The World Health Organization (WHO) has validated Timor-Leste for having eliminated lymphatic filariasis (LF) as a public health problem, making it the fifth country in the Region to achieve this milestone.
"Timor-Leste's success in eliminating lymphatic filariasis as a public health problem demonstrates the power of national leadership and strong partnership," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "I welcome Timor-Leste as the 54th member of the global family of countries to have eliminated one or more neglected tropical diseases, and congratulate the government, health workers, partners and affected communities on this achievement.
Dr Élia António de Araújo dos Reis Amaral, Minister of Health, Timor-Leste, and Ms Saima Wazed, Regional Director, WHO South-East Asia Region
LF, commonly known as elephantiasis, is a debilitating parasitic disease spread by mosquitoes. The infection is usually acquired in childhood with painful and disfiguring visible manifestations appearing much later in life, often in the form of enlargement of body parts causing pain, severe disability, and associated stigma.
"Timor-Leste's progress towards the elimination of lymphatic filariasis is driven by the strong leadership of its Government, dedication of health-care workers, and active participation of the community in collaboration with partners. Together, they have ensured high-quality mass drug administration (MDA) campaigns, effective surveillance, management of cases with chronic lymphatic filariasis, and promoted community engagement to stop transmission and support those affected by the disease," said Saima Wazed, Regional Director, WHO South-East Asia.
WHO considers 72 countries to be LF endemic, of which nine countries are in the WHO South-East Asia Region. Thailand, Maldives, Sri Lanka, and more recently Bangladesh have successfully eliminated LF as a public health problem. While India, Indonesia, Myanmar, and Nepal are continuing to implement mass drug administration (MDA) and strengthen access to an essential package of care through the health system for persons affected by the disease.
Effective collaborations and national leadership
The Ministry of Health in Timor-Leste initiated MDA to stop the spread of infection in 2005 in 5 out of the 13 districts but efforts were interrupted from 2007 to 2015 because of funding constraints. In 2015, WHO provided seed resources to re-initiate the LF elimination programme, which led in 2016, to a 5-year investment grant from the Korea International Cooperation Agency (KOICA) towards integrated multi-disease elimination in Timor-Leste. With this new collaboration, Timor-Leste continued to improve the quality and reach of MDA against LF and other NTDs. In 2019, the newly WHO-recommended triple drug therapy called IDA (ivermectin, diethylcarbamazine, and albendazole [i]) was introduced nationwide with remarkable treatment coverage.
Timor-Leste moved into post-MDA surveillance phase after successfully measuring impact of their renewed efforts using WHO recommended surveys, documenting that prevalence had been lowered below target thresholds and stopping MDA nationwide.
Simultaneously, the Ministry extended efforts to identify patients with lymphoedema and hydrocele and provided them with the essential package of care for morbidity management and disability prevention at respective health facilities. As part of the Primary Health Care service, health workers continue to provide regular home visits every six months to monitor patients' conditions and administer care.
From June-August 2024, with support of WHO and United States Agency For International Development (USAID), the Ministry of Health in Timor-Leste implemented a LF elimination validation survey to confirm that elimination of LF as a public health problem has been achieved.
An independent Regional Dossier Review Group convened by WHO thoroughly reviewed the evidence documenting the achievements, and recommended to the Director-General that he should proceed with validation.
"Lymphatic Filariasis - a disease that not only takes a toll on the body but also on one's quality of life and to eliminate this disease in Timor Leste is transformative," said Dr Arvind Mathur, WHO Representative to Timor-Leste and acknowledged the tireless efforts of health care workers who implemented proven evidence-based interventions over the years.
[i] These medicines were donated free of charge and are available globally to support elimination of LF from the following companies: ivermectin by MSD, diethycarbamazine by Eisai Co., Ltd., and albendazole by GSK.
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