Mass Drug Administration for the Elimination of Lymphatic Filariasis — Port-au-Prince, Haiti, 2011–2012

Lymphatic filariasis (LF), also known as elephantiasis, results from mosquito-borne infection with filarial worm parasites, predominantly Wuchereria bancrofti, and can lead to severe disfigurement from lymphedema and hydrocele. The World Health Organization (WHO) has called for the elimination of LF using the strategy of annual mass drug administration (MDA). WHO defines adequate MDA coverage (the percentage of all residents of an endemic area who swallow the drugs) as ≥65%. By late 2011, all areas in Haiti where LF is endemic had received MDA, except Port-au-Prince, which was considered the most challenging area. The first MDA in Port-au-Prince was conducted from November 2011 through February 2012. To evaluate coverage, a stratified, three-stage cluster-sample survey was conducted. In all, 71% (95% confidence interval = 69%-74%) of persons swallowed the MDA tablets, according to their own or a proxy respondent's recall. Coverage was highest (77%) among internally displaced persons (IDPs) in camps, and <65% in two of the remaining six survey strata (urban communes). Among the 1,976 adults asked additional questions, 88% said they heard about the MDA before it happened, 74% that they were given tablets, and 71% that they swallowed the tablets. Only 50% of those who did not hear about the MDA in advance swallowed the tablets. The MDA was a large step toward the elimination of LF in Haiti but must be followed by MDA rounds that maintain adequate coverage.