Characteristics of participants and households.

In Ghana and other countries pursuing elimination of lymphatic filariasis (LF), suspect cases of lymphoedema and hydrocele are routinely enumerated by community health workers (CHWs) during mass drug administration (MDA). These data, in addition to cases captured through the routine out-patient department are used for burden estimation and health service planning. To date there has been no systematic evaluation of the reliability of these data in Ghana. In December 2022, we conducted a cross-sectional survey of LF morbidity in two evaluation units in the Upper West Region of Ghana, including 19,180 participants. Participants with swelling affecting the scrotum or limbs were examined by clinicians to confirm whether symptoms were due to LF. Participants were asked whether their household had been visited by a CHW during the previous MDA. Suspect cases were asked whether they had reported their condition to a CHW or sought care elsewhere. We estimated the prevalence of each condition according to survey data and pre-existing routine data collected by CHWs and compared estimates. Lymphoedema prevalence rates were 87.3 and 61.2 per 10,000 in the two evaluation units, and hydrocele prevalence rates were 111.3 and 65.3 per 10,000 males. Routine enumeration underestimated lymphoedema prevalence by 81% in both cases, and underestimated hydrocele prevalence by 41%–52%. Nearly all households were visited during the previous MDA, but only 60.7% of lymphoedema and 28.3% of hydrocele cases had reported symptoms. 61.8% of lymphoedema and 42.9% of hydrocele cases had sought care from health facilities. Routine surveillance underestimates the prevalence of LF morbidity in the study area. Process modifications, including re-training of CHWs and health workers should be considered to improve data for service planning and validation of LF elimination. Anticipating cessation of MDA, continuous health service delivery, with periodic coverage evaluation, should be prioritised to strengthen passive surveillance.

在加纳及其他致力于消除淋巴丝虫病（lymphatic filariasis, LF）的国家中，社区卫生工作者（community health workers, CHWs）通常会在大规模药物给药（mass drug administration, MDA）期间，对疑似淋巴水肿（lymphoedema）和鞘膜积液（hydrocele）病例进行常规登记。此类数据与通过常规门诊科室收集的病例数据一同，被用于疾病负担评估与卫生服务规划。截至目前，加纳尚未对这类数据的可靠性开展系统性评估。
2022年12月，我们在加纳上西部省的两个评估单元中开展了LF发病情况横断面调查（cross-sectional survey），共纳入19180名研究对象。临床医生对阴囊或四肢出现肿胀的参与者进行检查，以确认其症状是否由LF引发。研究人员询问参与者，其家庭是否在之前的MDA期间有CHWs到访。针对疑似病例，研究人员进一步询问其是否已向CHWs报告自身症状，或曾在其他医疗机构就诊。
我们分别基于本次调查数据与CHWs此前收集的常规数据，估算了两种病症的患病率，并对估算结果进行了对比。两个评估单元的淋巴水肿患病率分别为每万人87.3例和61.2例；鞘膜积液在男性中的患病率则分别为每万人111.3例和65.3例。常规登记的淋巴水肿患病率均低估了81%，鞘膜积液患病率则被低估了41%至52%。尽管此前MDA期间几乎所有家庭都有CHWs到访，但仅有60.7%的淋巴水肿病例与28.3%的鞘膜积液病例报告了自身症状。61.8%的淋巴水肿病例与42.9%的鞘膜积液病例曾前往医疗机构就诊。
本研究结果显示，常规监测低估了本研究区域内LF相关发病的患病率。应考虑对工作流程进行优化调整，包括对CHWs与医护人员开展再培训，以完善用于卫生服务规划及LF消除验证的数据质量。鉴于MDA即将停止，应优先保障持续的卫生服务供给，并定期开展覆盖情况评估，以强化被动监测工作。