A comprehensive assessment of lymphatic filariasis in Sri Lanka six years after cessation of mass drug administration

The Sri Lankan Anti-Filariasis Campaign conducted 5 rounds of mass drug administration (MDA) with diethycarbamazine plus albendazole between 2002 and 2006. We now report results of a comprehensive surveillance program that assessed the lymphatic filariasis (LF) situation in Sri Lanka 6 years after cessation of MDA.Transmission assessment surveys (TAS) were performed per WHO guidelines in primary school children in 11 evaluation units (EUs) in all 8 formerly endemic districts. All EUs easily satisfied WHO criteria for stopping MDA. Comprehensive surveillance was performed in 19 Public Health Inspector (PHI) areas (subdistrict health administrative units). The surveillance package included cross-sectional community surveys for microfilaremia (Mf) and circulating filarial antigenemia (CFA), school surveys for CFA and anti-filarial antibodies, and collection of Culex mosquitoes with gravid traps for detection of filarial DNA (molecular xenomonitoring, MX). Provisional target rates for interruption of LF transmission were community CFA <2%, antibody in school children <2%, and filarial DNA in mosquitoes <0.25%. Community Mf and CFA prevalence rates ranged from 0-0.9% and 0-3.4%, respectively. Infection rates were significantly higher in males and lower in people who denied prior treatment. Antibody rates in school children exceeded 2% in 10 study sites; the area that had the highest community and school CFA rates also had the highest school antibody rate (6.9%). Filarial DNA rates in mosquitoes exceeded 0.25% in 10 PHI areas.Comprehensive surveillance is feasible for some national filariasis elimination programs. Low-level persistence of LF was present in all study sites; several sites failed to meet provisional endpoint criteria for LF elimination, and follow-up testing will be needed in these areas. TAS was not sensitive for detecting low-level persistence of filariasis in Sri Lanka. We recommend use of antibody and MX testing as tools to complement TAS for post-MDA surveillance

Enhancing community participation in dengue control through digital crowdsourcing: An analysis of a World Mosquito Program digital open call in Sri Lanka.

BACKGROUND: Two crowdsourcing open calls were created to enhance community engagement in dengue control in Sri Lanka. We analyzed the process and outcomes of these digital crowdsourcing open calls. METHODS: We used standard World Health Organization (WHO) methods to organize the open calls which used exclusively digital methods because of COVID-19. We collected and analyzed socio-demographic information and digital engagement metrics from each submission. Submissions in the form of textual data describing community-led strategies for mosquito release were coded using grounded theory. RESULTS: The open calls received 73 submissions. Most people who submitted ideas spoke English, lived in Sri Lanka, and were 18 to 34 years old. The total Facebook reach was initially limited (16,161 impressions), prompting expansion to a global campaign which reached 346,810 impressions over 14 days. Diverse strategies for the distribution of Wolbachia-infected mosquito boxes were identified, including leveraging traditional festivals, schools, and community networks. Fifteen submissions (21%) suggested the use of digital tools for monitoring and evaluation, sharing instructions, or creating networks. Thirteen submissions (18%) focused on social and economic incentives to prompt community engagement and catalyze community-led distribution. CONCLUSIONS: Our project demonstrates that digital crowdsourcing open calls are an effective way to solicit creative and innovative ideas in a resource-limited setting

Filarial DNA rates in Sri Lankan <i>Culex quinquefasciatus</i> mosquitoes by Public Health Inspector area.

a<p>Sentinel sites (PHIs) C3 and C4 were located in the city of Colombo. Sentinel site G3 is a PHFO area.</p>b<p>Each pool included 20 mosquitoes (blood fed, gravid and semigravid).</p>c<p>Filarial DNA was detected by qPCR. Rates of filarial DNA in mosquitoes (maximum likelihood and 95% CI) were estimated using PoolScreen2. Results are shown as pass (regular font), borderline (<i>italics</i>) or fail (<b>bold</b>) based on provisional endpoint criteria described in the <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003281#s1" target="_blank">Introduction</a>.</p><p>Filarial DNA rates in Sri Lankan <i>Culex quinquefasciatus</i> mosquitoes by Public Health Inspector area.</p

Transmission assessment survey (TAS^a) results from 11 evaluation units (EUs) in 8 districts^b in in Sri Lanka.

a<p>The critical cutoff value for assessing interruption of transmission was 18 in all EUs.</p>b<p>The 8 endemic districts were MDA implementation units.</p>c<p>BinaxNOW Filariasis tests were used for detection of filarial antigenemia. Data shown are the number of positive tests (% positive and 95% CI).</p><p>Transmission assessment survey (TAS^{<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003281#nt110" target="_blank">a</a>}) results from 11 evaluation units (EUs) in 8 districts^{<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003281#nt111" target="_blank">b</a>} in in Sri Lanka.</p

Background information for Public Health Inspector (PHI) areas selected for comprehensive filariasis surveillance and demographic information for subjects enrolled in community studies conducted in these areas.

a<p>Sentinel sites (PHI) C3 and C4 were in the city of Colombo.</p>b<p>Sentinel site G3 is a Public Health Field Officer area (PHFO).</p><p>Background information for Public Health Inspector (PHI) areas selected for comprehensive filariasis surveillance and demographic information for subjects enrolled in community studies conducted in these areas.</p

Crowdfunding for health research: a qualitative evidence synthesis and a pilot programme.

BACKGROUND: Many low-income and middle-income country (LMIC) researchers have disadvantages when applying for research grants. Crowdfunding may help LMIC researchers to fund their research. Crowdfunding organises large groups of people to make small contributions to support a research study. This manuscript synthesises global qualitative evidence and describes a Special Programme for Research and Training in Tropical Diseases (TDR) crowdfunding pilot for LMIC researchers. METHODS: Our global systematic review and qualitative evidence synthesis searched six databases for qualitative data. We used a thematic synthesis approach and assessed our findings using the GRADE-CERQual approach. Building on the review findings, we organised a crowdfunding pilot to support LMIC researchers and use crowdfunding. The pilot provided an opportunity to assess the feasibility of crowdfunding for infectious diseases of poverty research in resource-constrained settings. RESULTS: Nine studies were included in the qualitative evidence synthesis. We identified seven findings which we organised into three broad domains: public engagement strategies, correlates of crowdfunding success and risks and mitigation strategies. Our pilot data suggest that crowdfunding is feasible in diverse LMIC settings. Three researchers launched crowdfunding campaigns, met their goals and received substantial monetary (raising a total of US$26 546 across all three campaigns) and non-monetary contributions. Two researchers are still preparing for the campaign launch due to COVID-19-related difficulties. CONCLUSION: Public engagement provides a foundation for effective crowdfunding for health research. Our evidence synthesis and pilot data provide practical strategies for LMIC researchers to engage the public and use crowdfunding. A practical guide was created to facilitate these activities across multiple settings

Multivariable logistic regression of risk factors for filarial antigenemia in community survey data.

a<p>Results from all 19 public health inspector (PHI) areas that were surveyed.</p>b<p>This analysis was restricted to results from 14 PHI areas where one or more persons tested had a positive filarial antigen test.</p><p>Multivariable logistic regression of risk factors for filarial antigenemia in community survey data.</p

Summary of filariasis parameters from community (Comm) and school surveys conducted in public health inspector (PHI) areas.

a<p>Surveyed rates for ingestion of antifilarial medications during the national mass drug administration (MDA) program 2002–06.</p>b<p>Prevalence rates are mean values (95% CI) by PHI. Results are shown as pass (regular font), borderline (<i>italics</i>) or fail (<b>bold</b>) based on provisional endpoint criteria described in the <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003281#s1" target="_blank">Introduction</a>.</p>c<p>Study sites C3 and C4 were in the city of Colombo.</p><p>Summary of filariasis parameters from community (Comm) and school surveys conducted in public health inspector (PHI) areas.</p

Comparison of filarial infection parameters in Peliyagodawatta^a in 2008 and 2011.

a<p>Peliyagodawatta is a Public Health Field Officer area in Gampaha district.</p>b<p>Results shown are % positive (95% CI). Filarial DNA rates shown are maximum likelihood estimates (with 95% CI).</p>c<p><i>P</i> values are based on χ². NS, not significant.</p>d<p>Community microfilaremia (Mf) and circulating filarial antigenemia (CFA) rates are for ages ≥10 years. Mf rates are based on night blood smear results from all subjects in 2008 and from CFA positives only in 2011.</p><p>Comparison of filarial infection parameters in Peliyagodawatta^{<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0003281#nt116" target="_blank">a</a>} in 2008 and 2011.</p

Graphic summary of comprehensive filariasis surveillance data for Public Health Inspector areas in Sri Lanka.

<p>Data shown are rates (% with 95% confidence limits as vertical lines). The dotted line in the top panel and the lower dotted lines in the two lower panels show the old provisional targets for interruption of transmission. The upper dotted lines in the two lower panels are recommended revised targets for the upper confidence limits for antibody rates in first and second grade primary school children and for filarial DNA rates in mosquitoes, respectively.</p