Annual mass treatment with albendazole might eliminate human oesophagostomiasis from the endemic focus in northern Ghana
As a follow-up to the study by Ziem et al., in this issue, efforts to control human oesophagostomiasis and hookworm infections in northern Ghana were pursued, and the results evaluated in collaboration with the Lymphatic Filariasis Elimination Programme. This phase of evaluation of the impact of mass treatment was no longer limited to a small-scale research setting: it was done both in the context of an operationally viable national control programme and as a continuation of the Oesophagostomum Intervention Research Project (OIRP). The methods of evaluation included classical stool examination with Kato thick smears, stool culture and ultrasound examination of the colon wall. The results showed that yearly population-based albendazole–ivermectin treatment in 11 villages scattered over north-eastern Ghana, with a treatment coverage of 70–75%, resulted in a reduction of Oesophagostomum prevalence from about 20% pre-intervention to less than 1% after 2 years of mass treatment. Simultaneously, hookworm prevalence went down from 70% to approximately 15%. The data, however, cannot be readily compared with those of Ziem et al. because of the relatively crude diagnostic (single stool cultures) screening system that had to be used for the evaluation of the large-scale control programme. In the research area of the OIRP, interruption of mass treatment resulted in a rising hookworm prevalence. The Oesophagostomum prevalence, on the other hand, continued to go down. Transmission of human oesophagostomiasis appears interruptible and small numbers of persistent cases of Oesophagostomum infection were shown insufficient to serve as a nucleus of renewed spread of the infection. The data suggest that both the infection with and the pathology due to human oesophagostomiasis can be eliminated and that elimination is likely to be achieved through operationally feasible albendazole–ivermectin treatment as used by the Global Alliance for the Elimination of Lymphatic Filariasis.
Document Type: Research Article
Affiliations: 1: Institute for Health Research and Development, Charlottenlund, Denmark 2: Department of Pharmacology and Therapeutics, Liverpool University, UK 3: Board of Public Health Neuruppin, Bonn, Germany 4: Disease Control Unit, Regional Health Directorate, Ghana Health Service, Bolgatanga, Ghana 5: Lymphatic Filariasis Elimination Programme, Health Research Unit, Ghana Health Service, Accra, Ghana 6: Department of Parasitology, Leiden, Leiden University Medical Centre, The Netherlands
Publication date: November 1, 2006