The Global Programme to Eliminate Lymphatic Filariasis: Health Impact after 8 Years
The Global Programme to Eliminate Lymphatic Filariasis: Health Impact after 8 Years
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DOI：
10.1371/journal.pntd.0000317
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发表时间：
2008-10-01
影响因子：
3.8
通讯作者：
Biswas, Gautam
中科院分区：
文献类型：
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作者：
Ottesen, Eric A.;Hooper, Pamela J.;Biswas, Gautam
背景：全球消除淋巴丝虫病规划（GPELF）在其最初的8年中实现了前所未有的快速扩大：通过每年大规模给药（MDA）向83个最初确定的淋巴丝虫病流行国家中的48个国家的至少5.7亿人提供了190亿次抗丝虫病药物（阿苯达唑、伊维菌素和乙基卡马嗪）治疗。方法：为了评估这一大规模全球努力所产生的健康影响，我们首先分析了预防或阻止LF疾病进展所产生的益处，然后分析了阿苯达唑和伊维菌素使用所产生的更广泛的抗寄生虫作用（“超越LF”益处）。预测是根据人口资料局、世界银行和世界卫生组织出版物中的人口统计和疾病流行数据作出的。结果：在2000年至2007年期间，GPELF预防了大约660万本来会患上LF的新生儿的LF疾病，从而在他们的一生中避免了近140万例鞘膜积液，80万例淋巴水肿和440万例亚临床疾病。同样，有950万以前感染但没有明显疾病表现的人没有出现鞘膜积液（600万）或淋巴水肿（350万）。这些与生活自理有关的福利本身就可转化为避免3200万残疾调整生命年（DALYs）。此外，GPELF提供的19亿美元治疗方案带来的“超越lf”效益也是巨大的，特别是因为阿苯达唑加/不加伊维菌素的育龄儿童和妇女获得了3.1亿美元的治疗（有效治疗肠蠕虫、盘尾丝虫病、虱子、疥疮和其他疾病）。这些好处可以描述，但仍然难以量化，主要是因为这些后一种感染的流行病学定义不清。结论：GPELF早先曾被描述为全球卫生领域的“最合算”；目前对前8年可归因的健康益处的统计大大加强了这一观念。
Background: In its first 8 years, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) achieved an unprecedentedly rapid scale- up: >1.9 billion treatments with anti-filarial drugs (albendazole, ivermectin, and diethylcarbamazine) were provided via yearly mass drug administration (MDA) to a minimum of 570 million individuals living in 48 of the 83 initially identified LF-endemic countries.Methodology: To assess the health impact that this massive global effort has had, we analyzed the benefits accrued first from preventing or stopping the progression of LF disease, and then from the broader anti-parasite effects ('beyond-LF' benefits) attributable to the use of albendazole and ivermectin. Projections were based on demographic and disease prevalence data from publications of the Population Reference Bureau, The World Bank, and the World Health Organization.Result: Between 2000 and 2007, the GPELF prevented LF disease in an estimated 6.6 million newborns who would otherwise have acquired LF, thus averting in their lifetimes nearly 1.4 million cases of hydrocele, 800,000 cases of lymphedema and 4.4 million cases of subclinical disease. Similarly, 9.5 million individuals-previously infected but without overt manifestations of disease-were protected from developing hydrocele (6.0 million) or lymphedema (3.5 million). These LF-related benefits, by themselves, translate into 32 million DALYs (Disability Adjusted Life Years) averted. Ancillary, 'beyond-LF' benefits from the >1.9 billion treatments delivered by the GPELF were also enormous, especially because of the >310 million treatments to the children and women of childbearing age who received albendazole with/without ivermectin (effectively treating intestinal helminths, onchocerciasis, lice, scabies, and other conditions). These benefits can be described but remain difficult to quantify, largely because of the poorly defined epidemiology of these latter infections.Conclusion: The GPELF has earlier been described as a 'best buy' in global health; this present tally of attributable health benefits from its first 8 years strengthens this notion considerably.