What is it about?

Elephantiasis is a disease that is common in Ghana. Since the year 2000 the country has implemented a control programme aimed at eliminating the disease as a public health problem, through the yearly treatment of entire communities in districts where the disease is found. Achievements have been made, and treatment has stopped in many districts; however, some districts have received many years of treatment without successfully reducing the infections below the targeted levels. Many individuals go untreated every year, as can be observed from the low reported treatment coverage after MDA. This untreated population may explain why some districts have failed to achieve the criteria for stopping treatment. Fortunately, the treatments are recorded in community registers, which contain the details of all community members, as well as their treatment participation. These registers can therefore be used to identify people who have not received treatment and design appropriate interventions to reach them. Through these registers, we were able to identify and characterize individuals who were not treated between 2016 and 2018 in 10 communities. We found that 4 out of 10 people missed at least one treatment between 2016 and 2018, and the majority of them were 10–30 years of age. Using the information from the registers we were also able to verify the proportion of people who took part in the treatments in 2017 and 2018, and compared this to what was reported. This comparison revealed that the reporting was only accurate in 33% of cases. A questionnaire was also used to cross-check the participation of study participants in the 2017 MDA, with results indicating that 13.8% of the respondents did not receive treatment for various reasons, the most prominent among them being “absence/travel” (37.1%). Although these registers are seldom used by the Lymphatic Filariasis Control Programme for anything other than recording and reporting treatment information, this study shows that the registers provide an opportunity to identify individuals who have not received treatment, develop a plan to appropriately address their reasons for not taking part in the treatments, target these untreated individuals to improve the overall proportion of people taking part in MDA, and assess the accuracy of reported coverage information. These activities will allow the programme to better monitor the progress towards, and ultimately achieve, elimination of lymphatic filariasis as a public health problem.

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Why is it important?

Addressing the endgame challenges of poor or low treatment coverages and never-treatment requires the need for innovative ideas and strategies. While MDA registers may not be available in every country, some form of record is collected as part of MDA. These records should be scrutinized beyond just the tallying of people treated.


There is the need to support other studies exploring the use of MDA registers and tally sheets to improve treatment coverage. It is the hope that this article serves as the basis for such engagement with funders and other stakeholders

Dziedzom de Souza
University of Ghana

Read the Original

This page is a summary of: Review of MDA registers for Lymphatic Filariasis: Findings, and potential uses in addressing the endgame elimination challenges, PLoS Neglected Tropical Diseases, May 2020, PLOS,
DOI: 10.1371/journal.pntd.0008306.
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