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Collecting Baseline Information for National Morbidity Alleviation Programs: Different Methods to Estimate Lymphatic Filariasis Morbidity Prevalence

The lymphatic filariasis elimination program aims not only to stop transmission, but also to alleviate morbidity. Although geographically limited morbidity projects exist, few have been implemented nationally. For advocacy and planning, the program coordinators need prevalence estimates that are currently rarely available. This article compares several approaches to estimate morbidity prevalence: (1) data routinely collected during mapping or sentinel site activities; (2) data collected during drug coverage surveys; and (3) alternative surveys. Data were collected in Plateau and Nasarawa States in Nigeria and in 6 districts in Togo. In both settings, we found that questionnaires seem to underestimate the morbidity prevalence compared with existing information collected through clinical examination. We suggest that program managers use the latter for advocacy and planning, but if not available, questionnaires to estimate morbidity prevalence can be added to existing surveys. Even though such data will most likely underestimate the real burden of disease, they can be useful in resource-limited settings.

Received September 13, 2006. Accepted for publication October 3, 2007.

Acknowledgments: We thank the survey teams from the Carter Center in Nigeria and the Ministries of Health in Togo and Nigeria. We thank Adam Wolkon and Jodi Vanden End for adding the LF question to their survey and sharing the results with us, David Addis for his advice, and a special thanks to George Gerlong and Francis Doglo for data entry and other support.

Financial support: The surveys were possible thanks to the financial support from the Bill and Melinda Gates Foundation, The Carter Center, Emory LF Support Center, and GSK.

^* Address correspondence to Els Mathieu, Division of Parasitic Diseases, National Center of Infectious Diseases, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, NE, MS-F22, Atlanta, GA. E-mail: emm7{at}cdc.gov

Authors’ addresses: Els Mathieu, Josef Amann, Patrick Lammie, Division of Parasitic Diseases, National Center of Infectious Diseases, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway, NE, MS-F22, Atlanta, GA, Tel: 770-488-3603, Fax: 770-488-4465. Eigege Abel, Frank Richards, The Carter Center, 1 Copenhill, Atlanta, GA, Tel: 770-488-4511, Fax: 770-488-4521. Yao Sodahlon, Mectizan Donation Program, 750 Commerce Drive, Suite 400, Decatur, GA. Tel: 404-687-5601.

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.