02964nas a2200193   4500000000100000008004100001260004500042653002200087653001400109653002900123653002500152653001000177653002100187100001300208245016000221856004300381300001000424520233600434       2011                            d  bRollins School of Public HealthaAtlanta10aSystematic review10aMorbidity10aMass drug administration10aLymphatic filariasis10aGPELF10aFilarial Disease1 aStrahm M00aAssessing the impact of mass drug administration (MDA) in the Global Programme to Eliminate Lymphatic Filariasis (GPELF) on patients with filarial disease.  uhttp://pid.emory.edu/ark:/25593/bmfnj   a72 p.3 a<p><strong>Background:</strong> Lymphatic filariasis (LF) is a chronically disabling and debilitating mosquito-borne parasitic infection that infects an estimated 120 million persons<br />
worldwide. LF is endemic in 81 countries with approximately more than 1.3 billion people at risk of infection worldwide. The Global Programme for the Elimination of Lymphatic Filariasis (GPELF) was launched in 2000, and as of 2009 scaled up to introduce MDA in 53 endemic countries. The GPELF focuses on the interruption of transmission through mass drug administration and managing and preventing disability, such as ADL, lymphedema, and hydrocele, for infected individuals.</p>

<p><strong>Objective:</strong> The objective of this analysis was to evaluate studies assessing the impact of mass drug administration on filarial morbidity.</p>

<p><strong>Methods</strong>: Studies were included from a Pubmed search via criteria established a priori. Analysis was performed on studies that met the standards based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for rating<br />
evidence.</p>

<p><strong>Results:</strong> Data from 25 studies met the criteria for inclusion. Of these, ten evaluated ADL events, 15 assessed lymphedema, and 15 assessed hydrocele outcomes. Study design included 14 clinical trials and eleven prospective cohort, case study, or cross sectional evaluations. Of the included studies, 15 studies were considered to be of sufficient quality for in depth analysis. Five studies reported a decrease in ADL events over the course of the study period. Improvement was noted in five studies, and a lack of improvement was found in four studies assessing lymphedema and/or elephantiasis. Hydrocele was found to improve in five studies, whereas no improvement was recorded in four.</p>

<p><strong>Conclusion:</strong> The data suggests inconclusive results derived from studies assessing the impact of MDA on LF morbidity. Studies on MDA and clinical disease demonstrate numerous inconsistencies related to methodology. The mixed results of this review stress the need to adopt and employ more rigorous and standardized case definitions, study design, and outcome measurements to better understand and respond to the course of clinical disease after MDA employment.</p>