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.