Garchitorena, A., Raza-Fanomezanjanahary, E.M., Mioramalala, S.A., Chesnais, C.B., Ratsimbasoa, C.A., Ramarosata, H., Bonds, M.H., Rabenantoandro, H. (2018). PLOS Neglected Tropical Diseases, 12(9): e0006780.
Lymphatic filariasis is a neglected disease with chronic disabling consequences. Endemic countries have reduced lymphatic filariasis transmission through a strategy of annual rounds of mass drug administration (MDA), but the impact of such strategy has not yet been reported for Madagascar. In this study we conducted three different surveys and used rapid diagnostic tests to evaluate lymphatic filariasis transmission in four health districts of southeastern Madagascar. This included a school-based transmission assessment survey (TAS), the international gold standard to help national programs confirm that they have interrupted lymphatic filariasis transmission, and two complementary community-based surveys. Our TAS results suggested that MDA could be stopped in three districts, confirming the consistent decline in lymphatic filariasis observed in recent years. However, the other two surveys revealed that the adult population still had high prevalence levels. This discordance raises questions about the TAS procedures and the interpretation of their results in contexts where, like in Madagascar, implementation of MDA is different for school age children than for the rest of the population.