans-mission of LF in all endemic communities byuse of chemotherapy with ivermectin/DECand albendazole, as well as vector controlthrough the promotion of insecticide-treatedmaterials.

� To alleviate the suffering of people withovert disease such as lymphoedema andhydrocele by use of specific morbiditycontrol tools.

� To set up an effective programme moni-toring system that will continually assessprogress of the programme and bring to thefore operational issues or problems relatedto programme implementation.

� To continually improve programme deliverythrough operational research.

Mapping

It is estimated that some 480 million peopleare at risk of infection in the WHO AfricanRegion. More than 4.6 million cases of lym-phoedema and over 10 million cases ofhydrocele are estimated to occur in theregion. These represent about 38% of theglobal burden of the disease.

The exact distribution of the disease withinmost endemic countries in the subregionremains unknown. Mapping the geographicaldistribution of LF within the countries is there-fore a top priority in our elimination goal. Ofthe 39 endemic countries in the African Region,15 have completed mapping, and 5 are in theprocess of mapping. In the countries wheremapping has been conducted, at least in part,the exercise has shown widespread occur-rence of the disease in areas where this wasnot expected.

MDA

Four countries (Ghana, Nigeria, Togo and theUnited Republic [UR] of Tanzania) startedimplementing MDA in 2000 on a smallscale. Another 5 countries started in 2001–2002: Benin, Burkina Faso, Comoros, Kenya

and Uganda. There have since been no newprogrammes because of lack of resources. OnlyComoros, Togo and Zanzibar (UR Tanzania)are currently covering all of the at-risk popula-tion. The rest of the programmes are coveringproportions ranging from 60% to 70% of theat-risk population.

Approximately 16.7 (77.3%) million peoplewere treated out of the 21.6 million targetedin 2003. National average figures of popula-tion coverage ranged from 67% in mainlandUR Tanzania to 83.1% in Zanzibar.

Denominators for estimating coverage con-tinue to be a challenge due to unreliable censusfigures. Strategies for achieving high-coverageurban and periurban MDA remain under-developed and continue to be a challenge.

Impact of MDA

Assessment of the impact of MDA is an inte-gral part of the elimination programme. Datafrom the sentinel sites are now being collectedin most countries to provide an indication of the impact of the previous treatments.Preliminary information from Zanzibar indi-cates more than 90% reduction in microfila-raemia prevalence and an even higherreduction in intensity of infection.

Morbidity control

Morbidity control continues to remain on theback seat of most country programmes becauseof inadequate resources and also because it isrelatively more difficult to implement comparedwith the MDA programme. Pilot activities have been initiated in Burkina Faso, Ghana,Madagascar and UR Tanzania. With the sup-port of several NGOs, a urologist has beenengaged to provide technical assistance forhydrocele surgery within the West African zone.Of the 9 countries implementing LF elimina-tion, 6 have reported handling 8781 cases oflymphoedema and 4339 hydrocelectomies.Most of these cases came from Burkina Faso,Ghana, Nigeria and UR Tanzania, while Kenyaand Uganda are only at the beginning stage.

The management of lymphoedema and ele-phantiasis has been integrated into some massdrug distribution activities and, in a fewinstances, the primary health-care system.

Table 1. Total population of all IUs for MDA with drug coadministration in 2003

LF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis2Progress on the eliminationof LF in African PRG

LF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis3 LF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis4Challenges

Funding for the programme continues to be amajor challenge. Political commitment at alllevels is high but does not usually translateinto allocation of resources, primarily becauseof competing health needs. Within the inter-national disease control arena, the specialinterest in malaria, TB and HIV/AIDS hasaffected the resource allocation paradigm thusmaking LF and other diseases “unfashionable”and neglected.

A major challenge is how the LF programmecould work with these relatively betterresource-endowed programmes to maximizethe benefits to the endemic communities.However, a specific fundraising strategy at thenational and subregional level is needed tofill the resource gap for these neglected diseases.

Synergies with other programmes such asthose for onchocerciasis, soil-transmittedhelminths and malaria are yet to be fullyexploited and continue to be a challenge inmany endemic countries. In most parts of

Central Africa where Loa loa is endemic, it hasnot been possible to initiate any programmesbecause of the potential severe adverse eventsassociated with the use of programme drugsin such communities. The rapid mapping ofLoa loa would have to be done in all suchareas before any programmes can be initiated.

Sustaining the interest of endemic communi-ties over 5–7 years in a treatment pro-gramme is a challenge. Demand for incen-tives continues to be a major issue, butcountries are finding innovative ways ofdealing with it at the community level.

In order to achieve the elimination goal,there is a need for rapid scaling-up of theprogramme within countries that havealready initiated programmes, and alsoexpansion to cover all endemic countries.Support for country programmes in devel-oping skills in programme management,mapping, laboratory techniques and datamanagement will be paramount. One way ofaddressing such a need will be to developcentres of excellence to provide technicalsupport in the subregion.

Conclusion

Enthusiasm from endemic countries to start theprogramme has come from the great achieve-ments of the PELF. However, their demand forassistance far outweighs the available mean, andthis has resulted in a prolonged period of diseasemapping (including countries already imple-menting MDA), a slow rate of scaling-up ofnational programmes to cover all the at-risk pop-ulations, and stagnation in the number of activeprogrammes.

In the active programmes greater effort needsto be put on achieving and sustaining highpopulation and geographical coverage rates.Insufficient funding remains the major con-straining factor. At this stage, the need forgood evaluation data is critical, and all effortsneed to be carried out in order to obtainthem. Country ownership and partnershipbuilding at all levels as well as creating syn-ergies between disease control programmesneed to be highly encouraged.

John Gyapong, Chair of African PRG

Executive summary of theCommunication Strategy of GAELF

The overall objective of the GAELF commu-nication strategy is to facilitate and provideaccess to all relevant information aboutlymphatic filariasis (LF) and its elimination,reaching out effectively to the public and toall partners.

The broad areas of communication includedin this plan are as follows:

� General communications, where emphasiswill be put on addressing the public, to increase awareness and to provide generalsupport for the global elimination of LF asa major public health and poverty-relatedproblem.

�Advocacy is directed at selected audi-ences, including both current and potentialpartners/donors (i.e. donors, foundations,international agencies, the private sector,NGDOs) and affected countries.

�Scientific communications will focus onkeeping interested parties abreast of recentdevelopments by providing them with thelatest information, which may have an impacton GAELF and its implementation.

�Programme development deals specificallywith programmatic matters, both ongoingand planned. The target audiences for thistype of communication are national pro-gramme managers and their teams respon-sible for LF elimination as well as all actorsinvolved in LF elimination activities.

This communication plan will be reviewedon an annual basis to enable new issues andchallenges to be properly addressed. TheExecutive Group will allocate the resourcesnecessary for the implementation of thepriority activities included in this plan, whileadditional resources will be sought to allowfor future expansion of communicationactivities.

Resumé of fundraising activities of GAELF

In Burkina Faso, a team led by the Pro-gramme Manager, Dominique Kyelem, hasbeen successful in raising in-country funding.A full report of how they achieved successwill appear in the next issue of LF News.

The Global Fund: Togo is the first country tobe successful in applying to the Global Fundfor malaria funding incorporating lymphaticfilariasis. The decision by the Global Fund toprovide funding for the integration of otherdiseases has opened up a massive oppor-tunity for countries to include LF into theirapplications.

The Executive Group is in the process ofplanning workshops to assist countries inapplying to the Global Fund.

HIPC/PRSP/debt swap funding: Dr BernhardLiese of the World Bank, heading a Task Forceon Country Level Funding, has receivedcommitment from the governments of Ghanaand UR Tanzania to provide support for theircountry programmes via HIPC funding from2005. Dr Liese plans to visit Burkina Faso asthe next target.

Johnson & Johnson, the world’s mostcomprehensive and broadly based manu-facturer of health-care products, hasagreed to consider a proposal to providenecessary items to create a hydrocelesurgical kit, initially for training andsurgeries in West Africa.

The Bill & Melinda Gates Foundation hasindicated its receptivity to receiving aLetter of Inquiry from the Global Allianceand has invited the Alliance chair and otherpartners to make a presentation, which isscheduled for mid-November. In addition,following a meeting on integration that washosted by the Foundation and attended byrepresentatives of multiple disease pro-grammes, a number of Letters of Inquiryhave been submitted in the context of inte-grating LF with other programmes.

There have also been promising initial indi-cations of interest from other foundationssuch as the Izumi Foundation, which hasrequested a Letter of Intent, and theRockefeller Foundation, where a recent visittook place.

In line with the Burkina Faso success story(which will be fully reported in the nextissue), Ms Sandra Libunao, a fundraising con-sultant, will be working with National LFProgramme Managers to ensure properfollow-up on the promising discussions withvarious in-country companies, such as Shell,Heineken and Standard Chartered Bank,which have indicated that their localoperating units may be able to help supportnational programmes in their respectivecountries.

Drug coverage (%)a

Total population Population reported As reported Geographical GeographicalRegional PRG Country of all IUs covered to have ingested drugs by IUs coverage coverage by

by MDA in 2003 during MDA in 2003 by IUs population

Africa Benin 839 321 678 638 80.9 31 24.5Burkina Faso 7 074 048 5 504 199 77.8 59 55.2Comoros 545 537 374 556 68.7 100 100.0Ghana 3 777 488 2 681 404 71.0 98 62.4Kenya 1 450 991 1 153 468 79.5 na 5.0e

Nigeria 4 323 401 3 112 889 72.0 na 4.1e

Togo 1 060 569 855 132 80.6 100 100.0Ugandad no MDA no MDA 0.0 0 0.0UR Tanzania 2 813 866 1 462 830 52.0 na 8.8e

Zanzibar, UR Tanzania 1 049 399 872 731 83.2 100 100.0Americas Dominican Republic 332 778 250 049 75.1 na 22.0e

Guyana 709 506 426 000 na na naHaiti 757 976 583 541 77.0 18 12.6

Eastern Egypt 2 731 644 2 547 143 93.2 100 100.0Mediterranean Yemen 104 821 82 089 78.3 100 92.3Mekong-Plus Indonesia 746 064 635 017 85.1 na 0.5

Malaysiab 2 912 375 2 912 375 na 100 100.0Myanmar 8 339 234 7 667 061 91.9 na 29.1e

Philippines 11 559 383 9 093 216 78.7 na 49.2e

Thailand 138 988 123 722 89.0 100 100.0Viet Nam 117 205 105 079 89.7 na 12.0e

PacCARE American Samoa 57 291 40 211 70.2 100 100.0Cook Islands 18 700 13 048 69.2 100 100.0Fiji 776 173 483 983 62.4 100 100.0French Polynesia 245 516 221 300 90.1 100 100.0Kiribatib 90 700 36 742 40.5 100 100.0Marshall Islands 51 800 933 1.8 100 naMicronesia 1 520 756 49.7 100 naNiue 1 788 1 386 77.5 100 100.0Samoa 176 848 140 855 79.6 100 100.0Tonga 97 784 88 752 90.8 100 100.0Tuvalu 9 561 7 896 82.5 100 100.0Vanuatu 186 678 163 271 87.0 100 100.0Wallis and Futuna 14 600 9 252 63.4 100 100.0

South Asia Bangladesh 6 692 672 6 168 267 92.2 na 13.4e

Indiac 15 460 508 12 755 037 82.5 3 3.4Nepal 508 534 412 923 81.2 na 2.3e

Sri Lanka 9 847 588 8 584 037 87.2 100 100.036 countries under MDA 85 622 855 70 249 788 82.05

a: drug coverage calculated as percentage of people administered the drugs over a total population in IUs — b: incomplete data c: in addition 52 million covered with DEC alone — d: Uganda stopped MDA in 2003 during the civil war – e: denominator: estimated at-risk populationna: not available

Regional PRG Number At-risk population At-risk global Number At-risk population % of at-risk of endemic in endemic countries population (%) of countries covered in 2003 populationcountries (million)* started MDA (million) covered in 2003

Africa** 39 477 38.6 8 16.7 12.00Americas 7 9 0.7 3 1.3 14.44Eastern Mediterranean 3 15 1.2 2 2.6 17.33Mekong-Plus 12 214 17.3 4 20.5 9.58PacCARE 17 4 0.3 13 1.2 30.00South Asia 5 514 41.6 6 27.9 5.43

TOTAL 83 1233 100 36 0.0 5.69

*At-risk population adjusted according to mapping** Africa PRG, only 8 countries had MDA in 2003; Uganda had no MDA due to internal unrest

Table 2. LF-endemic countries covered by MDA in 2003 by regional PRG

continued on page 4

Lymphatic filariasis (LF) is a majorcause of clinical morbidity and is an impediment to socioeconomicdevelopment in Africa. The diseasehas grave socioeconomic andpsychological consequences.It also imposes a tremendousburden on the health-care systemsin endemic areas.

The goal of the African programme is toeliminate LF as a public health problem

in Africa by the year 2020 and contribute tothe attainment of better health for the under-privileged majority of communities living withthe burden of the disease, in order to promoteproductive life. Improving the health status ofcommunities, especially poor communities,empowers them to improve their socioeco-nomic status, thereby contributing to nationaldevelopment and the attainment of the mil-lennium development goals. The cost ofeliminating LF is, therefore, an investmentleading to attainment of good health for theaffected communities as an immediate bene-fit and, in the long term, an important elementof poverty alleviation. The rationale for theinitiation of this programme is as follows:

� LF elimination, as a public health inter-vention, serves as a vehicle for promotinggeneral health care.

� The reduction and subsequent interrup-tion of transmission by mass drug adminis-tration (MDA) will protect future generationsagainst lymphatic filarial disease.

� Palliative and beneficial treatment of thoseaffected is now feasible using simple inter-ventions, which can be implemented at thecommunity level.

� Working with the malaria control pro-gramme to promote the use of insecticide-treated materials as a vector control strategy willgreatly enhance the elimination programmeand would also be cost effective.

� Programme activities will be backed upwith strong operational research to regularlyreview and confirm that the policies andstrategies followed are the most effective andefficient.

The strategic objectives are therefore:

� To improve the general health status ofendemic populations through increasedaccess to public health interventions, prefer-ably working through existing health struc-tures and programmes.

� To reduce and ultimately interrupt trans-mission of LF in all endemic communities byuse of chemotherapy with ivermectin/DECand albendazole, as well as vector controlthrough the promotion of insecticide-treatedmaterials.

� To alleviate the suffering of people withovert disease such as lymphoedema andhydrocele by use of specific morbiditycontrol tools.

� To set up an effective programme moni-toring system that will continually assessprogress of the programme and bring to thefore operational issues or problems relatedto programme implementation.

� To continually improve programme deliverythrough operational research.

Mapping

It is estimated that some 480 million peopleare at risk of infection in the WHO AfricanRegion. More than 4.6 million cases of lym-phoedema and over 10 million cases ofhydrocele are estimated to occur in theregion. These represent about 38% of theglobal burden of the disease.

The exact distribution of the disease withinmost endemic countries in the subregionremains unknown. Mapping the geographicaldistribution of LF within the countries is there-fore a top priority in our elimination goal. Ofthe 39 endemic countries in the African Region,15 have completed mapping, and 5 are in theprocess of mapping. In the countries wheremapping has been conducted, at least in part,the exercise has shown widespread occur-rence of the disease in areas where this wasnot expected.

MDA

Four countries (Ghana, Nigeria, Togo and theUnited Republic [UR] of Tanzania) startedimplementing MDA in 2000 on a smallscale. Another 5 countries started in 2001–2002: Benin, Burkina Faso, Comoros, Kenya

and Uganda. There have since been no newprogrammes because of lack of resources. OnlyComoros, Togo and Zanzibar (UR Tanzania)are currently covering all of the at-risk popula-tion. The rest of the programmes are coveringproportions ranging from 60% to 70% of theat-risk population.

Approximately 16.7 (77.3%) million peoplewere treated out of the 21.6 million targetedin 2003. National average figures of popula-tion coverage ranged from 67% in mainlandUR Tanzania to 83.1% in Zanzibar.

Denominators for estimating coverage con-tinue to be a challenge due to unreliable censusfigures. Strategies for achieving high-coverageurban and periurban MDA remain under-developed and continue to be a challenge.

Impact of MDA

Assessment of the impact of MDA is an inte-gral part of the elimination programme. Datafrom the sentinel sites are now being collectedin most countries to provide an indication of the impact of the previous treatments.Preliminary information from Zanzibar indi-cates more than 90% reduction in microfila-raemia prevalence and an even higherreduction in intensity of infection.

Morbidity control

Morbidity control continues to remain on theback seat of most country programmes becauseof inadequate resources and also because it isrelatively more difficult to implement comparedwith the MDA programme. Pilot activities have been initiated in Burkina Faso, Ghana,Madagascar and UR Tanzania. With the sup-port of several NGOs, a urologist has beenengaged to provide technical assistance forhydrocele surgery within the West African zone.Of the 9 countries implementing LF elimina-tion, 6 have reported handling 8781 cases oflymphoedema and 4339 hydrocelectomies.Most of these cases came from Burkina Faso,Ghana, Nigeria and UR Tanzania, while Kenyaand Uganda are only at the beginning stage.

The management of lymphoedema and ele-phantiasis has been integrated into some massdrug distribution activities and, in a fewinstances, the primary health-care system.

Table 1. Total population of all IUs for MDA with drug coadministration in 2003

LF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis2Progress on the eliminationof LF in African PRG

LF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis3 LF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis4Challenges

Funding for the programme continues to be amajor challenge. Political commitment at alllevels is high but does not usually translateinto allocation of resources, primarily becauseof competing health needs. Within the inter-national disease control arena, the specialinterest in malaria, TB and HIV/AIDS hasaffected the resource allocation paradigm thusmaking LF and other diseases “unfashionable”and neglected.

A major challenge is how the LF programmecould work with these relatively betterresource-endowed programmes to maximizethe benefits to the endemic communities.However, a specific fundraising strategy at thenational and subregional level is needed tofill the resource gap for these neglected diseases.

Synergies with other programmes such asthose for onchocerciasis, soil-transmittedhelminths and malaria are yet to be fullyexploited and continue to be a challenge inmany endemic countries. In most parts of

Central Africa where Loa loa is endemic, it hasnot been possible to initiate any programmesbecause of the potential severe adverse eventsassociated with the use of programme drugsin such communities. The rapid mapping ofLoa loa would have to be done in all suchareas before any programmes can be initiated.

Sustaining the interest of endemic communi-ties over 5–7 years in a treatment pro-gramme is a challenge. Demand for incen-tives continues to be a major issue, butcountries are finding innovative ways ofdealing with it at the community level.

In order to achieve the elimination goal,there is a need for rapid scaling-up of theprogramme within countries that havealready initiated programmes, and alsoexpansion to cover all endemic countries.Support for country programmes in devel-oping skills in programme management,mapping, laboratory techniques and datamanagement will be paramount. One way ofaddressing such a need will be to developcentres of excellence to provide technicalsupport in the subregion.

Conclusion

Enthusiasm from endemic countries to start theprogramme has come from the great achieve-ments of the PELF. However, their demand forassistance far outweighs the available mean, andthis has resulted in a prolonged period of diseasemapping (including countries already imple-menting MDA), a slow rate of scaling-up ofnational programmes to cover all the at-risk pop-ulations, and stagnation in the number of activeprogrammes.

In the active programmes greater effort needsto be put on achieving and sustaining highpopulation and geographical coverage rates.Insufficient funding remains the major con-straining factor. At this stage, the need forgood evaluation data is critical, and all effortsneed to be carried out in order to obtainthem. Country ownership and partnershipbuilding at all levels as well as creating syn-ergies between disease control programmesneed to be highly encouraged.

John Gyapong, Chair of African PRG

Executive summary of theCommunication Strategy of GAELF

The overall objective of the GAELF commu-nication strategy is to facilitate and provideaccess to all relevant information aboutlymphatic filariasis (LF) and its elimination,reaching out effectively to the public and toall partners.

The broad areas of communication includedin this plan are as follows:

� General communications, where emphasiswill be put on addressing the public, to increase awareness and to provide generalsupport for the global elimination of LF asa major public health and poverty-relatedproblem.

�Advocacy is directed at selected audi-ences, including both current and potentialpartners/donors (i.e. donors, foundations,international agencies, the private sector,NGDOs) and affected countries.

�Scientific communications will focus onkeeping interested parties abreast of recentdevelopments by providing them with thelatest information, which may have an impacton GAELF and its implementation.

�Programme development deals specificallywith programmatic matters, both ongoingand planned. The target audiences for thistype of communication are national pro-gramme managers and their teams respon-sible for LF elimination as well as all actorsinvolved in LF elimination activities.

This communication plan will be reviewedon an annual basis to enable new issues andchallenges to be properly addressed. TheExecutive Group will allocate the resourcesnecessary for the implementation of thepriority activities included in this plan, whileadditional resources will be sought to allowfor future expansion of communicationactivities.

Resumé of fundraising activities of GAELF

In Burkina Faso, a team led by the Pro-gramme Manager, Dominique Kyelem, hasbeen successful in raising in-country funding.A full report of how they achieved successwill appear in the next issue of LF News.

The Global Fund: Togo is the first country tobe successful in applying to the Global Fundfor malaria funding incorporating lymphaticfilariasis. The decision by the Global Fund toprovide funding for the integration of otherdiseases has opened up a massive oppor-tunity for countries to include LF into theirapplications.

The Executive Group is in the process ofplanning workshops to assist countries inapplying to the Global Fund.

HIPC/PRSP/debt swap funding: Dr BernhardLiese of the World Bank, heading a Task Forceon Country Level Funding, has receivedcommitment from the governments of Ghanaand UR Tanzania to provide support for theircountry programmes via HIPC funding from2005. Dr Liese plans to visit Burkina Faso asthe next target.

Johnson & Johnson, the world’s mostcomprehensive and broadly based manu-facturer of health-care products, hasagreed to consider a proposal to providenecessary items to create a hydrocelesurgical kit, initially for training andsurgeries in West Africa.

The Bill & Melinda Gates Foundation hasindicated its receptivity to receiving aLetter of Inquiry from the Global Allianceand has invited the Alliance chair and otherpartners to make a presentation, which isscheduled for mid-November. In addition,following a meeting on integration that washosted by the Foundation and attended byrepresentatives of multiple disease pro-grammes, a number of Letters of Inquiryhave been submitted in the context of inte-grating LF with other programmes.

There have also been promising initial indi-cations of interest from other foundationssuch as the Izumi Foundation, which hasrequested a Letter of Intent, and theRockefeller Foundation, where a recent visittook place.

In line with the Burkina Faso success story(which will be fully reported in the nextissue), Ms Sandra Libunao, a fundraising con-sultant, will be working with National LFProgramme Managers to ensure properfollow-up on the promising discussions withvarious in-country companies, such as Shell,Heineken and Standard Chartered Bank,which have indicated that their localoperating units may be able to help supportnational programmes in their respectivecountries.

Drug coverage (%)a

Total population Population reported As reported Geographical GeographicalRegional PRG Country of all IUs covered to have ingested drugs by IUs coverage coverage by

by MDA in 2003 during MDA in 2003 by IUs population

Africa Benin 839 321 678 638 80.9 31 24.5Burkina Faso 7 074 048 5 504 199 77.8 59 55.2Comoros 545 537 374 556 68.7 100 100.0Ghana 3 777 488 2 681 404 71.0 98 62.4Kenya 1 450 991 1 153 468 79.5 na 5.0e

Nigeria 4 323 401 3 112 889 72.0 na 4.1e

Togo 1 060 569 855 132 80.6 100 100.0Ugandad no MDA no MDA 0.0 0 0.0UR Tanzania 2 813 866 1 462 830 52.0 na 8.8e

Zanzibar, UR Tanzania 1 049 399 872 731 83.2 100 100.0Americas Dominican Republic 332 778 250 049 75.1 na 22.0e

Guyana 709 506 426 000 na na naHaiti 757 976 583 541 77.0 18 12.6

Eastern Egypt 2 731 644 2 547 143 93.2 100 100.0Mediterranean Yemen 104 821 82 089 78.3 100 92.3Mekong-Plus Indonesia 746 064 635 017 85.1 na 0.5

Malaysiab 2 912 375 2 912 375 na 100 100.0Myanmar 8 339 234 7 667 061 91.9 na 29.1e

Philippines 11 559 383 9 093 216 78.7 na 49.2e

Thailand 138 988 123 722 89.0 100 100.0Viet Nam 117 205 105 079 89.7 na 12.0e

PacCARE American Samoa 57 291 40 211 70.2 100 100.0Cook Islands 18 700 13 048 69.2 100 100.0Fiji 776 173 483 983 62.4 100 100.0French Polynesia 245 516 221 300 90.1 100 100.0Kiribatib 90 700 36 742 40.5 100 100.0Marshall Islands 51 800 933 1.8 100 naMicronesia 1 520 756 49.7 100 naNiue 1 788 1 386 77.5 100 100.0Samoa 176 848 140 855 79.6 100 100.0Tonga 97 784 88 752 90.8 100 100.0Tuvalu 9 561 7 896 82.5 100 100.0Vanuatu 186 678 163 271 87.0 100 100.0Wallis and Futuna 14 600 9 252 63.4 100 100.0

South Asia Bangladesh 6 692 672 6 168 267 92.2 na 13.4e

Indiac 15 460 508 12 755 037 82.5 3 3.4Nepal 508 534 412 923 81.2 na 2.3e

Sri Lanka 9 847 588 8 584 037 87.2 100 100.036 countries under MDA 85 622 855 70 249 788 82.05

a: drug coverage calculated as percentage of people administered the drugs over a total population in IUs — b: incomplete data c: in addition 52 million covered with DEC alone — d: Uganda stopped MDA in 2003 during the civil war – e: denominator: estimated at-risk populationna: not available

Regional PRG Number At-risk population At-risk global Number At-risk population % of at-risk of endemic in endemic countries population (%) of countries covered in 2003 populationcountries (million)* started MDA (million) covered in 2003

Africa** 39 477 38.6 8 16.7 12.00Americas 7 9 0.7 3 1.3 14.44Eastern Mediterranean 3 15 1.2 2 2.6 17.33Mekong-Plus 12 214 17.3 4 20.5 9.58PacCARE 17 4 0.3 13 1.2 30.00South Asia 5 514 41.6 6 27.9 5.43

TOTAL 83 1233 100 36 0.0 5.69

*At-risk population adjusted according to mapping** Africa PRG, only 8 countries had MDA in 2003; Uganda had no MDA due to internal unrest

Table 2. LF-endemic countries covered by MDA in 2003 by regional PRG

continued on page 4

Lymphatic filariasis (LF) is a majorcause of clinical morbidity and is an impediment to socioeconomicdevelopment in Africa. The diseasehas grave socioeconomic andpsychological consequences.It also imposes a tremendousburden on the health-care systemsin endemic areas.

The goal of the African programme is toeliminate LF as a public health problem

in Africa by the year 2020 and contribute tothe attainment of better health for the under-privileged majority of communities living withthe burden of the disease, in order to promoteproductive life. Improving the health status ofcommunities, especially poor communities,empowers them to improve their socioeco-nomic status, thereby contributing to nationaldevelopment and the attainment of the mil-lennium development goals. The cost ofeliminating LF is, therefore, an investmentleading to attainment of good health for theaffected communities as an immediate bene-fit and, in the long term, an important elementof poverty alleviation. The rationale for theinitiation of this programme is as follows:

� LF elimination, as a public health inter-vention, serves as a vehicle for promotinggeneral health care.

� The reduction and subsequent interrup-tion of transmission by mass drug adminis-tration (MDA) will protect future generationsagainst lymphatic filarial disease.

� Palliative and beneficial treatment of thoseaffected is now feasible using simple inter-ventions, which can be implemented at thecommunity level.

� Working with the malaria control pro-gramme to promote the use of insecticide-treated materials as a vector control strategy willgreatly enhance the elimination programmeand would also be cost effective.

� Programme activities will be backed upwith strong operational research to regularlyreview and confirm that the policies andstrategies followed are the most effective andefficient.

The strategic objectives are therefore:

� To improve the general health status ofendemic populations through increasedaccess to public health interventions, prefer-ably working through existing health struc-tures and programmes.

� To reduce and ultimately interrupt trans-mission of LF in all endemic communities byuse of chemotherapy with ivermectin/DECand albendazole, as well as vector controlthrough the promotion of insecticide-treatedmaterials.

� To alleviate the suffering of people withovert disease such as lymphoedema andhydrocele by use of specific morbiditycontrol tools.

� To set up an effective programme moni-toring system that will continually assessprogress of the programme and bring to thefore operational issues or problems relatedto programme implementation.

� To continually improve programme deliverythrough operational research.

Mapping

It is estimated that some 480 million peopleare at risk of infection in the WHO AfricanRegion. More than 4.6 million cases of lym-phoedema and over 10 million cases ofhydrocele are estimated to occur in theregion. These represent about 38% of theglobal burden of the disease.

The exact distribution of the disease withinmost endemic countries in the subregionremains unknown. Mapping the geographicaldistribution of LF within the countries is there-fore a top priority in our elimination goal. Ofthe 39 endemic countries in the African Region,15 have completed mapping, and 5 are in theprocess of mapping. In the countries wheremapping has been conducted, at least in part,the exercise has shown widespread occur-rence of the disease in areas where this wasnot expected.

MDA

Four countries (Ghana, Nigeria, Togo and theUnited Republic [UR] of Tanzania) startedimplementing MDA in 2000 on a smallscale. Another 5 countries started in 2001–2002: Benin, Burkina Faso, Comoros, Kenya

and Uganda. There have since been no newprogrammes because of lack of resources. OnlyComoros, Togo and Zanzibar (UR Tanzania)are currently covering all of the at-risk popula-tion. The rest of the programmes are coveringproportions ranging from 60% to 70% of theat-risk population.

Approximately 16.7 (77.3%) million peoplewere treated out of the 21.6 million targetedin 2003. National average figures of popula-tion coverage ranged from 67% in mainlandUR Tanzania to 83.1% in Zanzibar.

Denominators for estimating coverage con-tinue to be a challenge due to unreliable censusfigures. Strategies for achieving high-coverageurban and periurban MDA remain under-developed and continue to be a challenge.

Impact of MDA

Assessment of the impact of MDA is an inte-gral part of the elimination programme. Datafrom the sentinel sites are now being collectedin most countries to provide an indication of the impact of the previous treatments.Preliminary information from Zanzibar indi-cates more than 90% reduction in microfila-raemia prevalence and an even higherreduction in intensity of infection.

Morbidity control

Morbidity control continues to remain on theback seat of most country programmes becauseof inadequate resources and also because it isrelatively more difficult to implement comparedwith the MDA programme. Pilot activities have been initiated in Burkina Faso, Ghana,Madagascar and UR Tanzania. With the sup-port of several NGOs, a urologist has beenengaged to provide technical assistance forhydrocele surgery within the West African zone.Of the 9 countries implementing LF elimina-tion, 6 have reported handling 8781 cases oflymphoedema and 4339 hydrocelectomies.Most of these cases came from Burkina Faso,Ghana, Nigeria and UR Tanzania, while Kenyaand Uganda are only at the beginning stage.

The management of lymphoedema and ele-phantiasis has been integrated into some massdrug distribution activities and, in a fewinstances, the primary health-care system.

Table 1. Total population of all IUs for MDA with drug coadministration in 2003

LF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis2Progress on the eliminationof LF in African PRG

LF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis3 LF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis4Challenges

Funding for the programme continues to be amajor challenge. Political commitment at alllevels is high but does not usually translateinto allocation of resources, primarily becauseof competing health needs. Within the inter-national disease control arena, the specialinterest in malaria, TB and HIV/AIDS hasaffected the resource allocation paradigm thusmaking LF and other diseases “unfashionable”and neglected.

A major challenge is how the LF programmecould work with these relatively betterresource-endowed programmes to maximizethe benefits to the endemic communities.However, a specific fundraising strategy at thenational and subregional level is needed tofill the resource gap for these neglected diseases.

Synergies with other programmes such asthose for onchocerciasis, soil-transmittedhelminths and malaria are yet to be fullyexploited and continue to be a challenge inmany endemic countries. In most parts of

Central Africa where Loa loa is endemic, it hasnot been possible to initiate any programmesbecause of the potential severe adverse eventsassociated with the use of programme drugsin such communities. The rapid mapping ofLoa loa would have to be done in all suchareas before any programmes can be initiated.

Sustaining the interest of endemic communi-ties over 5–7 years in a treatment pro-gramme is a challenge. Demand for incen-tives continues to be a major issue, butcountries are finding innovative ways ofdealing with it at the community level.

In order to achieve the elimination goal,there is a need for rapid scaling-up of theprogramme within countries that havealready initiated programmes, and alsoexpansion to cover all endemic countries.Support for country programmes in devel-oping skills in programme management,mapping, laboratory techniques and datamanagement will be paramount. One way ofaddressing such a need will be to developcentres of excellence to provide technicalsupport in the subregion.

Conclusion

Enthusiasm from endemic countries to start theprogramme has come from the great achieve-ments of the PELF. However, their demand forassistance far outweighs the available mean, andthis has resulted in a prolonged period of diseasemapping (including countries already imple-menting MDA), a slow rate of scaling-up ofnational programmes to cover all the at-risk pop-ulations, and stagnation in the number of activeprogrammes.

In the active programmes greater effort needsto be put on achieving and sustaining highpopulation and geographical coverage rates.Insufficient funding remains the major con-straining factor. At this stage, the need forgood evaluation data is critical, and all effortsneed to be carried out in order to obtainthem. Country ownership and partnershipbuilding at all levels as well as creating syn-ergies between disease control programmesneed to be highly encouraged.

John Gyapong, Chair of African PRG

Executive summary of theCommunication Strategy of GAELF

The overall objective of the GAELF commu-nication strategy is to facilitate and provideaccess to all relevant information aboutlymphatic filariasis (LF) and its elimination,reaching out effectively to the public and toall partners.

The broad areas of communication includedin this plan are as follows:

� General communications, where emphasiswill be put on addressing the public, to increase awareness and to provide generalsupport for the global elimination of LF asa major public health and poverty-relatedproblem.

�Advocacy is directed at selected audi-ences, including both current and potentialpartners/donors (i.e. donors, foundations,international agencies, the private sector,NGDOs) and affected countries.

�Scientific communications will focus onkeeping interested parties abreast of recentdevelopments by providing them with thelatest information, which may have an impacton GAELF and its implementation.

�Programme development deals specificallywith programmatic matters, both ongoingand planned. The target audiences for thistype of communication are national pro-gramme managers and their teams respon-sible for LF elimination as well as all actorsinvolved in LF elimination activities.

This communication plan will be reviewedon an annual basis to enable new issues andchallenges to be properly addressed. TheExecutive Group will allocate the resourcesnecessary for the implementation of thepriority activities included in this plan, whileadditional resources will be sought to allowfor future expansion of communicationactivities.

Resumé of fundraising activities of GAELF

In Burkina Faso, a team led by the Pro-gramme Manager, Dominique Kyelem, hasbeen successful in raising in-country funding.A full report of how they achieved successwill appear in the next issue of LF News.

The Global Fund: Togo is the first country tobe successful in applying to the Global Fundfor malaria funding incorporating lymphaticfilariasis. The decision by the Global Fund toprovide funding for the integration of otherdiseases has opened up a massive oppor-tunity for countries to include LF into theirapplications.

The Executive Group is in the process ofplanning workshops to assist countries inapplying to the Global Fund.

HIPC/PRSP/debt swap funding: Dr BernhardLiese of the World Bank, heading a Task Forceon Country Level Funding, has receivedcommitment from the governments of Ghanaand UR Tanzania to provide support for theircountry programmes via HIPC funding from2005. Dr Liese plans to visit Burkina Faso asthe next target.

Johnson & Johnson, the world’s mostcomprehensive and broadly based manu-facturer of health-care products, hasagreed to consider a proposal to providenecessary items to create a hydrocelesurgical kit, initially for training andsurgeries in West Africa.

The Bill & Melinda Gates Foundation hasindicated its receptivity to receiving aLetter of Inquiry from the Global Allianceand has invited the Alliance chair and otherpartners to make a presentation, which isscheduled for mid-November. In addition,following a meeting on integration that washosted by the Foundation and attended byrepresentatives of multiple disease pro-grammes, a number of Letters of Inquiryhave been submitted in the context of inte-grating LF with other programmes.

There have also been promising initial indi-cations of interest from other foundationssuch as the Izumi Foundation, which hasrequested a Letter of Intent, and theRockefeller Foundation, where a recent visittook place.

In line with the Burkina Faso success story(which will be fully reported in the nextissue), Ms Sandra Libunao, a fundraising con-sultant, will be working with National LFProgramme Managers to ensure properfollow-up on the promising discussions withvarious in-country companies, such as Shell,Heineken and Standard Chartered Bank,which have indicated that their localoperating units may be able to help supportnational programmes in their respectivecountries.

Drug coverage (%)a

Total population Population reported As reported Geographical GeographicalRegional PRG Country of all IUs covered to have ingested drugs by IUs coverage coverage by

by MDA in 2003 during MDA in 2003 by IUs population

Africa Benin 839 321 678 638 80.9 31 24.5Burkina Faso 7 074 048 5 504 199 77.8 59 55.2Comoros 545 537 374 556 68.7 100 100.0Ghana 3 777 488 2 681 404 71.0 98 62.4Kenya 1 450 991 1 153 468 79.5 na 5.0e

Nigeria 4 323 401 3 112 889 72.0 na 4.1e

Togo 1 060 569 855 132 80.6 100 100.0Ugandad no MDA no MDA 0.0 0 0.0UR Tanzania 2 813 866 1 462 830 52.0 na 8.8e

Zanzibar, UR Tanzania 1 049 399 872 731 83.2 100 100.0Americas Dominican Republic 332 778 250 049 75.1 na 22.0e

Guyana 709 506 426 000 na na naHaiti 757 976 583 541 77.0 18 12.6

Eastern Egypt 2 731 644 2 547 143 93.2 100 100.0Mediterranean Yemen 104 821 82 089 78.3 100 92.3Mekong-Plus Indonesia 746 064 635 017 85.1 na 0.5

Malaysiab 2 912 375 2 912 375 na 100 100.0Myanmar 8 339 234 7 667 061 91.9 na 29.1e

Philippines 11 559 383 9 093 216 78.7 na 49.2e

Thailand 138 988 123 722 89.0 100 100.0Viet Nam 117 205 105 079 89.7 na 12.0e

PacCARE American Samoa 57 291 40 211 70.2 100 100.0Cook Islands 18 700 13 048 69.2 100 100.0Fiji 776 173 483 983 62.4 100 100.0French Polynesia 245 516 221 300 90.1 100 100.0Kiribatib 90 700 36 742 40.5 100 100.0Marshall Islands 51 800 933 1.8 100 naMicronesia 1 520 756 49.7 100 naNiue 1 788 1 386 77.5 100 100.0Samoa 176 848 140 855 79.6 100 100.0Tonga 97 784 88 752 90.8 100 100.0Tuvalu 9 561 7 896 82.5 100 100.0Vanuatu 186 678 163 271 87.0 100 100.0Wallis and Futuna 14 600 9 252 63.4 100 100.0

South Asia Bangladesh 6 692 672 6 168 267 92.2 na 13.4e

Indiac 15 460 508 12 755 037 82.5 3 3.4Nepal 508 534 412 923 81.2 na 2.3e

Sri Lanka 9 847 588 8 584 037 87.2 100 100.036 countries under MDA 85 622 855 70 249 788 82.05

a: drug coverage calculated as percentage of people administered the drugs over a total population in IUs — b: incomplete data c: in addition 52 million covered with DEC alone — d: Uganda stopped MDA in 2003 during the civil war – e: denominator: estimated at-risk populationna: not available

Regional PRG Number At-risk population At-risk global Number At-risk population % of at-risk of endemic in endemic countries population (%) of countries covered in 2003 populationcountries (million)* started MDA (million) covered in 2003

Africa** 39 477 38.6 8 16.7 12.00Americas 7 9 0.7 3 1.3 14.44Eastern Mediterranean 3 15 1.2 2 2.6 17.33Mekong-Plus 12 214 17.3 4 20.5 9.58PacCARE 17 4 0.3 13 1.2 30.00South Asia 5 514 41.6 6 27.9 5.43

TOTAL 83 1233 100 36 0.0 5.69

*At-risk population adjusted according to mapping** Africa PRG, only 8 countries had MDA in 2003; Uganda had no MDA due to internal unrest

Table 2. LF-endemic countries covered by MDA in 2003 by regional PRG

continued on page 4

Dear Partners,

The fifth issue of LF News is in itsregular format of six pages. It focuseson two reports from the Chairs of theAfrican and Eastern MediterraneanProgramme Review Groups, while onthe first page you will find an articlewritten by Dr Yankum Dadzie, Chair of the Executive Group.

On page 3 you will find a table of dataconcerning the total population of allimplementation units where mass drugadministration has been carried out in2003, where 70 million people werereported to have ingested the drugcombination of either DEC plusalbendazole or ivermectin plusalbendazole in 36 countries. A secondtable shows the number of endemiccountries that were covered by massdrug administration in 2003 organizedunder their respective RegionalProgramme Review Groups.

LF News, Issue 5 has been printed in 3000 copies and widely distributedin countries and regions. Electroniccopies can be downloaded from the site of the Global Alliance at:www.filariasis.org and the HTMLversion has been e-mailed to severalhundred people throughout the world.

Once again, your suggestions onthemes and articles will be mostwelcome and may be sent via the website by clicking “contact” in the upperright-hand corner on the home page of www.filariasis.org.

The Editor

The frontispiece to LF News Issue 4provided a review of the newstructure of the Global Alliance to

Eliminate Lymphatic Filariasis (GAELF)that was established at the Third Meetingof the Global Alliance held in Cairo,Egypt, on 23–25 March 2004.

Since then, activities have continuedapace. A first aim of the Executive Group(EG) was to consider their role anddevelop an appropriate mission state-ment. The following mission statement,they believe, encompasses their role andthe ethos of the GAELF in its role to assistthe Global Programme to EliminateLymphatic Filariasis (GPELF):“The Executive Group of GAELF worksto support the GPELF by enhancing theeffectiveness of national, regional andglobal fundraising, advocacy, commu-nication and planning for theProgramme.”

Included in this issue are two regionalreports – one from the African Pro-gramme Review Group (PRG) and theother from the Eastern MediterraneanPRG, both of which provide an insightinto their activities. Focus is also on theprogress achieved by the EG and variousother partners.

As indicated previously, the EG iscommitted to ensuring that the GPELF issuccessful. In Cairo and in the creation ofthe Action Plan for the EG, fundraising

was highlighted as being the priorityneed for the Programme.

To achieve success, the EG has instigatedseveral initiatives. North American andEuropean fundraising teams have beenappointed, and approaches to potentialdonor foundations, organizations andbilaterals are under way. The NorthAmerican team is also establishing aNorth American Committee headed byFather Ted Hesburgh, former President of the University of Notre Dame inIndiana, former Chair of the RockefellerFoundation and one of the primaryproponents of the Green Revolution. Heis highly respected and widely consid-ered a luminary in humanitarian circles.The North American Committee will actas advocate for the Global Alliance toraise public awareness and secure addi-tional programmatic and donor partnersfor the Alliance in the United States andCanada.

Also in this issue are articles on thesuccesses already achieved. BurkinaFaso, with training and support, has beensuccessful in raising in-country funds,and Togo has been successful inobtaining the Global Fund to Fight AIDS,TB and Malaria (GFATM) support formalaria with integrated LF activities.Advocacy with the GFATM has alsoresulted in the inclusion of a sectionregarding disease intervention strategyintegration. Workshops are planned to

assist countries prepare applications tothe Global Fund. Dr Bernhard Liese ofthe World Bank generously agreed tolead a task force to investigate the avail-ability of in-country funds related toHIPC/PRSP and debt swap.

To support the advocacy and fundraisingactivities, a brochure, a four-page leafletand a DVD are currently being devel-oped. Copies of these will be availablefrom the EG Secretariat (see contactdetails on back cover).

The Executive summary of the Commu-nication Strategy appears on page 4. Thefull Communication Strategy has beenseparately circulated by e-mail. Commu-nication, not only with our partners butalso globally to achieve a higher diseasefocus, is a complicated and mammothundertaking. To date, two issues of thequarterly e-mail publication Executivegroup update, which provides greaterdetail of the activities of the EG, havebeen circulated. The EG believes thattransparency in information-sharing isessential, and only by frequent commu-nication can it be achieved. Any feed-back on communication and informa-tion sharing to the EG Secretariat wouldbe appreciated.

Yankum Dadzie Chair, Executive Group

Global Alliance to Eliminate Lymphatic Filariasis

Nº5AUTUMN 2004

THE NEWSLETTER This document may be freely reviewed, abstracted,reproduced or translated, in part or in whole, butnot for sale or for use in conjunction withcommercial purposes. The designations employedand the presentation of all material in LF News donot imply the expression of any opinion whatsoeveron the part of the Executive Group of the GlobalAlliance to Eliminate Lymphatic Filariasis concerningthe legal status of any country, territory, city or areaor of its authorities, or concerning the delimitation ofits frontiers or boundaries.

LF News is a publication of GAELF and is publishedquarterly by the Global Alliance Secretariat. Publisheddata reflect information available at the time of print.

The editor welcomes articles of interest on publichealth and lymphatic filariasis for publication andsuggestions of themes or issues that readers would liketo see discussed or written about in LF News.

MEETINGS7–11 November 200453rd Meeting of the American Society of Tropical Medicine Miami, USA

12–13 November 2004WHO Informal Consultation on TechnicalIssues Faced by the GPELF after the first five years Miami, USA

20 December 20044th Regional Programme Review GroupMeeting on Lymphatic FilariasisElimination Cairo, Egypt

8–9 March 2005Intercountry meeting of nationalprogramme managers of the South AsiaProgramme Review GroupBangalore, India

10–11 March 20057th Meeting of the South Asia (formerlyIndian Subcontinent) Programme ReviewGroup Bangalore, India

25–28 January 2005Global Fund Workshop for FrancophoneCountriesLomé, Togo

31 January–3 February 2005Global Fund Workshop for AnglophoneCountriesAccra, Ghana

PARTNERSThe Global Alliance to EliminateLymphatic Filariasis is a coalitionforged among many organizations, eachwith a different mandate but all having acommon goal: to tackle the wide-rangingand complex process of science and practice that will result in theelimination of lymphatic filariasis.Partners of the Global Alliance are:

Ministries of Health of the 80 endemic countries;

World Bank Group; United Nations Children’s

Fund (UNICEF); World Health Organization (WHO);

Binax, Inc., USA; Merck & Co., Inc., USA;

GlaxoSmithKline, UK; Arab Fund for Economic and

Social Development (AFESD), Kuwait; Bill &

Melinda Gates Foundation, USA; Centers for

Disease Control and Prevention (CDC), Atlanta,

USA; Department for International Development

(DFID), UK; Directorate General for Development

Cooperation (DGCS), Italy; Japan International

Cooperation Agency (JICA), Japan; Ministry of

Health, Labour and Welfare, Japan; Ministeral des

Affaires sociales, de la Santé publique et de

l’Environnment, Belgium; Ministerio de Sanidad y

Consumo, Spain; Ministry of Health, Welfare and

Sport, The Netherlands; Amaury Couthino, Brazil;

Fondazione Franco Moschino, Italy; Handicap

International; Health and Development

International (HDI), Norway; Interchurch Medical

Assistance (IMA), USA; International Foundation

for Dermatology, UK; International Skin-Care

Nursing Group, UK; International Volunteers in

Urology, USA; Carter Center, Atlanta, USA; Centres

for Partnerships in Health, Australia; Mectizan®

Donation Program, USA; World Alliance for

Community Health, Canada; Ain Shams University,

Egypt; Bernhard Nocht Institute for Tropical

Medicine, Germany; Chinese Academy of

Preventive Medicine, China; Danish Bilharziasis

Laboratory (DBL), Denmark; Institute for Medical

Research (IMR), Malaysia; James Cook University,

Australia; Lymphatic Filariasis Support Center,

Emory University, USA; Lymphatic Filariasis

Support Centre, Liverpool School of Tropical

Medicine, UK; Michigan State University, USA;

University of Notre Dame, USA; Universidade

Federal de Pernambuco, Brazil; Vector Control

Research Centre (VCRC), Indian Council of

Medical Research, India; Washington University in

St Louis, Barnes-Jewish Hospital, USA.

LF NEWSLF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis6The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis

All comments and feedback on LF News should be sent to the Executive Group of GAELF fax: + 44 (0)151 709 0354 — E-mail: gaelf@liv.ac.uk

EDITORIAL

LF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis5LF elimination in the EasternMediterranean PRGThe Eastern Mediterranean PRGincludes 23 countries. LF is wellknown to be focally endemic inthree countries in the region:Egypt, Sudan and Yemen; whereasthe LF situation in Djibouti, Oman,Pakistan, Saudi Arabia and Somaliais currently uncertain.

In these countries, LF is caused entirely by Wuchereria bancrofti transmitted primarily

by Culex mosquitoes in most rural and semi-urban areas.

A regional PRG for the elimination of LF was as-sembled in 2001 to meet on a yearly basis. TheArab Fund for Economic and Social Develop-ment, located in Kuwait, made a generous con-tribution aimed at helping these countries tostart LF elimination programmes.

Current status of LF elimination programmes in endemic countries

EGYPTThe population of Egypt (administratively con-sisting of 27 governorates) is currently more than70 million people. The disease has a focal distribution in 8 governorates.

Egypt is among the first countries to develop anational programme to eliminate LF (NPELF).The programme is based on MDA of singleannual doses of DEC (6 mg/kg) in combina-tion with albendazole (400 mg). The villagelevel was chosen as the implementation unit(IU) for MDA.

The programme depended on a well-devel-oped infrastructure with a network of ruralhealth centres and good social mobilization.

The NPELF has successfully completed 5rounds. The number of identified endemic vil-lages increased from 161 in 2000 to 181 in2004. The coverage rate was estimated (de-pendently and independently) to be consistentlyover 80%.

Adverse events were rare and mild-to-moderatein severity. Spot surveys in several localities fol-lowing each round of MDA showed a remark-able impact of the drug combination on MFprevalence rates and intensities.

YEMENYemen (approximately 20 million people) is aknown endemic country for onchocerciasis andhas proved to be for LF too. The ozla (subdis-trict) is considered as the IU of the NPELF.

Integration of the NPELF was done with the lep-rosy mission, a unit related to the YemeniMinistry of Public Health (MOPH), which is responsible for onchocerciasis control and pre-vention and has a well-developed network ofclinics distributed throughout the country.

In 2000, questionnaires were distributed to keyinformants and revealed that 13 ozlas (11 laterproved to be endemic by ICT) and 24 ozlas indifferent governorates (none proved to beendemic) were less likely endemic localities.

Training sessions for 634 primary health-careworkers were carried out in addition to socialmobilization activities. In 2002, an initial pilotMDA was implemented in 3 ozlas (42 800inhabitants). Then, the first round of MDA withivermectin (200 µg/kg) and albendazole (400 mg) was carried out house-to-house. Theprogramme estimated an overall 85% MDAcoverage rate. No serious adverse events wereidentified.

In 2003, the second round of MDA was carriedout in the same areas and in 9 additional endemic IUs. Lack of ICT cards and resources hin-dered the completion of LF mapping in Yemen.

SUDANLF is endemic in Sudan. During 2003, a pilotsurvey in 4 states was carried out for rapidassessment of the LF situation using the ques-tionnaire approach and a limited number ofICT cards. The administrative unit (mahaliat)was chosen as the IU.

Currently, LQAS surveys using ICT are beingconducted in highly suspect administrativeunits identified by questionnaire surveys in 2states: Bahr El-Gabal and Bahr El-Ghazal. Forsecurity reasons, mapping of LF in Sudan iscurrently hampered.

Countries with uncertain LF situation

SAUDI ARABIASaudi Arabia, with an estimated population ofapproximately 24 million inhabitants, hasreported a few chronic cases of LF from 3areas: Assir, Jazan and Mekka.

Consequently, 34 laboratory technicians weretrained to perform ICT. However, due to a tech-nical problem encountered at that time withthe Binax ICT cards, the evaluation of thecurrent LF situation in Saudi Arabia was post-poned.

OMANOman has a population of approximately 2.5million inhabitants, of which 26.3% are expa-triates. Many of the expatriates come to workin Oman from LF-endemic countries (e.g.India). Over the past decade, 15 LF cases wereidentified; only 7 were Omani.

In 2002, health authorities in Oman carriedout a rapid assessment of community burdenof the disease using the questionnaireapproach: 23 (3.6%) informants, representing12 districts, reported that they had seen at least1 case of LF and 21 physicians (3.1%) hadobserved cases of lymphoedema and/orhydrocele.

Oman is currently conducting LQAS surveysusing the ICT in high schools in highlysuspected areas.

Maged El Setouhy Chair of the Eastern MediterraneanPRG

EDITORIAL

Dear Partners,

The fifth issue of LF News is in itsregular format of six pages. It focuseson two reports from the Chairs of theAfrican and Eastern MediterraneanProgramme Review Groups, while onthe first page you will find an articlewritten by Dr Yankum Dadzie, Chair of the Executive Group.

On page 3 you will find a table of dataconcerning the total population of allimplementation units where mass drugadministration has been carried out in2003, where 70 million people werereported to have ingested the drugcombination of either DEC plusalbendazole or ivermectin plusalbendazole in 36 countries. A secondtable shows the number of endemiccountries that were covered by massdrug administration in 2003 organizedunder their respective RegionalProgramme Review Groups.

LF News, Issue 5 has been printed in 3000 copies and widely distributedin countries and regions. Electroniccopies can be downloaded from the site of the Global Alliance at:www.filariasis.org and the HTMLversion has been e-mailed to severalhundred people throughout the world.

Once again, your suggestions onthemes and articles will be mostwelcome and may be sent via the website by clicking “contact” in the upperright-hand corner on the home page of www.filariasis.org.

The Editor

The frontispiece to LF News Issue 4provided a review of the newstructure of the Global Alliance to

Eliminate Lymphatic Filariasis (GAELF)that was established at the Third Meetingof the Global Alliance held in Cairo,Egypt, on 23–25 March 2004.

Since then, activities have continuedapace. A first aim of the Executive Group(EG) was to consider their role anddevelop an appropriate mission state-ment. The following mission statement,they believe, encompasses their role andthe ethos of the GAELF in its role to assistthe Global Programme to EliminateLymphatic Filariasis (GPELF):“The Executive Group of GAELF worksto support the GPELF by enhancing theeffectiveness of national, regional andglobal fundraising, advocacy, commu-nication and planning for theProgramme.”

Included in this issue are two regionalreports – one from the African Pro-gramme Review Group (PRG) and theother from the Eastern MediterraneanPRG, both of which provide an insightinto their activities. Focus is also on theprogress achieved by the EG and variousother partners.

As indicated previously, the EG iscommitted to ensuring that the GPELF issuccessful. In Cairo and in the creation ofthe Action Plan for the EG, fundraising

was highlighted as being the priorityneed for the Programme.

To achieve success, the EG has instigatedseveral initiatives. North American andEuropean fundraising teams have beenappointed, and approaches to potentialdonor foundations, organizations andbilaterals are under way. The NorthAmerican team is also establishing aNorth American Committee headed byFather Ted Hesburgh, former President of the University of Notre Dame inIndiana, former Chair of the RockefellerFoundation and one of the primaryproponents of the Green Revolution. Heis highly respected and widely consid-ered a luminary in humanitarian circles.The North American Committee will actas advocate for the Global Alliance toraise public awareness and secure addi-tional programmatic and donor partnersfor the Alliance in the United States andCanada.

Also in this issue are articles on thesuccesses already achieved. BurkinaFaso, with training and support, has beensuccessful in raising in-country funds,and Togo has been successful inobtaining the Global Fund to Fight AIDS,TB and Malaria (GFATM) support formalaria with integrated LF activities.Advocacy with the GFATM has alsoresulted in the inclusion of a sectionregarding disease intervention strategyintegration. Workshops are planned to

assist countries prepare applications tothe Global Fund. Dr Bernhard Liese ofthe World Bank generously agreed tolead a task force to investigate the avail-ability of in-country funds related toHIPC/PRSP and debt swap.

To support the advocacy and fundraisingactivities, a brochure, a four-page leafletand a DVD are currently being devel-oped. Copies of these will be availablefrom the EG Secretariat (see contactdetails on back cover).

The Executive summary of the Commu-nication Strategy appears on page 4. Thefull Communication Strategy has beenseparately circulated by e-mail. Commu-nication, not only with our partners butalso globally to achieve a higher diseasefocus, is a complicated and mammothundertaking. To date, two issues of thequarterly e-mail publication Executivegroup update, which provides greaterdetail of the activities of the EG, havebeen circulated. The EG believes thattransparency in information-sharing isessential, and only by frequent commu-nication can it be achieved. Any feed-back on communication and informa-tion sharing to the EG Secretariat wouldbe appreciated.

Yankum Dadzie Chair, Executive Group

Global Alliance to Eliminate Lymphatic Filariasis

Nº5AUTUMN 2004

THE NEWSLETTER This document may be freely reviewed, abstracted,reproduced or translated, in part or in whole, butnot for sale or for use in conjunction withcommercial purposes. The designations employedand the presentation of all material in LF News donot imply the expression of any opinion whatsoeveron the part of the Executive Group of the GlobalAlliance to Eliminate Lymphatic Filariasis concerningthe legal status of any country, territory, city or areaor of its authorities, or concerning the delimitation ofits frontiers or boundaries.

LF News is a publication of GAELF and is publishedquarterly by the Global Alliance Secretariat. Publisheddata reflect information available at the time of print.

The editor welcomes articles of interest on publichealth and lymphatic filariasis for publication andsuggestions of themes or issues that readers would liketo see discussed or written about in LF News.

MEETINGS7–11 November 200453rd Meeting of the American Society of Tropical Medicine Miami, USA

12–13 November 2004WHO Informal Consultation on TechnicalIssues Faced by the GPELF after the first five years Miami, USA

20 December 20044th Regional Programme Review GroupMeeting on Lymphatic FilariasisElimination Cairo, Egypt

8–9 March 2005Intercountry meeting of nationalprogramme managers of the South AsiaProgramme Review GroupBangalore, India

10–11 March 20057th Meeting of the South Asia (formerlyIndian Subcontinent) Programme ReviewGroup Bangalore, India

25–28 January 2005Global Fund Workshop for FrancophoneCountriesLomé, Togo

31 January–3 February 2005Global Fund Workshop for AnglophoneCountriesAccra, Ghana

PARTNERSThe Global Alliance to EliminateLymphatic Filariasis is a coalitionforged among many organizations, eachwith a different mandate but all having acommon goal: to tackle the wide-rangingand complex process of science and practice that will result in theelimination of lymphatic filariasis.Partners of the Global Alliance are:

Ministries of Health of the 80 endemic countries;

World Bank Group; United Nations Children’s

Fund (UNICEF); World Health Organization (WHO);

Binax, Inc., USA; Merck & Co., Inc., USA;

GlaxoSmithKline, UK; Arab Fund for Economic and

Social Development (AFESD), Kuwait; Bill &

Melinda Gates Foundation, USA; Centers for

Disease Control and Prevention (CDC), Atlanta,

USA; Department for International Development

(DFID), UK; Directorate General for Development

Cooperation (DGCS), Italy; Japan International

Cooperation Agency (JICA), Japan; Ministry of

Health, Labour and Welfare, Japan; Ministeral des

Affaires sociales, de la Santé publique et de

l’Environnment, Belgium; Ministerio de Sanidad y

Consumo, Spain; Ministry of Health, Welfare and

Sport, The Netherlands; Amaury Couthino, Brazil;

Fondazione Franco Moschino, Italy; Handicap

International; Health and Development

International (HDI), Norway; Interchurch Medical

Assistance (IMA), USA; International Foundation

for Dermatology, UK; International Skin-Care

Nursing Group, UK; International Volunteers in

Urology, USA; Carter Center, Atlanta, USA; Centres

for Partnerships in Health, Australia; Mectizan®

Donation Program, USA; World Alliance for

Community Health, Canada; Ain Shams University,

Egypt; Bernhard Nocht Institute for Tropical

Medicine, Germany; Chinese Academy of

Preventive Medicine, China; Danish Bilharziasis

Laboratory (DBL), Denmark; Institute for Medical

Research (IMR), Malaysia; James Cook University,

Australia; Lymphatic Filariasis Support Center,

Emory University, USA; Lymphatic Filariasis

Support Centre, Liverpool School of Tropical

Medicine, UK; Michigan State University, USA;

University of Notre Dame, USA; Universidade

Federal de Pernambuco, Brazil; Vector Control

Research Centre (VCRC), Indian Council of

Medical Research, India; Washington University in

St Louis, Barnes-Jewish Hospital, USA.

LF NEWSLF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis6The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis

All comments and feedback on LF News should be sent to the Executive Group of GAELF fax: + 44 (0)151 709 0354 — E-mail: gaelf@liv.ac.uk

EDITORIAL

LF NEWS The Newsletter of the Global Alliance to Eliminate Lymphatic Filariasis5LF elimination in the EasternMediterranean PRGThe Eastern Mediterranean PRGincludes 23 countries. LF is wellknown to be focally endemic inthree countries in the region:Egypt, Sudan and Yemen; whereasthe LF situation in Djibouti, Oman,Pakistan, Saudi Arabia and Somaliais currently uncertain.

In these countries, LF is caused entirely by Wuchereria bancrofti transmitted primarily

by Culex mosquitoes in most rural and semi-urban areas.

A regional PRG for the elimination of LF was as-sembled in 2001 to meet on a yearly basis. TheArab Fund for Economic and Social Develop-ment, located in Kuwait, made a generous con-tribution aimed at helping these countries tostart LF elimination programmes.

Current status of LF elimination programmes in endemic countries

EGYPTThe population of Egypt (administratively con-sisting of 27 governorates) is currently more than70 million people. The disease has a focal distribution in 8 governorates.

Egypt is among the first countries to develop anational programme to eliminate LF (NPELF).The programme is based on MDA of singleannual doses of DEC (6 mg/kg) in combina-tion with albendazole (400 mg). The villagelevel was chosen as the implementation unit(IU) for MDA.

The programme depended on a well-devel-oped infrastructure with a network of ruralhealth centres and good social mobilization.

The NPELF has successfully completed 5rounds. The number of identified endemic vil-lages increased from 161 in 2000 to 181 in2004. The coverage rate was estimated (de-pendently and independently) to be consistentlyover 80%.

Adverse events were rare and mild-to-moderatein severity. Spot surveys in several localities fol-lowing each round of MDA showed a remark-able impact of the drug combination on MFprevalence rates and intensities.

YEMENYemen (approximately 20 million people) is aknown endemic country for onchocerciasis andhas proved to be for LF too. The ozla (subdis-trict) is considered as the IU of the NPELF.

Integration of the NPELF was done with the lep-rosy mission, a unit related to the YemeniMinistry of Public Health (MOPH), which is responsible for onchocerciasis control and pre-vention and has a well-developed network ofclinics distributed throughout the country.

In 2000, questionnaires were distributed to keyinformants and revealed that 13 ozlas (11 laterproved to be endemic by ICT) and 24 ozlas indifferent governorates (none proved to beendemic) were less likely endemic localities.

Training sessions for 634 primary health-careworkers were carried out in addition to socialmobilization activities. In 2002, an initial pilotMDA was implemented in 3 ozlas (42 800inhabitants). Then, the first round of MDA withivermectin (200 µg/kg) and albendazole (400 mg) was carried out house-to-house. Theprogramme estimated an overall 85% MDAcoverage rate. No serious adverse events wereidentified.

In 2003, the second round of MDA was carriedout in the same areas and in 9 additional endemic IUs. Lack of ICT cards and resources hin-dered the completion of LF mapping in Yemen.

SUDANLF is endemic in Sudan. During 2003, a pilotsurvey in 4 states was carried out for rapidassessment of the LF situation using the ques-tionnaire approach and a limited number ofICT cards. The administrative unit (mahaliat)was chosen as the IU.

Currently, LQAS surveys using ICT are beingconducted in highly suspect administrativeunits identified by questionnaire surveys in 2states: Bahr El-Gabal and Bahr El-Ghazal. Forsecurity reasons, mapping of LF in Sudan iscurrently hampered.

Countries with uncertain LF situation

SAUDI ARABIASaudi Arabia, with an estimated population ofapproximately 24 million inhabitants, hasreported a few chronic cases of LF from 3areas: Assir, Jazan and Mekka.

Consequently, 34 laboratory technicians weretrained to perform ICT. However, due to a tech-nical problem encountered at that time withthe Binax ICT cards, the evaluation of thecurrent LF situation in Saudi Arabia was post-poned.

OMANOman has a population of approximately 2.5million inhabitants, of which 26.3% are expa-triates. Many of the expatriates come to workin Oman from LF-endemic countries (e.g.India). Over the past decade, 15 LF cases wereidentified; only 7 were Omani.

In 2002, health authorities in Oman carriedout a rapid assessment of community burdenof the disease using the questionnaireapproach: 23 (3.6%) informants, representing12 districts, reported that they had seen at least1 case of LF and 21 physicians (3.1%) hadobserved cases of lymphoedema and/orhydrocele.

Oman is currently conducting LQAS surveysusing the ICT in high schools in highlysuspected areas.

Maged El Setouhy Chair of the Eastern MediterraneanPRG

EDITORIAL