Contributed by Zubin Hill, Communications Specialist at FHI360
In an important step for progress toward lymphatic filariasis elimination among the countries under the Act | West consortium, Senegal’s neglected tropical disease (NTD) program has advanced to the phase of conducting Transmission Assessment Surveys (TAS) against lymphatic filariasis (LF). These surveys occur prior to stopping mass drug administration (MDA) and serve to test LF levels in a community.
“The Louga region is incredibly endemic [for LF],” said Dr. Cheikh Senghor, the chief medical officer for the Louga Regional Health Center. “[Before 2011, we had] campaigns where we didn’t have any money or didn’t have enough money. But the constant with [the Act to End NTDs | West program and USAID] is that they partner with us in a significant financial way.”
This partnership with the Act | West program has made a difference in the Louga region and Senegal at large. Currently, over 94% of endemic health districts in Senegal have succeeded in lowering LF transmission to the point that MDA has been stopped. But the north-central regions of Louga and Koki are among the last areas still conducting MDA. Even so, hope remains high that the region might finally have succeeded in lowering LF levels.
A pre-TAS, a survey to check LF within a small sample of people—before expanding to test on more people in a district or group of districts with a TAS—was conducted from July 16-27, 2023.
“The important thing for all our campaigns is our approach,” said Senghor. “Ours is a multisectoral approach that engages almost all the relevant stakeholders. So not only people from the health sector, but also from the educational sector.”
As a result of this engagement, much of the work against NTDs happens in schools. In 2014, primary school enrollment hovered around 93% and secondary school attendance sat at 68%–underscoring the vital role of schools in reaching school-age children. Senegalese students learn about life skills that improve their knowledge of diseases and prevention methods and participate in MDA. Importantly, more than MDA campaigns occur in schools. Lymphatic filariasis transmission assessments and impact surveys for schistosomiasis and soil-transmitted helmithiasis (two other NTDs for which the Louga region is co-endemic) are also organized within educational facilities.
Despite the success of this multisectoral approach, the Louga region still faces several challenges to local efforts to eliminate LF.
“[We need] to be more aggressive in our epidemiological surveillance, in our efforts to locate cases of people suffering from complications linked to lymphatic filariasis,” Senghor said. “As NTDs are linked to poverty, a goal is to help those who face complications from lymphatic filariasis and provide guaranteed free care.”
The Louga health district fits into Senegal’s broader LF elimination goals. These goals include managing LF morbidity, focusing efforts to draft a LF elimination dossier during the upcoming months, and increasing country ownership of the NTDs sustainability plan. Five of the country’s fourteen medical regions have even organized hydrocele (scrotal enlargement due to LF) surgery camps. USAID funding has also supported LF morbidity screening, training for health workers in lymphedema case management, and combined MDA for LF and schistosomiasis (which can cause variety of symptoms such as painful diarrhea, bloody stools or urine, and poor growth and cognitive problems in children) at the community level.
These efforts have been felt by local community participants.
“In the past, we’d see children infected by [schistosomiasis] because they’d gone near the water,” said Astou Diallo Fall, a 41-year-old community volunteer who has been supporting local MDA in Pété Ouarack since 2005. “But since the mass drug administration campaigns, the infections have disappeared. Thanks to those campaigns, I haven’t seen a case of [schistosomiasis] in the community.”
As a result of Senegal’s efforts at the local level in places like the Louga region, the country has been able to make great strides against LF. While the region has faced challenges in eliminating LF, collaboration with the educational sector, local community actors, and USAID’s Act | West program has yielded tangible success. Following the completion of the pre-TAS in July, the Louga region passed the pre-TAS with flying colors—proving the progress Louga has made against LF.
Since 2012, USAID has partnered with the government of Senegal in fighting LF through the financing of MDA, surveys to assess the impact of MDA on LF infection levels, finding cases of LF complications (lymphedema and hydrocele) for management. Most recently through its Act to End NTDs | West program, USAID continues to provide support for MDAs, surveys to determine when to stop MDA and monitor the impact , understanding where LF morbidity cases are located nationwide, assessing health facilities for their ability to care for LF patients, and building the capacity of health workers to diagnose and manage LF complications through the health system.
Thanks to these efforts to get Senegal through the last mile to LF elimination, the country now has only one health district still conducting MDA. That district will move to pre-TAS in the new year—bringing Senegal in sight of elimination of lymphatic filariasis as a public health problem.