Lymphatic Filariasis Elimination in Guyana
Introduction Guyana is located on the northern Atlantic coast of South America, west of Suriname, east of Venezuela, and north of Brazil. Its capital city, Georgetown, is located on the banks of the Demerara River. It is one of four countries in the Americas region with ongoing LF transmission. Quick Facts1
The current program aims to treat over half a million people with diethylcarbamazine (DEC) fortified salt in the period 2003-2005. The projected cost for this program, including morbidity treatment, is US $470,000.
90% of Guyana’s population lives in areas at risk of LF transmission. In 2002, an estimated 64,139 people were thought to be infected. However, prevalence varies from less than 1% to 42% throughout the country. Surveys in June 2002 to June 2003 found that approximately 0.82% of the total population has lymphedema and 0.4% hydrocele2. The risk of LF is mostly in the coastal areas; however, there is a high level of migration within the country. The parasite responsible for LF in Guyana is Wuchereria bancrofti spread mainly by Culex mosquitoes. Objectives Strategies
Organization A national task force for the elimination of LF was established in 1999 and renewed in 2002. It consists of representatives from the health, education, academic and private sectors, as well as non-governmental and international organizations. The Pan American Health Organization (PAHO) field office in Guyana provides technical assistance and organizational support for the national program, especially in the critical areas of social marketing and monitoring and evaluation. Mass Drug Administration Activities In 2002, the National Cabinet and the Food
and Drug Department approved the importation of diethylcarbamazine
(DEC)-fortified salt. After securing this legal authorization, the LF
Program developed DEC-fortified salt production capacity for three producers in
Trinidad, Jamaica and Cuba, traditional producers of salt for Guyana.
Quality control processes w Importation of DEC-fortified salt commenced in June 2003. The official program launch was in July when 30,000 households received DEC-fortified salt. DEC-fortified salt was available for purchase throughout the country in October 2003. Social Mobilization A Knowledge, Attitudes and Practice (KAP) survey of 588 households from six regions in June 2002 found that 39% of people surveyed think LF is a problem in their community and 59% do not know how LF is spread. The majority of respondents mentioned TV and health professionals as sources of health information. In addition, the survey found a willingness among respondents to buy DEC-fortified salt. Educational and marketing campaigns for DEC-fortified salt were developed based on this information. PAHO is working with the Ministry of Health and a local marketing firm to organize local launches, evaluate the marketing efforts so far, and continue to refine the marketing strategy. Listen to the DEC-fortified salt marketing jingle:
Health Worker Training Training of health workers was begun to create an awareness of LF as a public health problem, to define the DEC-fortified salt intervention and to teach morbidity control and management. As of July 2003, 10 regions had completed training of over 400 health care professionals. 138 health workers and 196 patients have been trained in skin self care techniques. Monitoring and Evaluation Two fixed sentinel sites and two spot check sites have been established. Baseline circulating filarial antigen (CFA) prevalence was 35% in the Georgetown sentinel site and 18% in the New Amsterdam site. The prevalence of hydrocele and lymphedema were mapped on a national scale in 2002. Surveys found that approximately 0.5% of the total population has lymphedema and 0.1% hydrocele. Five regions were found to have significant disease burdens and are targeted for interventions. Additional information collected between 2002 and 2003 indicated lymphedema in about 0.84% and hydrocele in 0.4% of the population. Morbidity/Disability Activities Five regions have been targeted for morbidity control operations. Already by September 2002, patient support groups had been established in three endemic communities. By September 2003, over 450 hydrocele operations were completed. In addition to the training of health care workers described above, LF disability clinics have been integrated into existing primary health care services in most regions. By the end of 2003, the program aims to have people trained in LF morbidity control at primary health care services in all regions. Economic Research The Lymphatic Filariasis Support Center, in collaboration with the Guyana Ministry of Health is developing a cost analysis of the DEC-fortified salt intervention. This analysis will examine the program costs associated with the educational and DEC-fortification components of the national program. Mass Drug Administration (Salt Fortification) Outcomes
Disability Prevention Outcomes
Partners collaborating with the Guyana Ministry of Health to implement the LF program
Further funding is required to purchase additional DEC, expand social marketing activities, 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 Guyana has already made in personnel and resources. This investment would help refine strategies to monitor and evaluate LF programs for other countries using the DEC-fortified salt strategy. For more information and to provide support to the Guyana LF Program or other LF elimination programs contact:
 LF Elimination in the Americas |
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developed and implemented, including the testing of samples from all
batches of DEC-fortified salt for accepted concentration levels and confirmatory
testing by CDC. In addition, CDC has provided a grant to UNICEF to
subsidize the cost of packaging the salt at the factories for the first year of
the program.
