| dc.description.abstract | Background: Lymphatic filariasis (LF) continues to cause preventable disability in tropical and
subtropical countries, including Uganda. It is a disease targeted for elimination by the World
Health Organisation using an Elimination strategy having Mass Drug Administration (MDA) as
the main component. In Uganda, MDA has been stopped in all 66 endemic districts. However, LF
transmission is focal in nature, and some districts have exhibited positive cases during
Transmission Assessment surveys when interruption of transmission is determined. Therefore, the
study investigated LF infection prevalence and associated factors in such areas in Lango sub region
(Lira, Alebtong and Otuke districts) five years after the stoppage of MDA.
Objective: To estimate the prevalence of Lymphatic filariasis infection and assess associated
factors in the rural Lango subregion in individuals aged five years and above after five years of
MDA discontinuation.
Method: A cross-sectional study was conducted among 1442 participants aged five years and
above. Four hundred and thirty one households in 30 villages from the eight sub-counties of Lira,
Alebtong and Otuke districts participated in the study which took place in February 2021. A semistructured
questionnaire was administered in each household to a proportion of consenting
occupants aged ≥18 years and later provided a blood sample. The other proportion below 18 years,
finger-prick blood samples were collected to test for the presence of infection using LF Test Strips
(LFTSs) which detects circulating Wuchereria bancrofti antigen. The snowballing method was
used to select participants for six focus group discussions. Quantitative data was analyzed using
proportions and frequencies. Chi-square tests and odd ratio was used to determine variables
associated with infection. For multivariate analysis, Cox Poisson Regression was used. Deductive
analysis with the help of code trees was used to develop themes for focus group discussions (FGDs). The FGDs findings were later cross-validated with those from the questionnaire. Some of
the instructive statements were pulled out as illustrative quotes.
Results: Of the 1,442 study participants, 56% were female. Lymphatic filariasis infection was
detected in 7/1442 people, giving a prevalence of 490 per 100,000 (95% CI 0.0023 – 0.0102). Lira
district had six positive cases, Otuke had one and no case was found in Alebtong. Out of the 30
villages sampled, three of them had positive cases. More males (5) were found to be positive
compared to females (2). All the positive cases were over 14 years of age. Bednets use showed to
be protective for lymphatic filariasis (aOR 0.10 (0.02-0.47)). Likewise, among those who has
positive results, none had adequate knowledge about LF. Focus group discussion revealed that LF
chronic signs are less common. This was partly attributed to preventive measures like MDA, vector
control and community sensitization. Participants during the discussion could not fail to mention
witchcraft among others when asked about cause and transmission of LF. Instances of
stigmatization and lack of mobility were common among those affected and their families.
Conclusion: The prevalence of LF in the Lango subregion is low and below the threshold for mass
drug administration. However, the positive cases among adults call for intensive control measures,
which may include the use of a test and treat strategy. The villages sampled lie in the same
ecological zone. This outcome needs to be investigated further by using appropriate surveillance
tools such as molecular xenomonitoring. The need to assess transmission dynamics in the areas
where positive cases are found is paramount. Meanwhile, ongoing investigation and surveillance
where positive cases have been found should be undertaken by the Program. The population should
have adequate knowledge about LF in order to avoid infection. Use of treated bednets could be a
suitable vector control strategy for control of LF after the stoppage of MDA. | en_US |
