Low prevalence of lymphatic filariasis infection among adults in a post-mass drug administration setting in Lira District, Northern Uganda: a cross-sectional study

Abstract Background Lymphatic filariasis (LF) is a mosquito-borne neglected tropical disease targeted for elimination as a public health problem. Uganda has implemented LF elimination activities, including mass drug administration (MDA), morbidity management, and post-intervention surveillance. Local evidence remains important for guiding surveillance and community-level prevention in previously endemic districts. This study estimated LF prevalence and examined individual, socioeconomic, and health-system factors among adults in Lira District, northern Uganda. Methods A cross-sectional study was conducted using structured questionnaire data and Ministry of Health Vector Control Division screening records for 150 adults from selected communities in Lira District. The questionnaire was developed specifically for this study and is provided as Additional file 4. LF infection status was abstracted from laboratory screening records. Data were analysed using IBM SPSS Statistics Version 25-compatible procedures. Prevalence was estimated with an exact binomial 95% confidence interval. Because only two participants were LF-positive, multivariable logistic regression was not fitted; bivariate analyses used Fisher exact or Fisher-Freeman-Halton exact tests and were interpreted as exploratory. Results Most participants were male (107/150, 71.3%), aged 35–44 years (64/150, 42.7%), farmers (139/150, 92.7%), and rural residents (150/150, 100.0%). Overall, 2 of 150 participants were LF-positive, yielding a prevalence of 1.33% (exact 95% CI 0.16–4.73). Exact bivariate tests did not provide statistical evidence of associations between LF infection and measured demographic, knowledge, prevention, or health-system variables. Descriptive findings showed high general awareness of LF (92.7%), but limited prioritization of prevention (77.3% disagreed that LF prevention was a personal priority) and weak reported communication from health workers about LF (77.3% strongly disagreed that healthcare professionals provided LF information). Conclusions Detectable LF infection prevalence among adults in this Lira District sample was low, consistent with a post-MDA setting. However, low prevalence in a small cross-sectional sample should not be interpreted as proof of the complete absence of residual transmission. Continued post-MDA surveillance, targeted health education, community engagement, morbidity detection, and integration of LF activities within routine health services remain important for protecting elimination gains.