Gestational Diabetes in Melanesia and Appropriateness of Current Screening and Diagnostic Tests

Abstract@#In low-resource settings such as Melanesia, gestational diabetes often goes undiagnosed due to many factors, including the unsuitability of current tests. Ideally a gestational diabetes test for low-resource settings should meet criteria related to acceptability, test performance and operational characteristics, with minimal impositions on individual patients or the wider health system. None of the six tests recommended in country-specific gestational diabetes guidelines in Melanesia (2-hour oral glucose tolerance test, glucose challenge test, fasting plasma glucose, random plasma glucose, 2-hour postprandial glucose and glycated haemoglobin) meet criteria related to these attributes. Additionally, each Melanesian country has different, complex algorithms that use multiple tests in different combinations. With a high and increasing burden of diabetes mellitus (and therefore assumed gestational diabetes), Melanesian health practitioners and policymakers should be aware of the limitations of recommended tests for gestational diabetes and be open to alternative technologies that may be more appropriate.

Situation analysis of COVID-19 on Domestic Violence in Fiji

@#COVID-19, a highly contagious and deadly virus rapidly swept across the world from the year 2019 to 2020 killing more than two million people. Due to the magnitude of affect the virus was having, governments were forced into taking measures that required isolation of the infected from the unaffected, as mitigation to halt the spread. This brought about the “COVID-19 Lockdown”. Though the Pacific Island Countries (PICs) were with one of the least numbers of COVID-19 cases, similar measures were implemented as measure to prevent the virus from entering the countries. Like other countries, PICs like Fiji had a lockdown and this affected the lifestyles of the people. Amidst the lockdown, there was a rise in domestic violence cases. The literature review was done using databases; Medline, ProQuest, Embase, and Scopus. The research was done by using the relevant keywords in the field of COVID-19 which was aimed specifically on domestic violence during the pandemic. Moreover, local, and international publications, like media reports and published reports were also used. Upon carrying out this research it could be stated that there was a rise in the number of domestic violence cases in the wake of the COVID-19 pandemic lockdown. The literature review was aimed at identifying the consequences of COVID-19 and why it triggered a spike in domestic violence cases. The study concluded that the psychological impacts, and socio-economic state created as the result of the lockdown was the main contributing factor which gives rise to substance abuse, depression, which collectively lead to violence

A Questionnaire-Based study to assess Health Care Providers' knowledge, attitudes, and practices regarding Oral Health and Oral Care for Hospitalized patients at St Giles Psychiatric Hospital in Fiji

@#A mental disorder is a pattern of behavior or thought that causes severe suffering or impairs one's ability to function. Due to their inability to lead a regular life, mentally challenged people have been found to have poor oral health. The aim of this study was to assess health care providers’ knowledge, attitudes, and practices regarding oral health care of hospitalized patients at St Giles Psychiatric Hospital in Fiji. A cross-sectional survey design was employed in which 29 health care providers completed a questionnaire that collected socio-demographic information, knowledge, attitude and practices regarding oral health maintenance and care of psychiatric patients. Results revealed that all participants (100%), had knowledge on oral health and oral hygiene practices. However, only 9 nurses (50%) and 5 ward orderlies (63%) reported practicing oral hygiene for in – patients. In fact, 5 (17%) respondents did not view oral hygiene as an important aspect in their patients’ health. All participants (100%) reported unavailability of oral hygiene aids and absence of frequent dental visits, as a key barrier in the oral health care of patients. The results emphasize on the need for a formal training program for health care providers, and clear policies and guidelines about oral health care of hospitalized patients must be instituted.

Descriptive analysis of deaths associated with COVID-19 in Fiji, 15 April to 14 November 2021

@#Objective: There is limited published information about deaths due to coronavirus disease 2019 (COVID-19) in Fiji, the World Health Organization’s Western Pacific Region and low- and middle-income countries. This report descriptively analyses deaths directly associated with COVID-19 in Fiji by age group, sex, ethnicity, geographical location, vaccination status and place of death for the first 7 months of the 2021 community outbreak. Methods: A retrospective analysis was conducted of deaths directly associated with COVID-19 that occurred from 15 April to 14 November 2021 in Fiji. Death rates per 100 000 population were calculated by utilizing divisional population estimates obtained from medical zone nurses in 2021. Results: A total of 1298 deaths relating to COVID-19 were reported, with 696 directly associated with COVID-19 and therefore included in the analysis. Of these, 71.1% (495) were reported from the Central Division, 54.6% (380) occurred among males, 75.6% (526) occurred among people of indigenous (iTaukei) ethnicity and 79.5% (553) occurred among people who were unvaccinated. Four deaths were classified as maternal deaths. The highest percentage of deaths occurred in those aged >=70 years (44.3%, 308), and the majority of deaths (56.6%, 394) occurred at home. Discussion: At-risk populations for COVID-19 mortality in Fiji include males, iTaukei peoples, and older (>=70 years) and unvaccinated individuals. A high proportion of deaths occurred either at home or during the first 2 days of hospital admission, potentially indicating both a reluctance to seek medical care and a health-care system that was stressed during the peak of the outbreak.

Computed-Tomography staging of Breast Cancer and its role in Patient Management in a resource-limited setting: A retrospective study from Fiji

@#Breast cancer is now the leading cause of mortality from cancer in Women in Fiji. State of the art diagnostic measures such as MRI, PET scanning and advanced tumour markers are unavailable in many LMIC countries including Fiji, but CT is becoming more widely available. The aim of the study was to determine the association between CT/anatomical staging and prognosis in a resource-limited setting, and its role in planning appropriate treatment strategies. This was a retrospective, analytical study of the data from the Colonial War Memorial Hospital Oncology department tumour register recorded between 2013 and 2018. The mean age of the breast cancer patients with confirmed diagnosis was 54.93 years with SD of 12.4 years. There was a 40% 3 year mortality rate. CT reports were available for 196 patients. Poor prognosis was very closely associated with Tumour size (p=0.002, OR 0.26 (0.10-0.63)), Nodes (p<0.001, OR 0.25 (0.13-0.48.)) and Metastases (p<0.001, OR 0.13 (0.07- 0.25)).The lungs were the most frequent site of metastases. CT staging enables accurate TNM classification, which is closely associated with prognosis. In the absence of advanced cytopathological and imaging modalities CT staging has an important part to play in planning appropriate treatment.

Prevalence of syphilis, gonorrhoea and chlamydia in women in Fiji, the Federated States of Micronesia, Papua New Guinea and Samoa, 1995–2017: Spectrum-STI model estimates

Objectives@#To estimate prevalence levels of and time trends for active syphilis, gonorrhoea and chlamydia in women aged 15–49 years in four countries in the Pacific (Fiji, the Federated States of Micronesia [FSM], Papua New Guinea [PNG] and Samoa) to inform surveillance and control strategies for sexually transmitted infections (STIs).@*Methods@#The Spectrum-STI model was fitted to data from prevalence surveys and screenings of adult female populations collected during 1995−2017 and adjusted for diagnostic test performance and to account for undersampled high-risk populations. For chlamydia and gonorrhoea, data were further adjusted for age and differences between urban and rural areas.@*Results@#Prevalence levels were estimated as a percentage (95% confidence interval). In 2017, active syphilis prevalence was estimated in Fiji at 3.89% (2.82 to 5.06), in FSM at 1.48% (0.93 to 2.16), in PNG at 3.91% (1.67 to 7.24) and in Samoa at 0.16% (0.07 to 0.37). For gonorrhoea, the prevalence in Fiji was 1.63% (0.50 to 3.87); in FSM it was 1.59% (0.49 to 3.58); in PNG it was 11.0% (7.25 to 16.1); and in Samoa it was 1.61% (1.17 to 2.19). The prevalence of chlamydia in Fiji was 24.1% (16.5 to 32.7); in FSM it was 23.9% (18.5 to 30.6); in PNG it was 14.8% (7.39 to 24.7); and in Samoa it was 30.6% (26.8 to 35.0). For each specific disease within each country, the 95% confidence intervals overlapped for 2000 and 2017, although in PNG the 2017 estimates for all three STIs were below the 2000 estimates. These patterns were robust in the sen sitivity analyses.@*Discussion@#This study demonstrated a persistently high prevalence of three major bacterial STIs across four countries in WHO’s Western Pacific Region during nearly two decades. Further strengthening of strategies to control and prevent STIs is warranted.

Ethnomedicinal knowledge of indigenous communities and pharmaceutical potential of rainforest ecosystems in Fiji Islands / 中西医结合学报

The World Health Organization recently raised concerns about antimicrobial resistance and lack of novel antibiotics in the health sector. The success rate of drug discovery is higher when chemical constituents are sourced from natural products and when drug candidates are based on the indigenous knowledge of local communities. Tropical rainforests are an important source of medicinal plants for traditional healthcare systems. The pharmaceutical industry also recognizes the potential of rainforests in novel drug development. However, habitat degradation and loss of traditional knowledge are endangering the healing powers of nature. The islands of Fiji have a rich cultural history of traditional medicine and a number of medicinal plants are sourced from the country's rainforest ecosystems. While deforestation and forest degradation are decimating unique rainforest biodiversity and reducing access to medicinal plants in the wild, inter-generational erosion of ethnobotanical knowledge is attributed to acculturation, rural-urban migration and their effects on the transmission of oral traditions from one generation to another. Under these conditions, plants may disappear before their therapeutic value is formally identified. This review summarizes the importance of traditional medicinal knowledge and the potential for drug discovery from the tropical rainforest ecosystems of Fiji. However, there are several challenges that need to be addressed to realize the true potential of ethnopharmacology in this country.

Quantification of Neurons of Human Nucleus Accumbens by Fractal Analysis

Background: Analysis of volumetric and morphological neuronal data has been of keen interest to neurologists and neuroscientists because of its implications in pathological conditions such as schizophrenia, autism, obsessive compulsive disorder etc. One such part of human brain which has been explored in recent years is nucleus accumbens, a part of ventral striatum leaning against septal nuclei. An easier, freely accessible and cost effective technique to measure neurons of nucleus accumbens is the use of Image J -Fiji software. One of the applications of software is Fractal box analysis. This technique helps in analysis of the Euclidean geometry of neurons (Parameters such as length and breadth which are not good characteristics of multipolar neurons). Aim and Objectives: The present study was undertaken to study and analyze images of morphology of neurons of nucleus accumbens using Image J as an automated image analysis technique. Methods & Results: A qualitative cross sectional study was done using fifty five serial sections of nucleus accumbens. The 4 μ tissue sections were stained with hematoxylin and eosin. Freely downloadable Image J software was installed, images of serial sections were imported to Image J, processed and fractal box analysis was done. Fractal Box analysis of image of neurons of nucleus accumbens revealed statistically significant value (D= 1.99). Conclusion: Results of the present study can be extrapolated to correlate with pathological conditions associated with emotional and behavioral disorders involving nucleus accumbens Image J is cost effective software which is beneficial to identify and measure neurons of Nucleus accumbens

Medical students’ perceptions on Clinical Skills Teaching (CST) sessions at the College of Medicine, Nursing, and Health Sciences, Fiji National University

Introduction and Aim@#Early exposure to clinical skills teaching (CST) helps medical students to apply their knowledge in basic sciences in a real situation. One of the big challenges that always needs to be considered is their ability to examine a patient appropriately and pick up physical signs, as well as the analysis and interpretation of the physical signs. Due to the lack of existing research in this area, this study is aimed at understanding medical students’ perceptions towards delivered CST courses at the College of Medicine, Nursing, and Health Sciences (CMNHS), Fiji National University (FNU).@*Methodology@#This descriptive cross sectional study was conducted among the Bachelor of Medicine/Bachelor of Surgery (MBBS) degree students in year 4 and 5 who have done internal medicine rotations in 2014 and also to the year 6 students who were doing their clinical attachments at Lautoka hospital in 2014. A self-administrated questionnaire was used to collect the data. Five-point Likert scaled questions were used to measure the medical students’ attitudes and perceptions towards delivered CST sessions. An information sheet and written consent form were used before the collection of the data. The data was analyzed using descriptive statistical tests. @*Results@#Eighty one students participated in this study; the majority of them were aged 23-24 years (48.2%). More than sixty one percent were females and over thirty-eight percent were males. Forty percent of the participants were MBBS year 4. The majority of the participants believed that the CST was well organized (72.9%) and was clear (79%). The majority of participants (92.6%) believed that the clinical content was relevant and 85.24% of the participants believed that they were able to apply what they learned from the clinical skills sessions during the clinical years. Overall, 75.4% of the respondents believed that the clinical skills teaching sessions were effective while 3.6% disagreed. @*Conclusion@#The results of this study showed high positive perceptions of medical students towards the organization, clarity, the relevance of the content, and the effectiveness of CST sessions. This study will help the School of Medical Sciences to examine other methods of CST to promote students’ clinical skills.

An outbreak investigation of paediatric severe acute respiratory infections requiring admission to intensive care units – Fiji, May 2016

Introduction@#Influenza-associated severe acute respiratory infections (SARI) are a major contributor to global morbidity and mortality. In response to a cluster of SARI cases and deaths in pregnant women, with two deceased cases testing positive for influenza A(H1N1)pdm09, an investigation was initiated to determine whether there was an increase of paediatric SARI cases admitted to divisional hospital intensive care units in Fiji in may 2016 compared to May 2013–2015.@*Methods@#Retrospective case finding was conducted at the paediatric intensive care units (PICUs) in Fiji’s three divisional hospitals. Data were collected from 1 January 2013 to 26 May 2016. Cases were identified using a list of clinical diagnoses compatible with SARI. Results: A total of 632 cases of paediatric SARI with complete details were identified. The median age of cases was 6 months (Interquartile range: 2–14 months). Children aged less than 5 years had a higher rate of paediatric SARI requiring admission to a divisional hospital PICU in May 2016 compared to May 2013–2015 (Incidence rate ratio: 1.7 [95% CI: 1.1–2.6]). This increase was not observed in children aged 5–14 years. The case-fatality ratio was not significantly different in 2016 compared to previous years.@*Conclusion@#The investigation enabled targeted public health response measures, including enhanced SARI surveillance at divisional hospitals and an emergency influenza vaccination campaign in the Northern Division.

Barriers to medication adherence among patients with non-communicable diseases: Fijian health professionals’ perceptions / 国際保健医療

<b>Objective</b><BR>  The purpose of this study was to examine health professionals’ perceptions of barriers to medication adherence in patients with non-communicable diseases (NCDs) in Fiji.<BR>Methods: Interviews were conducted with 25 health professionals (physicians and pharmacists) treating patients with NCDs in Fiji. The interview contained questions regarding barriers to medication adherence for specific NCDs. <BR><b>Results</b><BR>  Health professionals’ perception of these barriers were identified and divided into patient-related and non-patient-related factors. The patient-related factors included lifestyle, knowledge, technique, language, and beliefs and culture. The non-patient-related factors were cost and access to medication, therapy-related factors, and support from other people.<BR><b>Conclusion</b><BR>  Traditional medical beliefs, medication access and affordability, negative lifestyle habits, and insufficient knowledge about illnesses, medical devices, and medications were identified as barriers to medication adherence in Fiji. Barriers to medication adherence differ according to diagnosis. Knowledge was considered an important factor with respect to adherence to medication regimens, particularly for patients with asymptomatic conditions (e.g., diabetes, hypertension, and stable asthma).

Prostate cancer in Fiji - disease trends and services available for patients: a retrospective study

In this retrospective study prostate biopsy data from the three divisional hospitals in Fiji was reviewed to determine the rate of prostate cancer in the period 2001 – 2010. In addition key hospital staff members were interviewed to gain an understanding of the support services available to those diagnosed with cancer. A total of 455 prostate biopsies of patients in the age group 45 to 70+ years were done over the 10 year period. The results of 133 (29%) were positive. No statistically significant increase or decrease in prostate cancer (CaP) positive biopsies was observed over the study period. Although 80% of the samples were from the 60 years age group, the proportion of positive samples in each age group was not significantly different. Of 116 biopsies graded, 59% had a Gleason score of 7 or higher. The interviews with medical staff indicated that support was primarily surgical and clinical care. A number of areas of deficiency were perceived by staff including lack of support groups and counseling services, geographical and financial factors affecting access to clinics and medications and the need for improved staff training. Data obtained in this retrospective study indicated that those diagnosed with prostate cancer in Fiji are typically older, have a poor prognosis and that there is an opportunity for providing improved support services for patients.

Typhoid fever: hurdles to adequate hand washing for disease prevention among the population of a peri-urban informal settlement in Fiji

PROBLEM/CONTEXT: The Pacific island nation of Fiji Islands has high rates of endemic typhoid fever which is difficult to diagnose and often underreported. However, the majority of cases are preventable through use of safe water; adequate sanitation; vaccination; and, most sustainable of all, simple hygienic behaviour, such as hand washing with soap (HWWS). Despite many attempts by public health authorities, little progress has been made in the area of environmental adaptation and behaviour change. ACTION: To explore perceptions of typhoid fever risk among urban squatters and behavioural determinants surrounding HWWS, indigenous Fijians living in informal settlements with high typhoid fever incidence were invited to participate in focus group discussions. In-depth interviews were conducted with community leaders. OUTCOME: Perceptions of typhoid fever suggest confusion about risk factors, symptoms and communicability. Environmental barriers for hand washing were related to water and soap access. Standard social marketing approaches have been trialled with little clear evidence of impact. Despite this, we continue to advocate for the social and cultural determinants of typhoid prevention to remain central to future public health strategies. DISCUSSION: Despite behaviour change being notoriously difficult, we argue that community-driven behaviour adaptation initiatives based on sound epidemiological evidence and health communication theory are likely to have significant impact and greater likelihood of sustainability.

Learning gain of pharmacy students after introducing guided inquiry learning with computer simulation in a pharmacology class in Fiji / 보건의료교육평가

PURPOSE: Active learning methods such as problem-based learning have been widely adopted in health professions education, although guided inquiry learning has been used only in limited settings. The objective of this study was to determine students' learning gain when guided inquiry learning was combined with computer simulation in a basic pharmacology course. METHODS: The second-year pharmacy students from Fiji National University participated in the study. Following classroom lectures on pharmacokinetics and pharmacodynamics, the students used tutor-prepared practice problems in groups of 3-4 to explore their concepts with Cyber Patient and Virtual Organ Bath software. Pre- and posttest assessments were administered to determine the learning gain from the exercises based on Hake's criteria. RESULTS: Forty-two students participated in the study. The average normalized learning gain from the pharmacokinetics exercises was 0.68. Thirty-seven participants (88.1%) achieved a significant learning gain, while 5 (11.90%) did not. The average normalized learning gain from the pharmacodynamics exercises was 0.76. Forty-one participants (97.6%) achieved a significant learning gain, while one participant (2.4%) did not. CONCLUSION: These results demonstrated that use of guided inquiry learning with computer simulations could produce significant learning gains with improvement in students' understanding of basic pharmacology.

Hazardous Metal Pollution in the Republic of Fiji and the Need to Elicit Human Exposure

The fact that hazardous metals do not bio-degrade or bio-deteriorate translates to long-lasting environmental effects. In the context of evidently rapid global industrialization, this ought to warrant serious caution, particularly in developing countries. In the Republic of Fiji, a developing country in the South Pacific, several different environmental studies over the past 20 years have shown levels of lead, copper, zinc and iron in sediments of the Suva Harbor to be 6.2, 3.9, 3.3 and 2.1 times more than the accepted background reference levels, respectively. High levels of mercury have also been reported in lagoon shellfish. These data inevitably warrant thorough assessment of the waste practices of industries located upstream from the estuaries, but in addition, an exposure and health impact assessment has never been conducted. Relevant government departments are duty-bound, at least to the general public that reside in and consume seafood from the vicinities of the Suva Harbor, to investigate possible human effects of the elevated hazardous metal concentrations found consistently in 20 years of surface sediment analysis. Furthermore, pollution of the intermediate food web with hazardous metals should be investigated, regardless of whether human effects are eventually confirmed present or not.

Plasmablastic Lymphoma in AIDS: Case Report and review of literature

@#Human Immunodeficiency Virus (HIV) infection severely affects the immune status of the infected person. This is a slow process, which, apart from the acute HIV illness in some, does not affect the infected person’s health in the early stages of the disease. As the disease progresses to a more advanced stage, many of the common infections begin to appear at a higher frequency, and for prolonged durations. As the immune deficiency advances further, it predisposes the person to a variety of life threatening cancers and opportunistic infections, otherwise rare in a healthy person. Clinical manifestation of any of these conditions marks the state of the infected person as a case of full blown AIDS. This includes many types of leukaemia and lymphomas. The first reported case of plasmablastic lymphoma (PBL) in Fiji in an HIV seropositive person is reported here.

Strengthening the admissions process in health care professional education: focus on a premier Pacific Island medical college / 보건의료교육평가

Relying solely on measures of intellectual aptitude and academic performance in university admissions can be disadvantageous to underprivileged students. The Fiji School of Medicine primarily uses such measures to evaluate and select student applicants, and the introduction of supplementary assessments could provide better access for students from disadvantaged backgrounds. This study examined the need for supplementary assessments in the admission process, types of additional assessments needed, and stakeholders' views on a multi-entry multi-exit strategy currently in use at the Fiji School of Medicine. A survey of the key stakeholders was conducted in February and March 2012 using closed and open ended questionnaire. One hundred and twenty-two validated questionnaires were self-administered by key stakeholders from the College of Medicine, Nursing and Health Sciences (CMNHS) and Fiji Ministries of Education and Health, with a response rate of 61%. Returned questionnaires were analysed quantitatively and qualitatively. Sixty-five percent of respondents supported the introduction of supplementary assessments, 49% favoured admissions test, and 16% preferred assessing non-academic factors. Many respondents supported the School's multi-entry multi-exit strategy as a 'good policy' that provided 'flexibility' and opportunity for students, but should be better regulated. These findings demonstrate the need for supplementary assessments in the selection process and for continued support for the use of multi-entry multi-exit strategy at the school.

Decentralisation of Outpatient Services from Colonial War Memorial Hospital to the Health Centre in the Suva Subdivision

Patient choice forms a key part of health service improvement and forms a major determinant in patient health care delivery. At a time when the population of Fiji has access to 24 hour banking services and extended supermarket services, the outpatient services at health centres remained in the eight hour access, from 8am to 4.30pm. The Valelevu, Makoi and Raiwaqa health centres have been providing extension of service hours from 6.30am to 10pm on weekdays and 8am to 4pm on weekends, from 2nd March and 15th April, 2009, respectively. Ths concept is to be extended to all six health centres in the Suva Sub-division from the 31st of January 2011. Decentralization is about making services more accessible to the community, in other words, bringing the services closer to where people reside. A study of the health facilities in the Suva Sub-division are provided with statistical analysis and needs for future expansion of health facilities with the necessary infrastructural improvements or developments, staffi and medical supplies. The report provides recommendations to operationalizing the decentralization process by 46.4%. Th average number of patient arrivals for year 2010 was 7637 patients per month (251 patients/day) and for 2011 it was 4095 patients per month (135 patients/day). In 2010 the trend for patient arrivals has been a plateau whereas in 2011 a gradual decline reaching to a steady state of patient arrivals from September till the month of December was seen.

The Global Programme to Eliminate Lymphatic Filariasis: History and achievements with special reference to annual single-dose treatment with diethylcarbamazine in Samoa and Fiji

Diethylcarbamazine (DEC), first introduced in 1947, was shown to have strong efficacy and safety for treatment of human lymphatic filariasis, which is caused mostly by a species <I>Wuchereria bancrofti.</I> Many studies to optimize the dosage and treatment schedule of DEC followed, and, based on the results, control programs with various regimens were implemented in different endemic areas⁄countries. By the mid 1970s, with endorsement by the WHO Expert Committee on Filariasis (3rd report, 1974), the standard DEC regimen for <I>W. bancrofti</I> infection in mass treatment had been established in principle: a total dose of 72 mg⁄kg of body weight given in 12 divided doses, once weekly or monthly, at 6 mg⁄kg each. Not long after the committee report, the efficacy of annual single-dose treatment at 6 mg⁄kg, which is only one twelfth of the WHO-recommended dose in a year, was reported effective in French Polynesia (study period: 1973-78), and later in Samoa (study period: 1979-81). These results were published between 1978 and 1985 in the Bulletin of WHO but received little attention. In the mid 1980s, the efficacy of ivermectin, the first-choice drug for onchocerciasis, against lymphatic filariae came to light. Since the effect at a single dose was remarkable, and often better than DEC, it was predicted that the newly introduced drug would replace DEC. Treatment experiments with ivermectin increased quickly in number. Meanwhile, annual single-dose mass drug administration (MDA) with DEC at 6 mg⁄kg was under scrutiny in Samoa and Fiji. In the early 1990s, the Samoan study, which covered the entire population of 160,000 with 3 annual MDAs, reported a significant reduction in microfilaria (mf) prevalence and mean mf density, while in Fiji, the efficacy of 5 rounds of annual MDA (total dose, 30 mg⁄kg) was shown to be as effective as 28 multi-dose MDA spread over 2 years (6 weekly plus 22 monthly treatments at 5 mg⁄kg; total dose, 140 mg⁄kg). Several additional studies carried out in Samoa in relation to the annual single-dose MDAs revealed that low density mf carriers, who have a very low mf count of 1-20⁄ml of venous blood, could not play a significant role in filariasis transmission.<br>From around 1990, studies on spaced low-dose DEC treatments and various types of combination chemotherapy with DEC and ivermectin increased. Albendazole, a well-known anti-intestinal helminths agent, was later added to the combination. The main findings of these studies with <I>W. bancrofti</I> are: (i) a single dose of DEC at 6 mg⁄kg reduced mean mf density by ca. 90% 1 year after treatment; (ii) the same dose could damage⁄kill adult worms; (iii) a single dose of ivermectin at ca. 400 μg⁄kg was more effective than DEC in reducing mf density during the first year and was similarly or less effective in the second year; (iv) ivermectin probably could not kill adult worms; (v) a single combined dose of albendazole (400 mg) and DEC (6 mg⁄kg) was effective to reduce mf density by 85 to nearly 100% 12-24 months after treatment; and (vi) ivermectin or albendazole included in the combination chemotherapy produced “beyond-filariasis” benefits: clearance⁄reduction of intestinal helminths, and, additionally, in the case of ivermectin, skin-dwelling ectoparasites.<br>The Global Programme to Eliminate Lymphatic Filariasis (GPELF) started its worldwide activities in 2000, with the target of elimination by 2020. The basic strategy is to conduct annual single-dose MDAs for 4-6 years. In 2000-2007, a minimum of 570 million individuals were treated in 48 of 83 endemic countries. The drugs used are DEC 6 mg⁄kg plus albendazole 400 mg in most countries, or ivermectin 200-400 μg⁄kg plus albendazole 400 mg particularly in onchocerciasis endemic countries in Africa. (MDAs with DEC alone had been used in India.)