Towards Elimination of Lymphatic Filariasis in Nigeria: Predictive Modelling, Transmission Assessment Surveys, and Health System Readiness

Nigeria is one of the last remaining high-burden lymphatic filariasis countries globally, and achieving WHO elimination targets by 2030 requires a rigorous scientific evidence base linking predictive transmission models with health system readiness assessments at sub-national resolution. This doctoral research develops a comprehensive evidence framework for LF elimination feasibility in Nigeria integrating predictive transmission modelling, transmission assessment survey data analysis, and health system readiness evaluation. A multi-component mixed-methods design was employed. Transmission assessment survey data from 60 implementation units across Kano, Ogun, Benue, Cross River, Imo, and Sokoto States were compiled and analysed to determine the proportion meeting WHO microfilaraemia and antigenaemia thresholds for stopping MDA. The EpiDyn mathematical model was calibrated to Nigerian population parameters and used to simulate elimination timelines under current and enhanced MDA coverage scenarios, incorporating population compliance heterogeneity. Health system readiness was assessed through a scorecard tool evaluating drug procurement reliability, community distributor density, supervision systems, and post-MDA surveillance capacity across all states. Evidence from 2020 to 2024 identifies LF implementation units in South East and South West Nigeria as approaching elimination thresholds, while North West Nigeria lags significantly. This study produces state-stratified elimination readiness scores and a bottleneck analysis identifying the minimum health system investments required for programme acceleration. Findings will be presented to the Federal Ministry of Health and the WHO Global LF Programme. Keywords: lymphatic filariasis elimination, Nigeria, transmission modelling, health system readiness, mass drug administration.