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This article discusses the importance of sustaining the gains achieved by national neglected tropical disease (NTD) programs. NTDs affect over 1 billion people globally and have a significant impact on healthcare systems, particularly in low- and middle-income countries. While progress has been made in eliminating NTDs through interventions like mass drug administration, it is crucial to continue surveillance to detect any disease recurrence. The article emphasizes the need for countries to increase domestic investment and ownership of their NTD programs and highlights the importance of building capacity to mobilize domestic resources. The authors propose concrete steps and recommendations to enhance political will, engage business and civil society, and create a community of country partners to support effective resource mobilization efforts. [Extracted from the article]

Background: In 2020 the World Health Organization (WHO) declared that Malawi had successfully eliminated lymphatic filariasis (LF) as a public health problem. Understanding clinical case distributions at a national and sub-national level is important, so essential care packages can be provided to individuals living with LF symptoms. This study aimed to develop a national database and map of LF clinical case numbers across Malawi using geostatistical modelling approaches, programme-identified clinical cases, antigenaemia prevalence and climate information. Methodology: LF clinical cases identified through programme house-to-house surveys across 90 sub-district administrative boundaries (Traditional Authority (TA)) and antigenaemia prevalence from 57 sampled villages in Malawi were used in a two-step geostatistical modelling process to predict LF clinical cases across all TAs of the country. First, we modelled antigenaemia prevalence in relation to climate covariates to predict nationwide antigenaemia prevalence. Second, we modelled clinical cases for unmapped TAs based on our antigenaemia prevalence spatial estimates. Principle findings: The models estimated 20,938 (95% CrI 18,091 to 24,071) clinical cases in unmapped TAs (70.3%) in addition to the 8,856 (29.7%), programme-identified cases in mapped TAs. In total, the overall national number of LF clinical cases was estimated to be 29,794 (95% CrI 26,957 to 32,927). The antigenaemia prevalence and clinical case mapping and modelling found the highest burden of disease in Chikwawa and Nsanje districts in the Southern Region and Karonga district in the Northern Region of the country. Conclusions: The models presented in this study have facilitated the development of the first national LF clinical case database and map in Malawi, the first endemic country in sub-Saharan Africa. It highlights the value of using existing LF antigenaemia prevalence and clinical case data together with modelling approaches to produce estimates that may be used for the WHO dossier requirements, to help target limited resources and implement long-term health strategies. Author summary: Lymphatic filariasis (LF) is a disfiguring and painful Neglected Tropical Disease, transmitted by mosquitoes, and impairs affected individual's mental wellbeing, social participation, and ability to work. The two most common clinical manifestations are hydrocoele (scrotal swelling) and lymphoedema (swelling of the limbs). Estimates of LF clinical case numbers are required to provide national and local care needs assessment, and for elimination and surveillance purposes. Clinical case prevalence is currently not readily available or is unknown across many sub-Saharan African countries, however Malawi is unique as the LF Programme has conducted extensive house-to-house patient mapping activities across one third of the country. We used this clinical data in combination with measurements of LF infection prevalence and high-resolution climate information, to develop geostatistical models, which estimate the number of clinical cases in unmapped areas. This led to the development of a national database and map of clinical case estimates that will help the Malawi LF elimination programme to optimize limited resources, target morbidity management and disability prevention, and improve quality of life of the people affected by this disabling and disfiguring disease. [ABSTRACT FROM AUTHOR]

Coverage surveys for mass drug administration (MDA) rely on respondent recall and often permit proxy responses, whereby another household member is allowed to respond on behalf of an absent individual. In this secondary analysis of coverage surveys in Malawi, Burkina Faso, and Uganda, we explore the characteristics of individuals who require proxy responses and quantify the association between proxy responses and reported drug coverage. The adjusted logistic regression model found that men 11-39 years and women 11-18 years who were eligible for MDA had greater odds of requiring a proxy response compared with ineligible men and women in the same age groups. A hierarchical multivariable analysis found that proxy responses had 1.70 times the odds of reporting ingestion of MDA drugs compared with first-person responses, controlling for age and sex (95% CI: 1.17, 2.46). This finding is surprising, given that individuals absent during a coverage survey may also have been absent during the MDA, and suggests that proxy responses may be leading to an inflation of survey estimates of drug coverage. This study highlights the possibility for recall bias in proxy responses to MDA coverage; however, excluding absent individuals from coverage surveys would introduce a new bias. Further research is necessary to determine the best method for obtaining information on drug coverage when individuals are absent.

Background: Baseline prevalence and knowledge, attitude and perception (KAP) survey is a prerequisite for mass drug administration for the control of Lymphatic filariasis (LF) and other neglected tropical diseases., Methods: In preparation for the first mass drug administration for LF elimination, a baseline survey was conducted in six sentinel sites in the southern Malawi, amongst participants aged five years or more. A standard questionnaire was used to obtain data on socio-demographic factors, ownership and use of bed nets, previous ingestion of ivermectin and KAP toward hydrocele and lymphoedema. Finger prick blood samples were collected from 22:00 to 01:00 hours for LF microscopy, malaria and haemoglobin examination. Stool and urine samples were collected for internal helminths and schistosomiasis respectively., Results: A total of 1, 903 participants were enrolled. Knowledge on the cause of hydrocele and lymphoedema was low in all the sentinel sites (16%-42%, 10%-24% (respectively). Sexual intercourse with a menstruating woman, bad weather and HIV/AIDS were perceived causes of hydrocele. Microfilaraemia prevalence was 1.5% and varied little between sentinel sites (1.0%-2.1%). Childhood urinary schistosomiasis was common in Phalombe (94.9%) and Blantyre (26.9%)., Conclusion: Integrated approach and understanding of the community KAP is vital or successful implementation of LF elimination programme.