Background: Among the 216 districts in Ghana, 98 were declared endemic for lymphatic filariasis in 1999
after mapping. Pursuing the goal of elimination, WHO recommends annual treatment using mass drugs
administration (MDA) for at least 5 years. MDA was started in the country in 2001 and reached national coverage
in 2006. By 2014, 69 districts had ‘stopped-MDA’ (after passing the transmission assessment survey) while
29 others remained with persistent microfilaraemia (mf) prevalence (≥1%) despite more than 11 years of
MDA and were classified as ‘hotspots’.
Methods: An ecological study was carried out to compare baseline mf prevalence and anti-microfilaria interventions
between hotspot and stopped-MDA districts.
Results: Baseline mf prevalence was significantly higher in hotspots than stopped-MDA districts (p<0.001).
After three years of MDA, there was a significant decrease in mf prevalence in hotspot districts, but it was still
higher than in stopped-MDA districts. The number of MDA rounds was slightly higher in hotspot districts
(p<0.001), but there were no differences in coverage of MDA or long-lasting-insecticide-treated nets.
Conclusions: The main difference in hotspots and stopped-MDA districts was a high baseline mf prevalence.
This finding indicates that the recommended 5–6 rounds annual treatment may not achieve interruption of
transmission.