Name: Dunyo, Samuel Kwaku Home Country: Ghana Research Country: Ghana Project period: 1996-1999 Title Studies on the Epidemiology and Control of Lymphatic Filariasis on the Coast of Ghana Abstract Lymphatic filariasis is a major health problem in many countries in the tropics and sub-tropics. Most of these are, incidentally, also the poorest countries of the world. Lymphatic filariasis is rarely fatal but it results in clinical conditions that have a devastating effect on the affected individuals because of their lang-term and permanent disability and the concomitant social and psychological problems. Despite its enormous negative effects, lymphatic filariasis until recently has received little attention from the health sector, both locally in the endemic areas and internationally. The recent increase in knowledge about the epidemiology of lymphatic filariasis and about the plight of the patients and also improvements in the tools available for control have brought hop e for controlling this disease. Indeed, the world is now on the threshold of a newly launched initiative by the World Health Organization to eliminate lymphatic filariasis globally as a public health problem. Despite these positive developments, knowledge about lymphatic filariasis in Africa is still inadequate. Apart from clinical examination, the detection of infection in night blood samples, which is impractical in field surveys, remains the only diagnostic method available for lymphatic filariasis in most endemic areas. Furthermore, the control of lymphatic filariasis in Africa is difficult with the currently available measures, and new control tools, especially the development of new drug regimens for mass treatment, are greatly needed. In view of these challenges, it became particularly essential for the present PhD study to elucidate aspects of the epidemiology of lymphatic filariasis in coastal Ghana, to conduct studies to evaluate drugs that appeared promising for treatment and control in this region, and to determine if these drugs may have a provocative day test effect that can be utilised to simplify diagnosis. Studies to investigate lymphatic filariasis on the coast of Ghana were therefore conducted: to determine the prevalence and intensity of microfilaraemia and clinical manifestations of lymphatic filariasis resulting from Wuchereria bancrofti infection and to identify the vectors in selected villages and towns; to determine and compare the safety and the efficacy of ivermectin and albendazole alone and in cpmbination against lymphatic filariasis resulting from W bancrofti infection and; to determine the provocative day test effect of ivermectin and albendazole alone and in combination on W bancrofti microfilaraemia. Chapter 1 introduces the reader to the subject. It provides some relevant background information on lymphatic filariasis by giving a description of the life cycle and transmission, epidemiology, treatment and control of W bancrofti infection and disease. Finally, it presents an overview of the rationale and the objectives of the study. Chapter 2 presents the findings of an epidemiological study of lymphatic filariasis along the coast of Ghana. Chapter 3 present s the findings of a qualitative focus-group based survey among elephantiasis patients from three lymphatic filariasis endemic villages to obtain some insight into the condition of these patients and to identify risk factors for the development of elephantiasis. Chapter 4 presents the findings of detailed observations on patients with acute filarial disease (ADL attacks). Chapter 5 presents the results of a double-blind, placebo-controlled field trial to determine and compare the efficacy and safety of single-dose ivermectin (150-200 µg/kg) and albendazole (400 mg) treatment administered separately or in combination for the treatment of W bancrofti infections in Ghana. Chapter 6 presents the findings of further analyses of the randomised, double-blind, placebo-controlled field trial of the effect of single-dose ivermectin (150-200 µg/kg) and albendazole (400 mg) treatment alone and in combination on W bancrofti microfilaraemia, antigenaemia and clinical manifestations 12 months after treatment. Chapter 7 presents the findings of a randomised, double-blind, placebo-controlled study on the provocative day test effect of ivermectin and albendazole alone and in combination on nocturnal periodic W bancrofti microfilaraemia Involved research institutions Noguchi Memorial Institute for Medical Research, Ghana Institute for Health Research and Development, Copenhagen Supervisor(s) Professor Niels Ørnbjerg, Institute for Health Research and Development, Copenhagen Professor Francis K Nkrumah, Noguchi Memorial Institute for Medical Research (NMIMR), Ghana Correspondence