Lymphatic filariasis (Elephantiasis).

Sub-Saharan Africa (SSA) carries nearly one-third of the global burden of lymphatic filariasis (LF), a vector-borne and debilitating disease that afflicts the poorest population. Wuchereria bancrofti is the only species responsible for the disease and is mainly transmitted to humans by mosquito species belonging to Anopheles and Culex. The disease is estimated to be transmitted in 37 out of the 49 South Saharan countries with an estimated at-risk population of 432 million people. Recognizing the burden of the disease and the availability of new tools, the World Health Assembly took in 1997 the resolution WHA 50.29 calling for the elimination of the LF as a public health problem. The subsequent Global Programme to Eliminate Lymphatic Filariasis was set up with the aim to eliminate the disease by 2020. After more than a decade of program implementation in SSA, and despite available opportunities including the donation of the medicines, only 37 % of the populations in 24 countries that required mass drug administration were reached in 2013. The morbidity alleviation, the second pillar of the global program, is almost inexistent. This very slow program expansion is due to many factors including insufficient political commitment for adequate resources allocation for country programs, sociopolitical instability, and the prevalence of Loa loa infection in Central Africa that hampers the safe implementation of ivermectin-based mass treatment. Alternatives tools and strategies will be required to accelerate LF elimination in SSA by 2020.