Lymphatic Filariasis Elimination in the Dominican Republic
Introduction The Dominican Republic is one of four nations in the Americas Region with ongoing transmission of lymphatic filariasis. It is located in the Caribbean Ocean and occupies the eastern two-thirds of the island of Hispaniola. Haiti, another LF-endemic country, occupies the western one-third of the island. Quick Facts1
The current program aims to treat 400,000 people through mass drug administration (MDA) with once-yearly albendazole and diethylcarbamazine (DEC) in the period 2004-2009. The projected cost for this program is US $911,000.
Approximately 400,000 people live in endemic areas in the Dominican Republic. In 2002, the estimated number of infected individuals was 63,325 (0.73% of the total population). An August 2002 study found the prevalence of lymphedema to be 0.70% and prevalence of hydrocele to be 0.16%2. The highest infection rates occur in provinces in the southern region, indicated in red on the map above. The parasite responsible for LF in the Dominican Republic is Wuchereria bancrofti which is spread mainly by Culex mosquitoes. Objectives Strategies Organization A national program for the elimination of LF was established in 2000 in the Ministry of Health (MOH), in conjunction with the program to control intestinal helminths. Within the MOH, CENCET (the National Center for Control of Tropical Diseases) is responsible for overseeing the program. In 2001, the Ministry of Health and Jaime Mota hospital signed an agreement to develop a urogenital clinic to serve those affected by LF. A cooperative agreement between the Ministry of Health and the Dominican Institute of Skin Surgery has begun to integrate treatment of patients with LF with previously established leprosy clinics.
Mass Drug Administration Activities In December 2002, a mass drug administration (MDA) campaign, using once-yearly albendazole and DEC, was launched, targeting 140,000 people in 3 endemic areas. A team of 315 supervisors and 1096 volunteers completed the house-to-house MDA over 3 days. Reported coverage of 85% was achieved, with cluster surveys finding a coverage rate of 83%. In December 2003, 330,000 people were targeted in the endemic areas in the southwest, with a reported coverage of 85%. Plan International and World Vision have aided with logistics and field support during MDA campaigns.
Social Mobilization
Mobilization efforts include establishing regional LF councils. In 2002, IEC activity was initiated in the southwest, including development of a slogan and formation of support groups. In addition, a Knowledge, Attitudes and Practice (KAP) study was completed and results will be used to modify further community mobilization strategies. Health Worker Training Specialists from the urogenital clinic team trained in 2001 with Dr. Joaquin Noroes in Brazil. The clinic coordinator also received training in Brazil on ultrasound diagnostics. Monitoring and Evaluation As of December 2003, 119 of the 154 municipalities were mapped for the presence of LF. LF was found in 10 municipalities in border provinces in the southern region. Hydrocele and lymphedema were primarily found in two municipalities, Barahona and Ubilla. Mapping of the remaining municipalities continued into 2004. Three sentinel sites have been established and baseline data has been collected, including microfilaria (mf) and circulating filarial antigen (CFA) levels, as well as intestinal parasite rates. Of the 1381 samples taken, 21% were positive using the ICT card results for CFA and 6% were positive using the blood smear results for microfilaria. Baseline data is now being collected at two new sites. PCR techniques for detecting parasite DNA in mosquitoes were established in CENCET laboratories, with aid from Trinidad and the US. Baseline assessments by xeno-monitoring were conducted in both urban and rural areas prior to MDA. Morbidity/Disability Activities A LF-related disease survey was completed in 2002 in the southwest. CENCET aims to complete this survey in all endemic areas in 2004. Support groups were founded in 136 locations. The social mobilization campaign was begun in these areas, focusing on raising awareness of LF and its treatment. In 2003, 47 patients had hydrocele repair surgery and two lymphedema clinics were opened, caring for 561 patients. In collaboration with the CDC, a quality-of-life study of women with lymphedema in the Dominican Republic was begun in 2002. It examines the impact of LF-related disability on all aspects of individual, household and community life. Economic Research The Emory University Lymphatic Filariasis Support Center is working with CENCET to undertake a cost analysis of the MDA program, collecting data on costs for the first two years of distribution. Another study begun in 2002 is being conducted to estimate program and household costs for lymphedema treatment, by stage of disease. A urogenital disease study to estimate the costs of surgical repair of hydrocele will be completed in 2004. Mass Drug Administration Outcomes
* Disability Prevention Outcomes
Measures of Success
Partners collaborating with the
Dominican Republic Ministry of Health
Further funding is required to scale up the program to the 18% of people in at-risk areas that are not currently covered by MDA campaigns. It would expand the number of patient support groups, provide more training in home-based disability treatment, and increase the in-country capacity for hydrocele surgery. These funds would be used in addition to the contributions the government of the Dominican Republic has already made in personnel and resources. For more information and to provide support to the Dominican Republic LF Program or other LF elimination programs contact:
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LF Elimination in the Americas