RESUMO
Research provides the essential foundation of disease elimination programs, including the global program to eliminate lymphatic filariasis (GPELF). The development and validation of new diagnostic tools and intervention strategies, critical steps in the evolution of GPELF, required a global effort. Lymphatic filariasis research in Haiti involved many partners and was directly linked to the development of the national elimination program and to the success achieved to date. Ongoing research efforts involving many partners will continue to be important in resolving the challenges faced by the program today in its final efforts to achieve elimination.
Assuntos
Erradicação de Doenças , Filariose Linfática/prevenção & controle , Linfedema/terapia , Dietilcarbamazina/uso terapêutico , Filariose Linfática/complicações , Filariose Linfática/tratamento farmacológico , Filaricidas/uso terapêutico , Haiti , Humanos , Linfedema/etiologiaRESUMO
Among infections closely associated with poverty, lymphatic filariasis (LF) is a study in contrasts. It is both a consequence of and a contributor to poverty. Although rarely fatal, it is recognized as a leading global cause of lifelong disability as well as significant personal, social, and economic burdens coincident with disease. Infection is often considerably more prevalent in communities than the number of cases of overt pathology for which LF is best known (lymphedema, elephantiasis, and hydrocele). With an estimated 120 million to 130 million affected persons in 83 countries and 1.25 billion persons living in areas at risk, in some countries LF may be expanding its range, whereas in others, with economic development, it has disappeared with little if any targeted intervention. The transmission cycle is relatively inefficient, yet an association with pockets of deepest poverty remains tenacious. Thanks to scientific advances in diagnostic tools, and particularly in control strategies focused on large-scale drug donation and mass drug distribution programs, scientists and policy makers now consider LF eliminable. Together with new approaches for morbidity control, a hopeful tone surrounds a disease problem that as recently as two decades ago could easily have been categorized as among the most neglected of neglected diseases. Continued progress toward global LF elimination will require solutions to potential obstacles in the most challenging--that is, the poorest--endemic settings. This chapter reviews progress toward LF elimination and some of the remaining challenges from a perspective in Haiti, the only least developed country of the Americas.
Assuntos
Filariose Linfática/prevenção & controle , Pobreza , Filariose Linfática/diagnóstico , Filariose Linfática/tratamento farmacológico , Filariose Linfática/economia , Filariose Linfática/epidemiologia , Haiti , Humanos , Preparações Farmacêuticas/provisão & distribuição , Papel (figurativo) , CiênciaRESUMO
Annual mass treatment with antifilarial drugs is the cornerstone of the global program to eliminate lymphatic filariasis (LF). Although the primary goal of the program is to interrupt transmission of LF, additional public health benefits also are expected because of the known anthelminthic properties of these drugs. Since rapid re-infection with intestinal helminths occurs following treatment, annual de-worming may not be sufficient to produce a lasting reduction in the prevalence and intensity of these infections. We conducted stool examinations in four sentinel communities before and approximately nine months after each of two rounds of mass drug administration (MDA) with diethylcarbamazine and albendazole in the context of an LF elimination program in Leogane, Haiti. At baseline, overall Ascaris, Trichuris, and hookworm infection prevalences were 20.9%, 34.0%, and 11.2%, respectively (n = 2,716 stools). Nine months after the second MDA, Ascaris, Trichuris and hookworm prevalences had decreased significantly, to 14.1%, 14.6%, and 2.0%, respectively (n = 814 stools). Infection intensity decreased significantly for all three parasites as well. These results demonstrate that substantial reductions in intestinal helminth infections are associated with mass treatment of filariasis in Haiti and are consistent with the conclusion that high levels of coverage for the LF program can decrease transmission of geohelminths.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Dietilcarbamazina/uso terapêutico , Filariose Linfática/tratamento farmacológico , Enteropatias Parasitárias/tratamento farmacológico , Nematoides/efeitos dos fármacos , Adolescente , Adulto , Distribuição por Idade , Albendazol/administração & dosagem , Animais , Anti-Helmínticos/administração & dosagem , Criança , Pré-Escolar , Dietilcarbamazina/administração & dosagem , Filariose Linfática/epidemiologia , Filariose Linfática/prevenção & controle , Fezes/parasitologia , Feminino , Humanos , Lactente , Recém-Nascido , Enteropatias Parasitárias/epidemiologia , Enteropatias Parasitárias/parasitologia , Enteropatias Parasitárias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Prevalência , Vigilância de Evento SentinelaRESUMO
This paper details the steps to design and implement a positive deviance-informed, "Hearth" approach for the nutritional rehabilitation of malnourished children in the district of Leogane, Haiti. Groups of four to five children met daily for two weeks at the home of a local volunteer mother for nutritional and health messages and a well-balanced meal. Health messages and meal components were determined using information gathered from interviews with the mothers of positive deviant children in the community who are well nourished despite their family's limited economic resources. Hearth participants were then followed for six months in their own home by the program "monitrices," women hired from each village and intensively trained to supervise the Hearth program, periodically weigh the children to evaluate their progress, and liaise between the hospital and the community. Monitoring from the first cycle indicated that 100% of children in eight villages and 66% of children in the remaining five villages continued to gain weight as fast or faster than the international standard median six months after participating in a Hearth program. At the conclusion of this cycle, programmers interviewed participant and non-participant families and made six modifications to the model, including the addition of a microcredit option for participating mothers.