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Quality of life in filarial lymphoedema patients in Colombo, Sri Lanka. Trans R Soc Trop Med Hyg 2009; 104:219-24. [PMID: 19796782 DOI: 10.1016/j.trstmh.2009.08.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2009] [Revised: 08/07/2009] [Accepted: 08/07/2009] [Indexed: 11/23/2022] Open
Abstract
The quality of life (QOL) was assessed in 141 filarial lymphoedema patients and 128 healthy people in the Colombo district of Sri Lanka. Information was gathered by administering the validated translated version of the WHO 100-item QOL questionnaire (WHOQOL-100), which ascertains an individual's perception of QOL in the physical, psychological, level of independence, environmental and spiritual domains, as well as the general QOL. Healthy controls had a better QOL in all domains as well as in the overall general QOL, when compared to patients with lymphoedema. Several facets such as pain and discomfort, sleep and rest, activities of daily living, dependence on medication and treatment, working capacity and social support were significantly affected by the acute adenolymphangitis attack/s patients had suffered. The environmental and spiritual domains were significantly affected by the maximum grade of lymphoedema. The significant difference in the QOL as perceived by patients suffering from filarial lymphoedema and apparently healthy individuals reiterates the importance of morbidity control in patients already affected by filarial lymphoedema.
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Fenwick A, Zhang Y, Stoever K. Control of the Neglected Tropical Diseases in sub-Saharan Africa: the unmet needs. Int Health 2009; 1:61-70. [DOI: 10.1016/j.inhe.2009.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Huppatz C, Capuano C, Palmer K, Kelly PM, Durrheim DN. Lessons from the Pacific programme to eliminate lymphatic filariasis: a case study of 5 countries. BMC Infect Dis 2009; 9:92. [PMID: 19523192 PMCID: PMC2702370 DOI: 10.1186/1471-2334-9-92] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 06/12/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphatic Filariasis (LF) is an important Neglected Tropical Disease, being a major cause of disability worldwide. The Global Programme to Eliminate Lymphatic Filariasis aims to eliminate LF as a public health problem by the year 2020, primarily through repeated Mass Drug Administration (MDA). The Pacific region programme commenced in 1999. By June 2007, five of the eleven countries classified as endemic had completed five MDA campaigns and post-MDA prevalence surveys to assess their progress. We review available programme data and discuss their implications for other LF elimination programs in developing countries. METHODS Reported MDA coverage and results from initial surveys and post-MDA surveys of LF using the immunochromatographic test (ICT) from these five Pacific Island countries (Tonga, Niue, Vanuatu, Samoa and Cook Islands) were analysed to provide an understanding of their quality and programme progress towards LF elimination. Denominator data reported by each country programme for 2001 was compared to official sources to assess the accuracy of MDA coverage data. RESULTS Initial survey results from these five countries revealed an ICT prevalence of between 2.7 and 8.6 percent in individuals tested prior to commencement of the programme. Country MDA coverage results varied depending on the source of denominator data. Of the five countries in this case study, three countries (Tonga, Niue and Vanuatu) reached the target prevalence of <1% antigenaemia following five rounds of MDA. However, endpoint data could not be reliably compared to baseline data as survey methodology varied. CONCLUSION Accurate and representative baseline and post-campaign prevalence data is crucial for determining program effectiveness and the factors contributing to effectiveness. This is emphasised by the findings of this case study. While three of the five Pacific countries reported achieving the target prevalence of <1% antigenaemia, limitations in the data preclude identification of key determinants of this achievement.
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Affiliation(s)
- Clare Huppatz
- Hunter New England Population Health Unit, New South Wales Health, Wallsend, Australia.
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Babu BV, Mishra S, Nayak AN. Marriage, sex, and hydrocele: an ethnographic study on the effect of filarial hydrocele on conjugal life and marriageability from Orissa, India. PLoS Negl Trop Dis 2009; 3:e414. [PMID: 19381283 PMCID: PMC2666802 DOI: 10.1371/journal.pntd.0000414] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 03/17/2009] [Indexed: 11/26/2022] Open
Abstract
Background Lymphatic filariasis (LF), a leading cause of permanent and long-term disability, affects 120 million people globally. Hydrocele, one of the chronic manifestations of LF among 27 million people worldwide, causes economic and psychological burdens on patients and their families. The present study explores and describes the impact of hydrocele on sexual and marital life as well as on marriageability of hydrocele patients from rural areas of Orissa, an eastern state of India. Methodology/Principal Findings This paper is based on ethnographic data collected through focus group discussions and in-depth interviews with hydrocele patients, wives of hydrocele patients, and other participants from the community. The most worrisome effect of hydrocele for patients and their wives was the inability to have a satisfactory sexual life. The majority of patients (94%) expressed their incapacity during sexual intercourse, and some (87%) reported pain in the scrotum during intercourse. A majority of hydrocele patients' wives (94%) reported dissatisfaction in their sexual life. As a result of sexual dissatisfaction and physical/economic burden, communication has deteriorated between the couples and they are not living happily. This study also highlights the impact on marriageability. The wives of hydrocele patients said that a hydrocele patient is the “last choice” and that girls show reluctance to marry hydrocele patients. In some cases, the patients were persuaded by their wives to remove hydrocele by surgery (hydrocelectomy). Conclusions/Significance The objective of the morbidity management arm of the Global Programme to Eliminate LF should be to increase access to hydrocelectomy, as hydrocelectomy is the recommended intervention. Though the study area is covered by the programme, like in other endemic areas, hydrocelectomy has not been emphasised by the national LF elimination programme. The policy makers and programme managers should be sensitised by utilising this type of research finding. Lymphatic filariasis, the second leading cause of permanent and long-term disability, affects 120 million people globally. Hydrocele, an accumulation of fluid in the scrotum that causes it to swell, is one of the chronic manifestations of LF among men and there are about 27 million men with hydrocele worldwide. We conducted ethnographic interviews and discussions with patients, women whose husbands have hydrocele, and the general public in a rural community of eastern India. The study describes how hydrocele impacts patients' sexual and marital life. It reveals the most worrisome effect of hydrocele for patients and their wives due to the inability to have a satisfactory sexual life. Patients expressed their incapacity during sexual intercourse. A majority of hydrocele patients' wives reported that their married life became burdened and couples were not living happily. This study also highlights the impact on marriageability, and some women expressed that a hydrocele patient is the “last choice”. In some cases, the patients were persuaded by their wives to remove hydrocele by surgery (hydrocelectomy). Hence, access to hydrocelectomy has to be strengthened under the Global Programme to Eliminate Lymphatic Filariasis, which is operational in several endemic areas in the world. Also, this activity may be integrated with primary healthcare services and interventions of other neglected tropical diseases.
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Affiliation(s)
- Bontha V Babu
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India.
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Wijesinghe RS, Wickremasinghe AR, Ekanayake S, Perera MSA. Treatment-seeking behavior and treatment practices of lymphatic filariasis patients with lymphoedema in the Colombo district, Sri Lanka. Asia Pac J Public Health 2009; 20:129-38. [PMID: 19124306 DOI: 10.1177/1010539507311257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This cross-sectional, descriptive study describes the treatment-seeking behavior of 413 lymphoedema patients attending 2 filariasis clinics in the Colombo district, Sri Lanka. A pretested, interviewer-administered questionnaire obtained information regarding sources and types of treatment taken, time taken for diagnosis, and details regarding diethylcarbamazine citrate (DEC) treatment. There was a mean delay of 2.37 years (SD 1.37) in diagnosing filariasis after the first appearance of limb swelling. General practitioners were the most frequent first-contact health care providers and the most visited source overall, followed by government hospitals and Ayurvedic practitioners. Approximately 95% of patients were on DEC treatment ranging from 10 days to 43 years (mean 2.5 years SD +/- 1.1). Sixty-one percent of patients reported always having taken the recommended DEC course. Nonsteroidal anti-inflammatory drugs, diuretics, and antibiotics were liberally prescribed. Approximately 97% had sought treatment from a medical practitioner for an acute adenolymphangitis attack. Despite the area being endemic for filariasis, there was a delay in treatment and inappropriate use of DEC in patients with chronic filarial lymphoedema.
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Abstract
Hydrocele [Greek: water--sac] is abnormal fluid collection within the tunica vaginalis of the scrotum or a patent tunica vaginalis. It is a relatively common condition in surgical practice. However, a giant hydrocele, here defined for clinical purposes, as a hydrocele equal to or bigger than the patient's head, is rare as indicated by the limited number of reported cases in the literature. In this paper I am presenting three cases of giant hydroceles and highlighting how it affects the quality of patients' life by way of complications, infertility, sexual function and work capacity.
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Affiliation(s)
- Emmanuel E Akpo
- Surgery Department, Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria.
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Abstract
Among infections closely associated with poverty, lymphatic filariasis (LF) is a study in contrasts. It is both a consequence of and a contributor to poverty. Although rarely fatal, it is recognized as a leading global cause of lifelong disability as well as significant personal, social, and economic burdens coincident with disease. Infection is often considerably more prevalent in communities than the number of cases of overt pathology for which LF is best known (lymphedema, elephantiasis, and hydrocele). With an estimated 120 million to 130 million affected persons in 83 countries and 1.25 billion persons living in areas at risk, in some countries LF may be expanding its range, whereas in others, with economic development, it has disappeared with little if any targeted intervention. The transmission cycle is relatively inefficient, yet an association with pockets of deepest poverty remains tenacious. Thanks to scientific advances in diagnostic tools, and particularly in control strategies focused on large-scale drug donation and mass drug distribution programs, scientists and policy makers now consider LF eliminable. Together with new approaches for morbidity control, a hopeful tone surrounds a disease problem that as recently as two decades ago could easily have been categorized as among the most neglected of neglected diseases. Continued progress toward global LF elimination will require solutions to potential obstacles in the most challenging--that is, the poorest--endemic settings. This chapter reviews progress toward LF elimination and some of the remaining challenges from a perspective in Haiti, the only least developed country of the Americas.
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Affiliation(s)
- Thomas Streit
- Center for Global Health and Infectious Diseases, Department of Biological Sciences, University of Notre Dame, Notre Dame, IN 46556-0369, USA.
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Person B, Bartholomew LK, Addiss D, van den Borne B. Disrupted social connectedness among Dominican women with chronic filarial lymphedema. PATIENT EDUCATION AND COUNSELING 2007; 68:279-86. [PMID: 17707609 DOI: 10.1016/j.pec.2007.06.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 06/27/2007] [Accepted: 06/30/2007] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The objectives of this paper were to identify specific factors associated with intact or disrupted social connectedness among Dominican women with chronic filarial lymphedema and better understand the impact of disrupted connectedness on their lives. METHODS Data were collected through 28 individual interviews and 3 focus group discussions of 28 women from filariasis-endemic areas of the Dominican Republic presenting with lymphedema of one or both legs. RESULTS The confluence of chronic and acute stressors with severity of lymphedema lead women to rely on others for social support. Women described complications of aging, disability, reduced social networks, and inability to adhere to cultural scripts as contributing to disrupted social connectedness. CONCLUSION Social disconnectedness appears to exacerbate the negative consequences of living with lymphedema among women. Social connectedness and cultural scripts often define a social role for women that transcend physical deformity and disability, while disrupted social connectedness contributes to social isolation, depressive symptoms, and poor health outcomes. PRACTICE IMPLICATIONS Further behavioral research into the contribution of intact social connectedness to resiliency and coping is warranted in order to develop effective interventions for women. Identifying women with disrupted social connectedness and engaging them in behavioral interventions to enhance natural social networks and create new or enhanced social support opportunities may mitigate the negative effects of social disconnectedness and improve quality of life.
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Affiliation(s)
- Bobbie Person
- National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-C14, Atlanta, GA 30333, USA
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Wynd S, Melrose WD, Durrheim DN, Carron J, Gyapong M. Understanding the community impact of lymphatic filariasis: a review of the sociocultural literature. Bull World Health Organ 2007; 85:493-8. [PMID: 17639248 PMCID: PMC2636343 DOI: 10.2471/blt.06.031047] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2006] [Accepted: 12/14/2006] [Indexed: 11/27/2022] Open
Abstract
Lymphatic filariasis (LF) is endemic in approximately 80 tropical and subtropical countries. About 120 million people are infected with the parasite and a billion are estimated to be at risk of infection. The main focus of the LF elimination programme to date has been to interrupt transmission by means of annual community-wide treatment campaigns with diethylcarbamazine and albendazole, or albendazole and ivermectin, for a period of four to six years. Although substantial progress has been recorded wherever the strategy has been successfully implemented, initial gains have been accompanied by a realization that this strategy alone will not ensure a permanent solution in all settings. The fairly extensive LF literature is dominated by laboratory research and quantitative field measurement of the impact of LF, particularly local prevalence studies of parasite-infected humans and vectors. As the global elimination programme expands, the absence of sociocultural understanding is being recognized as a critical flaw in ensuring that programmes are appropriate and responsive to local needs and understanding. This paper assesses the current state of sociocultural understanding pertaining to LF. It concludes that, at present, there is insufficient understanding of the sociocultural factors associated with the presence and treatment of the disease, and that appropriate social science methods should be used to address this deficiency and ensure community partnership in delivering and sustaining the success of LF elimination programmes.
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Affiliation(s)
- Shona Wynd
- Department for International Development, East Kilbride, United Kingdom
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Person B, Addiss D, Bartholomew LK, Meijer C, Pou V, Gonzálvez G, van den Borne B. A qualitative study of the psychosocial and health consequences associated with lymphedema among women in the Dominican Republic. Acta Trop 2007; 103:90-7. [PMID: 17638614 DOI: 10.1016/j.actatropica.2007.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 05/20/2007] [Indexed: 11/19/2022]
Abstract
To date, few studies have addressed the sequelae of lymphatic filariasis, a mosquito-transmitted disease, on the quality of life of affected women in the Americas. In this qualitative study, we conducted 28 semi-structured interviews and 3 focus groups of women with lymphedema or elephantiasis of the leg living in filariasis-endemic areas of the Dominican Republic. Women in our study described a spectrum of consequences associated with their lymphedema but physical, functional, and psychological limitations were not always associated with severity of lymphedema. Data suggests that management frameworks need to be expanded to address women's explanatory models of illness, the cultural practices of seeking traditional healers for initial care, psychological distress, coping strategies unique to women, and the practice of self treating with antibiotics without medical supervision. Further research to better understand the depth and breadth of psychological states and coping strategies of women; the health seeking and self-management practices; and the strain on social support networks of women is needed in order to assist health program planners in establishing culturally tailored and gender-specific interventions for Dominican women.
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Affiliation(s)
- Bobbie Person
- National Center for Prevention, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS-C14, Atlanta, GA 30333, USA.
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Wijesinghe RS, Wickremasinghe AR, Ekanayake S, Perera MSA. Physical disability and psychosocial impact due to chronic filarial lymphoedema in Sri Lanka. FILARIA JOURNAL 2007; 6:4. [PMID: 17391538 PMCID: PMC1851956 DOI: 10.1186/1475-2883-6-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 03/29/2007] [Indexed: 11/25/2022]
Abstract
Background Information on the physical and psychosocial disability of lymphatic filariasis in Sri Lanka is scarce. Therefore this study was carried out to describe the physical disability and psychosocial impact associated with chronic lymphoedema in patients attending filariasis clinics in the Colombo district, Sri Lanka. Methods Four hundred and thirteen patients with lymphoedema of limbs attending filariasis clinics in Werahera and Dehiwala in the Colombo district were enrolled in the study after obtaining informed written consent. Data were collected using a pre-tested, interviewer-administered questionnaire and analyzed using SPSS. Results Majority (95%) of patients had lower limbs affected and there was a significant association with difficulty in walking (p = 0.023). The swollen limb affected the work of 87 (52 %) of employed patients and 26 persons reported loss of job. Approximately 25 % and 6 % reported having problems interacting with the community and family, respectively and 8.7 % felt that they were rejected by society. The swollen limb was perceived as a major problem by 36.8 % of patients. Of the married persons, 5.7 % and 6.2 % reported sexual and marital problems respectively, due to their swollen limb/s. Of those who had marital problems, 77.3% reported sexual problems as well (p < 0.001). Conclusion Lymphoedema significantly affects physical, psychological and social functioning in affected individuals. Morbidity control, in addition to control of physical disability, should target the psychosocial consequences.
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Affiliation(s)
- RS Wijesinghe
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - AR Wickremasinghe
- Department of Community Medicine, Faculty of Medicine, University of Kelaniya, P.O. Box 6, Thalagolla Road, Ragama, Sri Lanka
| | - Sriyani Ekanayake
- Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
| | - MSA Perera
- Department of Family Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
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Chandrasena TGAN, Premaratna R, Muthugala MARV, Pathmeswaran A, de Silva NR. Modified Dermatology Life Quality Index as a measure of quality of life in patients with filarial lymphoedema. Trans R Soc Trop Med Hyg 2007; 101:245-9. [PMID: 17098268 DOI: 10.1016/j.trstmh.2006.08.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 08/24/2006] [Accepted: 08/24/2006] [Indexed: 11/29/2022] Open
Abstract
The quality of life (QoL) and correlates of the QoL of lymphoedema patients attending filariasis clinics and a hospital outpatient department were studied using a Life Quality Index (LQI) in a region endemic for Bancroftian filariasis in Sri Lanka. The index was derived by modifying a previously validated Dermatology Life Quality Index (DLQI) to focus on the oedematous limb rather than the skin. The index was scored from 0 (normal) to 30 (severely affects QoL). Lymphoedema was graded using criteria recommended by the WHO. Another semi-structured questionnaire was used to assess the patient's socioeconomic status, frequency of acute adenolymphangitis attacks (ADLA) and measures practiced for morbidity control. Ninety-one patients (62 females, 29 males; mean age 50.4 years) were studied. A single lower limb, both lower limbs or a single upper limb were affected in 78 (85.7%), 10 (11.0%) and 3 (3.3%) patients, respectively. The severity of lymphoedema ranged from stage 1 (mild) to stage 6 (severe). The mean LQI was 8.2 (SD 5.2, range 0-20). The modified DLQI scores showed a significant positive correlation with severity of lymphoedema and a negative correlation with age (R=0.59 and R=-0.1, respectively). The frequency of ADLAs correlated with an increased modified DLQI score. Local pain, embarrassment and limitations of physical activities were the most distressing aspects of lymphoedema. Disease severity and early onset lymphoedema were found to be significantly associated with poorer QoL in filarial lymphoedema.
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Affiliation(s)
- T G A N Chandrasena
- Department of Parasitology, Faculty of Medicine, University of Kelaniya, PO Box 6, Thalagolla Road, Ragama, Sri Lanka.
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Addiss DG, Brady MA. Morbidity management in the Global Programme to Eliminate Lymphatic Filariasis: a review of the scientific literature. FILARIA JOURNAL 2007; 6:2. [PMID: 17302976 PMCID: PMC1828725 DOI: 10.1186/1475-2883-6-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 02/15/2007] [Indexed: 11/23/2022]
Abstract
The Global Programme to Eliminate Lymphatic Filariasis (GPELF) has two major goals: to interrupt transmission of the parasite and to provide care for those who suffer the devastating clinical manifestations of the disease (morbidity control). This latter goal addresses three filariasis-related conditions: acute inflammatory episodes; lymphoedema; and hydrocele. Research during the last decade has confirmed the importance of bacteria as a cause of acute inflammatory episodes in filariasis-endemic areas, known as acute dermatolymphangioadenitis (ADLA). Current lymphoedema management strategies are based on the central role of ADLA as a trigger for lymphoedema progression. Simple intervention packages are in use that have resulted in dramatic reductions in ADLA rates, a lower prevalence of chronic inflammatory cells in the dermis and subdermis, and improvement in quality of life. During the past decade, the socioeconomic impact of ADLA and lymphoedema in filariasis-endemic areas has received increasing attention. Numerous operational research questions remain to be answered regarding how best to optimize, scale up, monitor, and evaluate lymphoedema management programmes. Of the clinical manifestations targeted by the GPELF, hydrocele has been the focus of the least attention. Basic information is lacking on the effectiveness and complications of hydrocele surgery and risk of post-operative hydrocele recurrence in filariasis-endemic areas. Data on the impact of mass administration of antifilarial drugs on filarial morbidity are inconsistent. Several studies report reductions in acute inflammatory episodes, lymphoedema, and/or hydrocele following mass drug administration, but other studies report no such association. Assessing the public health impact of mass treatment with antifilarial drugs is important for programme advocacy and morbidity control strategies. Thus, although our knowledge of filariasis-related morbidity and its treatment has expanded in recent years, much work remains to be done to address the needs of more than 40 million persons who suffer worldwide from these conditions.
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Affiliation(s)
- David G Addiss
- WHO Collaborating Center for Control and Elimination of Lymphatic Filariasis in the Americas, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, Atlanta, Georgia, 30341, USA
- Fetzer Institute, 9292 West KL Avenue, Kalamazoo, Michigan, 49009, USA
| | - Molly A Brady
- Lymphatic Filariasis Support Center, The Task Force for Child Survival and Development, 750 Commerce Dr, Suite 400, Decatur, Georgia 30030, USA
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Richard SA, Mathieu E, Addiss DG, Sodahlon YK. A survey of treatment practices and burden of lymphoedema in Togo. Trans R Soc Trop Med Hyg 2006; 101:391-7. [PMID: 17112555 DOI: 10.1016/j.trstmh.2006.08.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2006] [Revised: 08/29/2006] [Accepted: 08/30/2006] [Indexed: 11/18/2022] Open
Abstract
Lymphatic filariasis, a mosquito-borne parasitic disease, can lead to lymphoedema and elephantiasis. This study describes the results of a baseline survey of a lymphoedema morbidity management programme in Togo. A convenience sample of 188 people with lymphoedema was asked about symptoms, treatment preferences and quality of life. Those with higher stage lymphoedema were more likely to have experienced an acute attack (odds ratio=1.9; P=0.002). Although only 28.2% of those surveyed reported currently using any lymphoedema treatment, 80.3% had used treatments in the past, primarily traditional products (68.1%) and scarification (38.8%). Medication was the preferred treatment for acute attacks, both currently (73.1%) and in the past (61.7%). Patients reported difficulties performing activities such as walking to the field (44%) and carrying a heavy load (63%) as a result of their lymphoedema. Patients felt avoided by their family (17%) and their community (36%). Using the Duke Anxiety-Depression scale, over 70% of patients were found to be at high risk of depression and this risk increased with lymphoedema stage (P=0.04). The survey results demonstrate the need for a morbidity management programme that will increase the use of morbidity management techniques and decrease the physical and emotional burden of this disease.
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Affiliation(s)
- Stephanie A Richard
- Division of Parasitic Diseases, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS-F22, Atlanta, GA 30341, USA
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Engels D, Savioli L. Reconsidering the underestimated burden caused by neglected tropical diseases. Trends Parasitol 2006; 22:363-6. [PMID: 16798088 DOI: 10.1016/j.pt.2006.06.004] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Revised: 05/19/2006] [Accepted: 06/02/2006] [Indexed: 10/24/2022]
Abstract
It is generally acknowledged that the burden caused by neglected tropical diseases needs to be reassessed. Not only are there several important diseases unaccounted for, but new information suggests they have a more substantial impact on health than initially thought. Looking at the tropical diseases as a group makes sense: they tend to cluster in the same poor populations and, to make progress with their control, they will have to be dealt with in an integrated manner. Measuring the effect of such integrated control is likely to reveal the real impact of tropical diseases on human health and wellbeing.
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Affiliation(s)
- Dirk Engels
- Department of Neglected Tropical Diseases, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland.
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Babu BV, Swain BK, Rath K. Impact of chronic lymphatic filariasis on quantity and quality of productive work among weavers in an endemic village from India. Trop Med Int Health 2006; 11:712-7. [PMID: 16640624 DOI: 10.1111/j.1365-3156.2006.01617.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the impact of hydrocele and lymphoedema on the quantity and quality of productive work of weavers. METHOD Case-control study in an endemic village in Andhra Pradesh, India. We collected qualitative data on work activities from cases and age- and sex-matched controls through informal discussions and observation. RESULTS The mean (+/-standard deviation) daily work time of cases was 7.38 h (+/-2.47), significantly less than that of controls (8.17+/-2.41 h). Lost work time was equivalent to around 29 days of work in a year. Gender had significant influence on the mean number of working hours in this occupational group. Most cases could not weave, which is physically demanding, and preferred less strenuous tasks such as spinning, starching, dyeing or sizing. Hard physical labour constitutes 71.5% of total work time among patients and 83.7% in controls. As income also depends on the type of work, cases earn less. CONCLUSIONS Filariasis has an adverse impact on the productivity of weavers, and morbidity management strategies and control programmes need to take this into account.
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Affiliation(s)
- B V Babu
- Epidemiology Division, Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, Orissa, India.
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Abstract
Lymphatic filariasis (LF) is a disease not just treatable or controllable; it is a disease that can be eliminated. Indeed, LF is currently the target of a major global initiative to do just that; a few visionaries of the past 50 years did hypothesize that LF elimination was feasible. However, for most of the scientific and global health communities, the elimination of such a broadly disseminated, mosquito-borne disease has seemed highly unlikely. During the past decade, however, both the treatment strategies and the control strategies for LF have undergone profound paradigm shifts-all because of a rapid increase in knowledge and understanding of LF that derived directly from a series of remarkable achievements by the scientific and medical research communities. As a result, a public health dimension with a focus on affected populations, now supplements the earlier, predominantly patient-oriented clinical approach to LF. The early uncertainties, then the essential steps leading to this change in outlook are outlined below, followed by descriptions of the new strategy for LF elimination, the Global Programme created to attain this goal and the successes achieved to date.
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Affiliation(s)
- Eric A Ottesen
- Lymphatic Filariasis Support Centre, The Task Force for Child Survival and Development, 750 Commerce Drive Decatur, GA 30030, USA
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