Community knowledge, chronic morbidity and microfilaraemia following mass drug administration for lymphatic filariasis in northern Ghana: a cross-sectional study

Objectives

To assess microfilaraemia, chronic lymphatic filariasis (LF)-related morbidity, and community knowledge and self-reported preventive behaviours in a rural community in northern Ghana following prolonged mass drug administration (MDA).

Design

Community-based cross-sectional study.

Setting

Birifor community, Lawra Municipality, Upper West Region, northern Ghana, from October 2024 to January 2025.

Participants

A total of 261 community members aged 10 years and above were selected using random sampling and participated in the study.

Outcome measures

Outcome measures included microfilaraemia detected by night blood microscopy, chronic LF-related morbidity identified through clinical examination, and community knowledge and self-reported preventive behaviours assessed using a structured questionnaire.

Results

No microfilariae were detected (0/261; 0%). Chronic lymphoedema was identified in five individuals (1.9%), all aged over 40 years. Awareness of LF was high (95.8%), yet only 39.5% of participants demonstrated good community knowledge and self-reported preventive behaviours. Misconceptions regarding transmission, particularly beliefs that LF is hereditary or caused by spiritual factors, were common. MDA participation was high (93.1%). All five individuals with chronic lymphoedema reported loss of income, and three (60%) reported additional household income loss due to caregiving responsibilities.

Conclusions

No microfilaraemia was detected, suggesting very low transmission in the study area, although residual infection cannot be excluded. Chronic LF-related morbidity and gaps in community knowledge persist despite high MDA participation. Sustained surveillance using more sensitive diagnostic approaches, together with morbidity management and disability prevention, community education and support for affected households, will be important to sustain LF elimination efforts.

Article Summary

This community-based cross-sectional study assessed microfilaraemia, chronic lymphatic filariasis-related morbidity, and community knowledge and self-reported preventive behaviours in a rural community in northern Ghana following prolonged mass drug administration. No microfilariae were detected, suggesting very low transmission, although residual infection could not be excluded. Chronic lymphoedema persisted among a small number of older community members, and important misconceptions regarding disease transmission and prevention remained common despite high awareness and MDA participation. These findings highlight the need for continued surveillance, strengthened morbidity management and disability prevention services, and targeted community education to sustain lymphatic filariasis elimination efforts.

Strengths and limitations of this study

• This study combined parasitological assessment, clinical evaluation of chronic lymphatic filariasis-related morbidity, and assessment of community knowledge and self-reported preventive behaviours within a single community-based survey.

• The study was conducted in a post-mass drug administration setting, providing evidence relevant to lymphatic filariasis elimination and post-elimination surveillance programmes.

• Use of a participant flow diagram and complete-data analysis improved transparency and reporting of participant recruitment and inclusion.

• The sample size was below the calculated minimum required for prevalence estimation, limiting the precision of prevalence estimates and the statistical power for multivariable analyses.

• Parasitological assessment relied on night blood microscopy because circulating filarial antigen detection and molecular diagnostic methods were not available during fieldwork, limiting detection of low-level residual infection.