Persistence of Onchocerciasis infection after decades of mass drug administration in the Western North Region of Ghana:

Derrick Adu Mensah; Linda Batsa Debrah; John Boateng; Monica Ahiadorme; Jubin Osei-Mensah; Vera Serwaa Opoku; Michael Obeng Agyemang; Prince Dennis Atisu; Eunice Kyaakyile Kuutiero; John Opoku; Charles Gyasi; Emmanuel Donawobuge Kutu; Alexander Yaw Debrah

Derrick Adu Mensah Kwame Nkrumah University of Science and Technology, Kumasi, Ghana https://orcid.org/0000-0002-8972-1757
Linda Batsa Debrah Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. https://orcid.org/0000-0001-9620-3408
John Boateng Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. https://orcid.org/0000-0003-1309-2840
Monica Ahiadorme Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. https://orcid.org/0000-0001-5909-082X
Jubin Osei-Mensah Department of Pathobiology, School of Veterinary Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. https://orcid.org/0000-0003-3470-2994
Vera Serwaa Opoku Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. https://orcid.org/0000-0001-7950-6650
Michael Obeng Agyemang Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. https://orcid.org/0000-0002-0265-1822
Prince Dennis Atisu https://orcid.org/0009-0000-8726-1585
Eunice Kyaakyile Kuutiero Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. https://orcid.org/0009-0001-3872-5571
John Opoku Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. https://orcid.org/0000-0002-6341-3131
Charles Gyasi Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. https://orcid.org/0000-0002-7549-7117
Emmanuel Donawobuge Kutu Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. https://orcid.org/0000-0003-4510-8616
Alexander Yaw Debrah Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. https://orcid.org/0000-0001-5721-0891

Keywords: Onchocerciasis, Microfilaria, mass drug administration, Ivermectin, Ghana

Abstract

Introduction

Onchocerciasis, a neglected tropical disease caused by Onchocerca volvulus, remains a significant public health concern in endemic regions despite decades of mass drug administration (MDA) with ivermectin (IVM). This study evaluates the impact of IVM MDA on onchocerciasis transmission in the Sefwi Akontombra district of Ghana and identifies factors contributing to the persistence of the infection.

Methodology

A cross-sectional study was conducted across 25 communities in the district. Participants were clinically examined for palpable onchocercomata, and compliance with IVM treatment was assessed through structured interviews and community health records. Participants with one or more palpable sub-cutaneous nodule had skin snips taken from the iliac crests for microfilariae assessment. Data were analysed using descriptive statistics, chi-square tests, and logistic regression models.

Results

Of the 1,980 participants assessed, 35.4% had subcutaneous nodules, with variations in prevalence across communities. The district community microfilariae load (CMFL) and geometric mean intensity were 0.25 MF/ss and 0.26 MF/ss respectively. Age, MDA compliance and gender were the independent predictive factors significantly associated with onchocerciasis in the district.

Conclusion

While MDA has reduced onchocerciasis prevalence, transmission persists. To accelerate elimination efforts, targeted interventions should focus on increasing MDA compliance through intensified community engagement, integrating alternative treatment strategies such as anti-Wolbachia therapy, and adopting more sensitive diagnostic tools for improved surveillance.

Author Biographies

Derrick Adu Mensah, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

Formally a Senior Clinical/Medical Research Scientist, working as a Post-Doctoral Research Fellow and the Field Coordinator on the Filariasis Research Project at the Kumasi Center for Collaborative Research in Tropical Medicine (KCCR). Currently working as a Part-Time Lecturer at KNUST, AAMUSTED and KSTU. His research focuses on clinical diagnostics, Molecular biology, Biostatistics and Clinical research methods, Clinical cytology, Epidemiology, Immunology and human Immune responses to infectious diseases, immunopathogenesis, prevention and control of infectious diseases, and Neglected Tropical Diseases (NTDs) such as Lymphatic filariasis, Onchocerciasis, and Soil-transmitted helminthiasis (STHs)

Linda Batsa Debrah, Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

A Senior lecturer in Medical Parasitology; School of Medical Sciences, Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. She holds a BSc in Biological Sciences, MPhil in Clinical Microbiology, and PhD in Medical Parasitology. Her research areas include: Clinical trials in Neglected Tropical Diseases (focusing on trials for Lymphatic Filariasis, Onchocerciasis and Mansonellosis), Intestinal Helminthes, Morbidity management and disease prevention for Lymphatic Filariasis

John Boateng, Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

John Boateng is a PhD candidate in Clinical Microbiology at KNUST and fellow of the German-West African Centre for Global Health and Pandemic Prevention (G-WAC). He conducts research at the Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), Ghana. His current research focuses on the role of the skin microbiome in filarial lymphoedema and its link to recurrent painful episodes. His broader interests include clinical trials on Neglected Tropical Diseases (NTDs), immunopathogenesis, epidemiology, genomics, and antimicrobial resistance (AMR). He is also involved in research data management and statistical analysis. He welcomes collaborations and training opportunities to enhance his research and career.

Monica Ahiadorme, Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Monica Ahiadorme is a PhD candidate in Clinical Microbiology at KNUST, Ghana. Her research is supported by the European & Developing Countries Clinical Trials Partnership (EDCTP) and the Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR). Her interests focus on infectious diseases, particularly neglected tropical diseases such as onchocerciasis and lymphatic filariasis. She is dedicated to developing novel therapeutic strategies and enhancing diagnostic tools for filarial infections. Her current work investigates alternative treatment approaches for onchocerciasis using anti-Wolbachia therapy. She is open to collaborative research and mentorship opportunities.

Jubin Osei-Mensah, Department of Pathobiology, School of Veterinary Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Jubin is a trained parasitologist with over a decade experience in neglected tropical diseases (NTD) research, mainly in filariasis (onchocerciasis and lymphatic filariasis). He had his first degree in Zoology at the University of Ghana and subsequently undertook graduate studies with the Filariasis Research Group at the Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), obtaining Master and Doctor of Philosophy degrees (MPhil and PhD, respectively) in Clinical Microbiology at the Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi, Ghana. He subsequently took up a position as a Postdoctoral Research Fellow, and later Project Manager on the Filariasis Project at the KCCR. He is currently a lecturer in Veterinary Parasitology at the Department of Pathobiology, School of Veterinary Medicine (SVM), KNUST. His research interests include immunogenetics of filarial parasites, human and animal (including zoonotic) host-parasite interactions and drug interventional / clinical trials in filariasis.

Vera Serwaa Opoku, Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Vera is a Postdoctoral Research Scientist at the Kumai Centre for Collaborative Research in Tropical Medicine (KCCR-KNUST), Kumasi-Ghana specializing in infectious diseases, with a particular focus on the genetics and molecular biology of neglected tropical diseases. She earned her PhD in Clinical Microbiology from the Kwame Nkrumah University of Science and Technology (KNUST), where she conducted pioneering research on the genetic factors influencing lymphatic filariasis.

Michael Obeng Agyemang, Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Michael Agyemang Obeng is a Clinical Researcher at the Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR). His research focuses on neglected tropical diseases such as lymphatic filariasis and onchocerciasis as he is involved in conducting clinical trials to find best therapy for the treatment and management of these diseases. Michael also has keen interest in viral hepatitis. He has worked consistently in this area since 2017 with rich experience in education and relevant research in viral hepatitis infection. He has consistently advocated for mass vaccination of people as the surest way of preventing the hepatitis B viral infection and seeks to work in line with WHO’s goal in bringing to the barest minimum the prevalence of the infection by 2030.

Prince Dennis Atisu

Prince Dennis Atisu has a B.Sc. in Biological Sciences from KNUST. He is currently an MPhil student in the Department of Clinical Microbiology, KNUST. His MPhil research is about the dynamics of filarial antigens among individuals in three districts in the Upper East Region of Ghana. He formally worked as a research assistant on the Filariasis project in KCCR.

Eunice Kyaakyile Kuutiero, Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Eunice is a data clerk on the filariasis project at the Kumasi Centre for Collaborative Research (KCCR), holding a degree in Applied Biology from the University for Development Studies. Specializing in data management, she ensures accurate data handling for the project.

John Opoku, Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

John is a trained research scientist with over six years’ experience in neglected tropical diseases (NTD) research, including lymphatic filariasis, Onchocerciasis, Schistosomiasis, and Soil-transmitted helminthiasis. He had his first degree in Biomedical Sciences at the University of Cape Coast and subsequently undertook graduate studies with the Filariasis Research Group at the Kumasi Centre for Collaborative Research in Tropical Medicine (KCCR), obtaining Master degree (MPhil) in Clinical Microbiology at the Kwame Nkrumah University of Science and Technology (KNUST) in Kumasi, Ghana. He subsequently took up a position as a Graduate Research Assistant on the Filariasis Project at the KCCR and currently a Biomedical Research Scientist on the Project. His research interests include diagnosis and immunogenetics of filarial diseases, interdisciplinary approaches and drug interventional / clinical trials in filariasis and other infectious diseases.

Charles Gyasi, Kumasi Centre for Collaborative Research in Tropical Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Charles is a Medical Laboratory Scientist and parasitologist currently pursuing doctoral research at The University of Manchester. His work explores how chronobiology and mucosal immune responses shape host parasite interactions in tropical infections. This focus builds on his earlier training at KNUST, Ghana, where he earned a BSc and MPhil in Clinical Microbiology. During his time with the Filariasis Research Group at KCCR, he investigated interventions for lymphatic filariasis and lymphedema. His involvement in field-based trials deepened his interest in immunogenetics and extracellular matrix remodeling. Seeking to broaden this expertise, he undertook an Erasmus+ research placement at University Hospital Bonn in Germany. There he studied the role of NCDs among individuals living with filarial lymphedema. This experience reinforced his commitment to translational research that bridges clinical science and community health. Charles now applies this cross-disciplinary perspective to developing evidence-based strategies for neglected tropical diseases.

Emmanuel Donawobuge Kutu, Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Emanuel Donawobuge Kutu is a PhD candidate at the Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi. He holds a BSc in Biological Science and an MPhil in Clinical Microbiology, all from KNUST. His research areas include Clinical bacteriology and Clinical parasitology, with specialty in helminthes responsible for lymphatic filariasis

Alexander Yaw Debrah, Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Alexander Yaw Debrah is a Full Professor of Parasitology and Global Health and currently the Dean of the Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. He is also the Principal Investigator of the Filariasis Research Group in KCCR and have overseen a number of Clinical trials mostly in Lymphatic Filariasis and Onchocerciasis. He holds a BSc in Biological Sciences, MPhil in Clinical Microbiology, and PhD in Medical Parasitology. His research areas include: Clinical trials in Neglected Tropical Diseases (focusing on trials for Lymphatic Filariasis, Onchocerciasis and Mansonellosis), Morbidity management and disease prevention for Lymphatic Filariasis

Persistence of Onchocerciasis infection after decades of mass drug administration in the Western North Region of Ghana

Onchocerciasis after MDA in Western North, Ghana

Abstract

Author Biographies