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Barrett C, Chiphwanya J, Mkwanda S, Matipula DE, Ndhlovu P, Chaponda L, Turner JD, Giorgi E, Betts H, Martindale S, Taylor MJ, Read JM, Kelly-Hope LA. The national distribution of lymphatic filariasis cases in Malawi using patient mapping and geostatistical modelling. PLoS Negl Trop Dis 2024; 18:e0012056. [PMID: 38527064 PMCID: PMC11018277 DOI: 10.1371/journal.pntd.0012056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/15/2024] [Accepted: 03/10/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND In 2020 the World Health Organization (WHO) declared that Malawi had successfully eliminated lymphatic filariasis (LF) as a public health problem. Understanding clinical case distributions at a national and sub-national level is important, so essential care packages can be provided to individuals living with LF symptoms. This study aimed to develop a national database and map of LF clinical cases across Malawi using geostatistical modelling approaches, programme-identified clinical cases, antigenaemia prevalence and climate information. METHODOLOGY LF clinical cases identified through programme house-to-house surveys across 90 sub-district administrative boundaries (Traditional Authority (TA)) and antigenaemia prevalence from 57 sampled villages in Malawi were used in a two-step geostatistical modelling process to predict LF clinical cases across all TAs of the country. First, we modelled antigenaemia prevalence in relation to climate covariates to predict nationwide antigenaemia prevalence. Second, we modelled clinical cases for unmapped TAs based on our antigenaemia prevalence spatial estimates. PRINCIPLE FINDINGS The models estimated 20,938 (95% CrI 18,091 to 24,071) clinical cases in unmapped TAs (70.3%) in addition to the 8,856 (29.7%), programme-identified cases in mapped TAs. In total, the overall national number of LF clinical cases was estimated to be 29,794 (95% CrI 26,957 to 32,927). The antigenaemia prevalence and clinical case mapping and modelling found the highest burden of disease in Chikwawa and Nsanje districts in the Southern Region and Karonga district in the Northern Region of the country. CONCLUSIONS The models presented in this study have facilitated the development of the first national LF clinical case database and map in Malawi, the first endemic country in sub-Saharan Africa. It highlights the value of using existing LF antigenaemia prevalence and clinical case data together with modelling approaches to produce estimates that may be used for the WHO dossier requirements, to help target limited resources and implement long-term health strategies.
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Affiliation(s)
- Carrie Barrett
- Centre for Neglected Tropical Disease, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - John Chiphwanya
- National Lymphatic Filariasis Elimination Programme, Ministry of Health, Lilongwe, Malawi
| | - Square Mkwanda
- National Lymphatic Filariasis Elimination Programme, Ministry of Health, Lilongwe, Malawi
| | - Dorothy E. Matipula
- National Lymphatic Filariasis Elimination Programme, Ministry of Health, Lilongwe, Malawi
| | - Paul Ndhlovu
- National Lymphatic Filariasis Elimination Programme, Ministry of Health, Lilongwe, Malawi
| | - Limbikani Chaponda
- National Lymphatic Filariasis Elimination Programme, Ministry of Health, Lilongwe, Malawi
| | - Joseph D. Turner
- Centre for Neglected Tropical Disease, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Emanuele Giorgi
- Lancaster Medical School, South West Drive, Bailrigg, Lancaster, United Kingdom
| | - Hannah Betts
- Centre for Neglected Tropical Disease, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Sarah Martindale
- Centre for Neglected Tropical Disease, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Mark J. Taylor
- Centre for Neglected Tropical Disease, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
| | - Jonathan M. Read
- Lancaster Medical School, South West Drive, Bailrigg, Lancaster, United Kingdom
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Disease, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
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Chiphwanya J, Mkwanda S, Kabuluzi S, Mzilahowa T, Ngwira B, Matipula DE, Chaponda L, Ndhlova P, Katchika P, Mahebere Chirambo C, Moses P, Kumala J, Chiumia M, Barrett C, Betts H, Fahy J, Rebollo Polo M, Reimer L, Stanton MC, Thomas B, Freer S, Molyneux DH, Bockarie MJ, Mackenzie CD, Taylor MJ, Martindale S, Kelly-Hope LA. Elimination of lymphatic filariasis as a public health problem in Malawi. PLoS Negl Trop Dis 2024; 18:e0011957. [PMID: 38363794 PMCID: PMC10903958 DOI: 10.1371/journal.pntd.0011957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/29/2024] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is a parasitic disease transmitted by mosquitoes, causing severe pain, disfiguring, and disabling clinical conditions such as lymphoedema and hydrocoele. LF is a global public health problem affecting 72 countries, primarily in Africa and Asia. Since 2000, the World Health Organization (WHO) has led the Global Programme to Eliminate Lymphatic Filariasis (GPELF) to support all endemic regions. This paper focuses on the achievements of the Malawi LF Elimination Programme between 2000 and 2020 to eliminate LF as a public health problem, making it the second sub-Saharan country to receive validation from the WHO. METHODOLOGY/PRINCIPAL FINDINGS The Malawi LF Programme addressed the widespread prevalence of LF infection and disease across the country, using the recommended WHO GPELF strategies and operational research initiatives in collaboration with key national and international partners. First, to stop the spread of infection (i.e., interrupt transmission) and reduce the circulating filarial antigen prevalence from as high as 74.4% to below the critical threshold of 1-2% prevalence, mass drug administration (MDA) using a two-drug regime was implemented at high coverage rates (>65%) of the total population, with supplementary interventions from other programmes (e.g., malaria vector control). The decline in prevalence was monitored and confirmed over time using several impact assessment and post-treatment surveillance tools including the standard sentinel site, spot check, and transmission assessment surveys and alternative integrated, hotspot, and easy-access group surveys. Second, to alleviate suffering of the affected populations (i.e., control morbidity) the morbidity management and disability prevention (MMDP) package of care was implemented. Specifically, clinical case estimates were obtained via house-to-house patient searching activities; health personnel and patients were trained in self-care protocols for lymphoedema and/or referrals to hospitals for hydrocoele surgery; and the readiness and quality of treatment and services were assessed with new survey tools. CONCLUSIONS Malawi's elimination of LF will ensure that future generations are not infected and suffer from the disfiguring and disabling disease. However, it will be critical that the Malawi LF Elimination programme remains vigilant, focussing on post-elimination surveillance and MMDP implementation and integration into routine health systems to support long-term sustainability and ongoing success. SUMMARY Lymphatic filariasis, also known as elephantiasis, is a disabling, disfiguring, and painful disease caused by a parasite that infected mosquitoes transmit to millions of people worldwide. Since 2000, the Global Programme to Eliminate Lymphatic Filariasis (GPELF) has supported endemic countries such as Malawi in south-eastern Africa, to eliminate the disease as a public health problem. The Malawi National LF Elimination Programme has worked tirelessly over the past two decades to implement the GPELF recommended strategies to interrupt the transmission with a two-drug regime, and to alleviate suffering in patients with lymphoedema and/or hydrocoele through morbidity management and disability prevention. Additionally, the LF Programme has collaborated with national and international stakeholders to implement a range of supplementary operational research projects to address outstanding knowledge gaps and programmatic barriers. In 2020, the World Health Organisation validated that Malawi had successfully eliminated LF as a public health problem, making it the second country in sub-Saharan Africa to achieve this, which is remarkable given that Malawi previously had very high infection rates. The LF Programme now remains vigilant, putting its efforts towards post-elimination surveillance and the continued implementation of care for patients with chronic conditions. Malawi's elimination of LF will ensure that future generations are not affected by this devastating disease.
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Affiliation(s)
| | | | | | - Themba Mzilahowa
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
- Centre for Health, Agriculture, Development Research, and Consulting, Blantyre, Malawi
| | - Bagrey Ngwira
- Centre for Health, Agriculture, Development Research, and Consulting, Blantyre, Malawi
| | | | | | | | | | | | - Philemon Moses
- Centre for Health, Agriculture, Development Research, and Consulting, Blantyre, Malawi
| | - Justin Kumala
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Martin Chiumia
- Malaria Alert Centre, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Carrie Barrett
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hannah Betts
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Joan Fahy
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Maria Rebollo Polo
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- World Health Organization, Geneva, Switzerland
| | - Lisa Reimer
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Michelle C. Stanton
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Brent Thomas
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sian Freer
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - David H. Molyneux
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Moses J. Bockarie
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Charles D. Mackenzie
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mark J. Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sarah Martindale
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
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Kini P, Wireko S, Osei‐Poku P, Asiedu SO, Amewu EKA, Asiedu E, Amanor E, Mensah C, Wilson MB, Larbi A, Boahen KG, Sylverken AA, Amato KR, Kwarteng A. Antibiotic resistance and mecA characterization of Staphylococcus hominis from filarial lymphedema patients in the Ahanta West District, Ghana: A cross-sectional study. Health Sci Rep 2023; 6:e1104. [PMID: 36778776 PMCID: PMC9904197 DOI: 10.1002/hsr2.1104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/10/2023] Open
Abstract
Background and Aim Filarial infections affect over 150 million people in the tropics. One of the major forms of filarial pathologies is lymphedema; a condition where the immune response is significantly altered, resulting in changes in the normal flora. Staphylococcus hominis, a human skin commensal, can also be pathogenic in immunocompromised individuals. Therefore, there is the possibility that S. hominis could assume a different behavior in filarial lymphedema patients. To this end, we investigated the levels of antibiotic resistance and extent of mecA gene carriage in S. hominis among individuals presenting with filarial lymphedema in rural Ghana. Method We recruited 160 individuals with stages I-VII lymphedema, in a cross-sectional study in the Ahanta West District of the Western Region of Ghana. Swabs from lymphedematous limb ulcers, pus, and cutaneous surfaces were cultured using standard culture-based techniques. The culture isolates were subjected to Matrix-Assisted Laser Desorption/Ionization Time of Flight (MALDI-TOF) mass spectrometry for bacterial identification. Antimicrobial susceptibility testing (AST) was performed using the Kirby-Bauer method. mecA genes were targeted by polymerase chain reaction for strains that were cefoxitin resistant. Results In all, 112 S. hominis were isolated. The AST results showed resistance to chloramphenicol (87.5%), tetracycline (83.3%), penicillin (79.2%), and trimethoprim/sulphamethoxazole (45.8%). Of the 112 strains of S. hominis, 51 (45.5%) were resistant to cefoxitin, and 37 (72.5%) of the cefoxitin-resistant S. hominis haboured the mecA gene. Conclusion This study indicates a heightened level of methicillin-resistant S. hominis isolated among filarial lymphedema patients. As a result, opportunistic infections of S. hominis among the already burdened filarial lymphedema patients in rural Ghana may have reduced treatment success with antibiotics.
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Affiliation(s)
- Priscilla Kini
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana,Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Solomon Wireko
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana,Department of Laboratory TechnologyKumasi Technical UniversityKumasiGhana
| | - Priscilla Osei‐Poku
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Samuel O. Asiedu
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana,Department of Theoretical and Applied Biology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Emmanuel K. A. Amewu
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ebenezer Asiedu
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ernest Amanor
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Caleb Mensah
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Mary B. Wilson
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana,Department of Biomedical EngineeringKoforidua Technical UniversityKoforiduaGhana
| | - Amma Larbi
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Kennedy G. Boahen
- Department of Clinical Microbiology, School of Medical SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Augustina A. Sylverken
- Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana,Department of Theoretical and Applied Biology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | | | - Alexander Kwarteng
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana,Kumasi Centre for Collaborative Research in Tropical MedicineKwame Nkrumah University of Science and TechnologyKumasiGhana
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Simpson H, Mengiste A, Mbonigaba JB, Kollie K, Nganda M, Dean L, Argaw D, Davey G, Semrau M. Research priorities to support the development of integrated national strategies to control skin-neglected tropical diseases. Trans R Soc Trop Med Hyg 2023; 117:132-138. [PMID: 36130404 PMCID: PMC9890312 DOI: 10.1093/trstmh/trac086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/04/2022] [Accepted: 08/25/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Skin-presenting neglected tropical diseases (skin-NTDs) impose large burdens on affected people, families and communities. The NTD Roadmap 2021-2030 presents a strategic plan to guide collaborative, multisectoral action to overcome these burdens, defining targets to control, eliminate and/or eradicate skin-NTDs by 2030. One of its targets is for 40 countries to adopt integrated skin-NTD strategies. Despite this high-level support for integration, only four countries were implementing integrated skin-NTD strategies in 2020. METHODS We hosted workshops at the 2021 annual meeting of the Coalition for Operational Research on NTDs, to discuss the operationalisation of Roadmap goals into national strategies and interventions for skin-NTD control. Speakers included NTD Programme Managers from NTD-endemic countries, technical experts and researchers of different aspects of skin-NTDs. RESULTS Challenges include community perceptions of interventions, demonstrating the cost-effectiveness of integrated care, availability and accessibility of community-based and primary healthcare services, the quality of data on skin-NTD morbidity and changes to operational structures required for integration. Research priorities included the identification of optimal case detection platforms, evaluation of integrated care, understanding the impacts of integration on community members and community health staff and development of point-of-care diagnostics. CONCLUSIONS The operational research priorities are intended to support the scale-up of integrated skin-NTDs programmes.
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Affiliation(s)
- Hope Simpson
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton BN1 9PX, UK.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Asrat Mengiste
- College of Health Sciences, Addis Ababa University, 2Q92+P2W, Addis Ababa, Ethiopia
| | - Jean Bosco Mbonigaba
- Rwanda Neglected Tropical Diseases Programme, Rwanda Biomedical Centre, Ministry of Health 23VV+3MM, Kigali, Rwanda
| | - Karsor Kollie
- Non Communicable and Neglected Tropical Disease Program in the Ministry of Health and Social Welfare, 8643+F7C, Monrovia, Liberia
| | - Motto Nganda
- Capacity Research Unit, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Laura Dean
- Capacity Research Unit, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Daniel Argaw
- Department of Control of Neglected Tropical Diseases, World Health Organization, 1211 Geneva, Switzerland
| | - Gail Davey
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
| | - Maya Semrau
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
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Simpson H, Konan DO, Brahima K, Koffi JD, Kashindi S, Edmiston M, Weiland S, Halliday K, Pullan RL, Meite A, Koudou BG, Timothy J. Effectiveness of community-based burden estimation to achieve elimination of lymphatic filariasis: A comparative cross-sectional investigation in Côte d'Ivoire. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000760. [PMID: 36962795 PMCID: PMC10022321 DOI: 10.1371/journal.pgph.0000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/23/2022] [Indexed: 11/19/2022]
Abstract
For lymphatic filariasis (LF) elimination, endemic countries must document the burden of LF morbidity (LFM). Community-based screening (CBS) is used to collect morbidity data, but evidence demonstrating its reliability is limited. Recent pilots of CBS for LFM alongside mass drug administration (MDA) in Côte d'Ivoire suggested low LFM prevalence (2.1-2.2 per 10,000). We estimated LFM prevalence in Bongouanou District, Côte d'Ivoire, using a comparative cross-sectional design. We compared CBS implemented independently of MDA, adapted from existing Ministry of Health protocols, to a population-based prevalence survey led by formally trained nurses. We evaluated the reliability of case identification, coverage, equity, and cost of CBS. CBS identified 87.4 cases of LFM per 10,000; the survey identified 47.5 (39.4-56.3; prevalence ratio [PR] 1.84; 95% CI 1.64-2.07). CBS identified 39.7 cases of suspect lymphoedema per 10,000; the survey confirmed 35.1 (29.2-41.5) filarial lymphoedema cases per 10,000 (PR 1.13 [0.98-1.31]). CBS identified 96.5 scrotal swellings per 10,000; the survey found 91.3 (83.2-99.8; PR 1.06 [0.93-1.21]); including 33.9 (27.7-38.8) filarial hydrocoele per 10,000 (PR of suspect to confirmed hydrocele 2.93 [2.46-3.55]). Positive predictive values for case identification through CBS were 65.0% (55.8-73.5%) for filarial lymphoedema; 93.7% (89.3-96.7%) for scrotal swellings; and 34.0% (27.3-41.2%) for filarial hydrocoele. Households of lower socioeconomic status and certain minority languages were at risk of exclusion. Direct financial costs were $0.17 per individual targeted and $69.62 per case confirmed. Our community-based approach to LFM burden estimation appears scalable and provided reliable prevalence estimates for LFM, scrotal swellings and LF-lymphoedema. The results represent a step-change improvement on CBS integrated with MDA, whilst remaining at programmatically feasible costs. Filarial hydrocoele cases were overestimated, attributable to the use of case definitions suitable for mass-screening by informal staff. Our findings are broadly applicable to countries aiming for LF elimination using CBS. The abstract is available in French in the S1 File.
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Affiliation(s)
- Hope Simpson
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Daniele O Konan
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Kouma Brahima
- Ministère de la Sante et de l'Hygiène Publique, Programme national de lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive (PNLMTN-CP) en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Jeanne d'Arc Koffi
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Saidi Kashindi
- American Leprosy Missions, Greenville, South Carolina, United States of America
- AIM Initiative, Accra, Ghana
| | - Melissa Edmiston
- American Leprosy Missions, Greenville, South Carolina, United States of America
- AIM Initiative, Accra, Ghana
| | - Stefanie Weiland
- American Leprosy Missions, Greenville, South Carolina, United States of America
- AIM Initiative, Accra, Ghana
| | - Katherine Halliday
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rachel L Pullan
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aboulaye Meite
- Ministère de la Sante et de l'Hygiène Publique, Programme national de lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive (PNLMTN-CP) en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | | | - Joseph Timothy
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Lama Yonzon C, Padmawati RS, Subedi RK, Paudel S, Ghimire A, Murhandarwati EH. Exploring determinants of hydrocele surgery coverage related to Lymphatic Filariasis in Nepal: An implementation research study. PLoS One 2021; 16:e0244664. [PMID: 33635870 PMCID: PMC7909642 DOI: 10.1371/journal.pone.0244664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/15/2020] [Indexed: 12/04/2022] Open
Abstract
Background Hydrocele is a chronic condition in males in which there is an excessive collection of straw-colored fluid, which leads to enlargement of the scrotum. It is a common manifestation of lymphatic filariasis (LF) affecting nearly 25 million men worldwide. Surgery is the recommended treatment for hydrocele and is available free of cost in all government hospitals in Nepal. This research explored patient, provider, and community factors related to accessing hydrocele surgery services by the patients. Methods This study employed a qualitative method. The research was conducted in two LF endemic districts, namely Kanchanpur and Dhading, which are reported to have the highest number of hydrocele cases during morbidity mapping conducted in 2016. In addition to five key informant interviews with the LF focal persons (one national and 4 district-level), nine in-depth interviews were conducted with hydrocele patients (5 of whom had undergone surgery and 4 who had not undergone surgery) and with 3 family members, and two focus group discussions with the female community health volunteers. Results Most of the respondents did not have knowledge of hydrocele as one of the clinical manifestations of LF nor that it is transmitted through a mosquito bite. Although perceived as treatable with surgery, most of the patients interviewed believed in as well as practiced home remedies. Meanwhile, fear of surgery, embarrassment, lack of money, along with no knowledge of the free hydrocele surgery acted as barriers for accessing the surgery. On the other hand, financial support, flexible guidelines enabling the hospital to conduct surgery, decentralization and scaling up of morbidity mapping along with free hydrocele surgery camps in any remaining endemic districts were identified as enablers for accessing surgery. Conclusion Hydrocele surgery coverage could be improved if the program further addresses community awareness. There is a need for more focus on information dissemination about hydrocele and hydrocele surgery.
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Affiliation(s)
- Choden Lama Yonzon
- Department of Health Behavior, Environment, and Social Medicine and Centre of Health Behavior and Promotion, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- * E-mail:
| | - Retna Siwi Padmawati
- Department of Health Behavior, Environment, and Social Medicine and Centre of Health Behavior and Promotion, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Sagun Paudel
- Department of Health Behavior, Environment, and Social Medicine and Centre of Health Behavior and Promotion, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ashmita Ghimire
- Department of Health Behavior, Environment, and Social Medicine and Centre of Health Behavior and Promotion, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Elsa Herdiana Murhandarwati
- Postgraduate Program of Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Morbidity management and surveillance of lymphatic filariasis disease and acute dermatolymphangioadenitis attacks using a mobile phone-based tool by community health volunteers in Ghana. PLoS Negl Trop Dis 2020; 14:e0008839. [PMID: 33180780 PMCID: PMC7685506 DOI: 10.1371/journal.pntd.0008839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/24/2020] [Accepted: 10/01/2020] [Indexed: 11/19/2022] Open
Abstract
Morbidity burden of lymphatic filariasis (LF) relies on the information from the Mass Drug Administration (MDA) programme where Community Health Volunteers (CHVs) passively report cases identified. Consequently, the exact prevalence of morbidity cases is not always accurate. The use of mobile phone technology to report morbidity cases was piloted in Ghana using a text-based short messaging service (SMS) tool by CHVs. Though successful, illiterate CHVs could not effectively use the SMS tool. The aim of this study was to evaluate the use of a mobile phone-based Interactive Voice Response System (mIVRS) by CHVs in reporting LF morbidity cases and acute dermatolymphangioadenitis (ADLA) attacks in Ghana. The mIVRS was designed as a surveillance tool to capture LF data in Kassena Nankana Districts of Ghana. One hundred CHVs were trained to identify and report lymphedema and hydrocele cases as well as ADLA attacks by calling a hotline linked to the mIVRS. The system asked a series of questions about the disease condition. The ability of the CHV to report accurately was assessed and the data from the mIVRS were compared with the paper records from the CHVs and existing MDA programme records from the same communities and period. Higher numbers of lymphedema and hydrocele cases were recorded by the CHVs using the mIVRS (n = 590 and n = 103) compared to the paper-based reporting (n = 417 and n = 76) and the MDA records (n = 154 and n = 84). Female CHVs, CHVs above 40 years, and CHVs with higher educational levels were better at paper-based reporting (P = 0.007, P = 0.001, P = 0.049 respectively). The system, when fully developed and linked to national databases, may help to overcome underreporting of morbidity cases and ADLA attacks in endemic communities. The system has the potential to be further expanded to other diseases. The goal towards the elimination of lymphatic filariasis as indicated by Global Programme to Eliminate Lymphatic Filariasis (GPELF) is to identify persons with morbidity such as lymphedema and hydrocele and manage their condition to make their lives better. Patients who experience acute attacks also need to be identified and given help or treatment. The number of lymphedema and hydrocele patients in lymphatic filariasis endemic communities are usually underreported. This consequently affects their management. Therefore, an innovative tool such as a mobile phone-based interactive voice response system (mIVRS) that can give accurate information on morbidity cases in real time and also reduce the underreporting of cases is needed. In this study, more morbidity cases and more acute attacks were reported using mIVRS than with the traditional methods. If implemented, this innovative method of reporting cases and acute attacks may help programme managers to ensure that the patients are identified to receive care. It can also be extended to other infectious and non-infectious diseases.
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Karim MJ, Haq R, Mableson HE, Sultan Mahmood ASM, Rahman M, Chowdhury SM, Rahman AKMF, Hafiz I, Betts H, Mackenzie C, Taylor MJ, Kelly-Hope LA. Developing the first national database and map of lymphatic filariasis clinical cases in Bangladesh: Another step closer to the elimination goals. PLoS Negl Trop Dis 2019; 13:e0007542. [PMID: 31306409 PMCID: PMC6658114 DOI: 10.1371/journal.pntd.0007542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/25/2019] [Accepted: 06/11/2019] [Indexed: 11/18/2022] Open
Abstract
Background The Bangladesh Lymphatic Filariasis (LF) Elimination Programme has made significant progress in interrupting transmission through mass drug administration (MDA) and has now focussed its efforts on scaling up managing morbidity and preventing disability (MMDP) activities to deliver the minimum package of care to people affected by LF clinical conditions. This paper highlights the Bangladesh LF Programme’s success in conducting a large-scale cross-sectional survey to determine the number of people affected by lymphoedema and hydrocoele, which enabled clinical risk maps to be developed for targeted interventions across the 34 endemic districts (19 high endemic; 15 low endemic). Methodology/Principal findings In the 19 high endemic districts, 8,145 community clinic staff were trained to identify and report patients in their catchment area. In the 15 low endemic districts, a team of 10 trained field assistants conducted active case finding with cases reported via a SMS mHealth tool. Disease burden and prevalence maps were developed, with morbidity hotspots identified at sub-district level based on a combination of the highest prevalence rates per 100,000 and case-density rates per square kilometre (km2). The relationship between morbidity and baseline microfilaria (mf) prevalence was also examined. In total 43,678 cases were identified in the 19 high endemic districts; 30,616 limb lymphoedema (70.1%; female 55.3%), 12,824 hydrocoele (29.4%), and 238 breast/female genital swelling (0.5%). Rangpur Division reported the highest cases numbers and prevalence of lymphoedema (26,781 cases, 195 per 100,000) and hydrocoele (11661 cases, 169.6 per 100,000), with lymphoedema predominately affecting females (n = 21,652). Rangpur and Lalmonirhat Districts reported the highest case numbers (n = 11,199), and prevalence (569 per 100,000) respectively, with five overlapping lymphoedema and hydrocoele sub-district hotspots. In the 15 low endemic districts, 732 cases were identified; 661 lymphoedema (90.2%; female 39.6%), 56 hydrocoele (7.8%), and 15 both conditions (2.0%). Spearman’s correlation analysis found morbidity and mf prevalence significantly positively correlated (r = 0.904; p<0.01). Conclusions/Significance The Bangladesh LF Programme has developed one of the largest, most comprehensive country databases on LF clinical conditions in the world. It provides an essential database for health workers to identify local morbidity hotspots, deliver the minimum package of care, and address the dossier elimination requirements. The Global Programme to Eliminate Lymphatic Filariasis (GPELF) requires lymphatic filariasis (LF) endemic countries, such as Bangladesh, to estimate the number of lymphoedema and hydrocoele cases in order to deliver the minimum package of care required to control morbidity and reduce patient suffering. This paper highlights the Bangladesh LF Elimination Programme’s progress in training more than 8000 community health workers to identify more than 44,000 cases across 34 endemic districts where approximately 70 million people are at risk. The morbidity data collected enabled the creation of a national database and a series of risk maps of lymphoedema and hydrocoele to be developed, which highlighted the significant burden in northern Rangpur Division, especially of lymphoedema among female patients. The Bangladesh LF Elimination Programme’s efforts to identify LF cases across all endemic districts represents one of the most comprehensive national databases on LF clinical cases in the world. It provides an informative database for health workers to use in the delivery of the minimum package of care and a template for other countries to adopt and develop national strategies to manage morbidity and prevent disability as recommended by GPELF.
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Affiliation(s)
- Mohammad J. Karim
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
- * E-mail: (MJK); (LAK)
| | - Rouseli Haq
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Hayley E. Mableson
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - A. S. M. Sultan Mahmood
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Mujibur Rahman
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | | | | | - Israt Hafiz
- Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Hannah Betts
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Charles Mackenzie
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mark J. Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail: (MJK); (LAK)
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Srividya A, Subramanian S, Jambulingam P, Vijayakumar B, Dinesh Raja J. Mapping and monitoring for a lymphatic filariasis elimination program: a systematic review. Res Rep Trop Med 2019; 10:43-90. [PMID: 31239804 PMCID: PMC6554002 DOI: 10.2147/rrtm.s134186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/02/2019] [Indexed: 11/23/2022] Open
Abstract
Lymphatic filariasis (LF) is targeted for elimination by the year 2020. The Global Programme for Elimination of LF (GPELF) aims to achieve elimination by interrupting transmission through annual mass drug administration (MDA) of albendazole with ivermectin or diethylcarbamazine. The program has successfully eliminated the disease in 11 of the 72 endemic countries, putting in enormous efforts on systematic planning and implementation of the strategy. Mapping areas endemic for LF is a pre-requisite for implementing MDA, monitoring and evaluation are the components of programme implementation. This review was undertaken to assess how the mapping and impact monitoring activities have evolved to become more robust over the years and steered the LF elimination programme towards its goal. The findings showed that the WHO recommended mapping strategy aided 17 countries to delimit, plan and implement MDA in only those areas endemic for LF thereby saving resources. Availability of serological tools for detecting infection in humans (antigen/antibody assays) and molecular xenomonitoring (MX) in vectors greatly facilitated programme monitoring and evaluation in endemic countries. Results of this review are discussed on how these existing mapping and monitoring procedures can be used for re-mapping of unsurveyed and uncertain areas to ensure there is no resurgence during post-MDA surveillance. Further the appropriateness of the tests (Microfilaria (Mf)/antigenemia (Ag)/antibody(Ab) surveys in humans or MX of vectors for infection) used currently for post-MDA surveillance and their role in the development of a monitoring and evaluation strategy for the recently WHO recommended triple drug regimen in MDA for accelerated LF elimination are discussed.
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Affiliation(s)
- Adinarayanan Srividya
- Division of Epidemiology, Biostatistics and Operations Research, ICMR - Vector Control Research Centre, Puducherry, India
| | - Swaminathan Subramanian
- Division of Epidemiology, Biostatistics and Operations Research, ICMR - Vector Control Research Centre, Puducherry, India
| | - Purushothaman Jambulingam
- Division of Epidemiology, Biostatistics and Operations Research, ICMR - Vector Control Research Centre, Puducherry, India
| | - Balakrishnan Vijayakumar
- Division of Epidemiology, Biostatistics and Operations Research, ICMR - Vector Control Research Centre, Puducherry, India
| | - Jeyapal Dinesh Raja
- Division of Epidemiology, Biostatistics and Operations Research, ICMR - Vector Control Research Centre, Puducherry, India
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Kihembo C, Masiira B, Lali WZ, Matwale GK, Matovu JKB, Kaharuza F, Ario AR, Nabukenya I, Makumbi I, Musenero M, Zhu BP, Nanyunja M. Risk Factors for Podoconiosis: Kamwenge District, Western Uganda, September 2015. Am J Trop Med Hyg 2017; 96:1490-1496. [PMID: 28719274 DOI: 10.4269/ajtmh.16-0932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractPodoconiosis, a noninfectious elephantiasis, is a disabling neglected tropical disease. In August 2015, an elephantiasis case-cluster was reported in Kamwenge District, western Uganda. We investigated to identify the disease's nature and risk factors. We defined a suspected podoconiosis case as onset in a Kamwenge resident of bilateral asymmetrical lower limb swelling lasting ≥ 1 month, plus ≥ 1 of the following associated symptoms: skin itching, burning sensation, plantar edema, lymph ooze, prominent skin markings, rigid toes, or mossy papillomata. A probable case was a suspected case with negative microfilaria antigen immunochromatographic card test (ruling out filarial elephantiasis). We conducted active case-finding. In a case-control investigation, we tested the hypothesis that the disease was caused by prolonged foot skin exposure to irritant soils, using 40 probable case-persons and 80 asymptomatic village control-persons, individually matched by age and sex. We collected soil samples to characterize irritants. We identified 52 suspected (including 40 probable) cases with onset from 1980 to 2015. Prevalence rates increased with age; annual incidence (by reported onset of disease) was stable over time at 2.9/100,000. We found that 93% (37/40) of cases and 68% (54/80) of controls never wore shoes at work (Mantel-Haenszel odds ratio [ORMH] = 7.7; 95% [confidence interval] CI = 2.0-30); 80% (32/40) of cases and 49% (39/80) of controls never wore shoes at home (ORMH = 5.2; 95% CI = 1.8-15); and 70% (27/39) of cases and 44% (35/79) of controls washed feet at day end (versus immediately after work) (OR = 11; 95% CI = 2.1-56). Soil samples were characterized as rich black-red volcanic clays. In conclusion, this reported elephantiasis is podoconiosis associated with prolonged foot exposure to volcanic soil. We recommended foot hygiene and universal use of protective shoes.
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Affiliation(s)
- Christine Kihembo
- Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda.,Uganda Public Health Fellowship Program, Field Epidemiology Track, Kampala, Uganda
| | - Ben Masiira
- Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda.,Uganda Public Health Fellowship Program, Field Epidemiology Track, Kampala, Uganda
| | - William Z Lali
- World Health Organization Uganda Country Office, Kampala, Uganda
| | | | | | - Frank Kaharuza
- Makerere University School of Public Health, Kampala, Uganda
| | - Alex R Ario
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Kampala, Uganda
| | | | - Issa Makumbi
- Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda
| | - Monica Musenero
- Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda
| | - Bao-Ping Zhu
- U.S. Centers for Disease Control and Prevention, Kampala, Uganda
| | - Miriam Nanyunja
- World Health Organization Uganda Country Office, Kampala, Uganda
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Mableson HE, Martindale S, Stanton MC, Mackenzie C, Kelly-Hope LA. Community-based field implementation scenarios of a short message service reporting tool for lymphatic filariasis case estimates in Africa and Asia. Mhealth 2017; 3:28. [PMID: 28828375 PMCID: PMC5547175 DOI: 10.21037/mhealth.2017.06.06] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/20/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is a neglected tropical disease (NTD) targeted for global elimination by 2020. Currently there is considerable international effort to scale-up morbidity management activities in endemic countries, however there remains a need for rapid, cost-effective methods and adaptable tools for obtaining estimates of people presenting with clinical manifestations of LF, namely lymphoedema and hydrocele. The mHealth tool 'MeasureSMS-Morbidity' allows health workers in endemic areas to use their own mobile phones to send clinical information in a simple format using short message service (SMS). The experience gained through programmatic use of the tool in five endemic countries across a diversity of settings in Africa and Asia is used here to present implementation scenarios that are suitable for adapting the tool for use in a range of different programmatic, endemic, demographic and health system settings. METHODS A checklist of five key factors and sub-questions was used to determine and define specific community-based field implementation scenarios for using the MeasureSMS-Morbidity tool in a range of settings. These factors included: (I) tool feasibility (acceptability; community access and ownership); (II) LF endemicity (high; low prevalence); (III) population demography (urban; rural); (IV) health system structure (human resources; community access); and (V) integration with other diseases (co-endemicity). RESULTS Based on experiences in Bangladesh, Ethiopia, Malawi, Nepal and Tanzania, four implementation scenarios were identified as suitable for using the MeasureSMS-Morbidity tool for searching and reporting LF clinical case data across a range of programmatic, endemic, demographic and health system settings. These include: (I) urban, high endemic setting with two-tier reporting; (II) rural, high endemic setting with one-tier reporting; (III) rural, high endemic setting with two-tier reporting; and (IV) low-endemic, urban and rural setting with one-tier reporting. CONCLUSIONS A decision-making framework built from the key factors and questions, and the resulting four implementation scenarios is proposed as a means of using the MeasureSMS-Morbidity tool. This framework will help national LF programmes consider appropriate methods to implement a survey using this tool to improve estimates of the clinical burden of LF. Obtaining LF case estimates is a vital step towards the elimination of LF as a public health problem in endemic countries.
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Affiliation(s)
- Hayley E. Mableson
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Sarah Martindale
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Michelle C. Stanton
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Charles Mackenzie
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
- Michigan State University, East Lansing, MI 48824, USA
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
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Mwingira U, Chikawe M, Mandara WL, Mableson HE, Uisso C, Mremi I, Malishee A, Malecela M, Mackenzie CD, Kelly-Hope LA, Stanton MC. Lymphatic filariasis patient identification in a large urban area of Tanzania: An application of a community-led mHealth system. PLoS Negl Trop Dis 2017; 11:e0005748. [PMID: 28708825 PMCID: PMC5529014 DOI: 10.1371/journal.pntd.0005748] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 07/26/2017] [Accepted: 06/25/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is best known for the disabling and disfiguring clinical conditions that infected patients can develop; providing care for these individuals is a major goal of the Global Programme to Eliminate LF. Methods of locating these patients, knowing their true number and thus providing care for them, remains a challenge for national medical systems, particularly when the endemic zone is a large urban area. METHODOLOGY/PRINCIPLE FINDINGS A health community-led door-to-door survey approach using the SMS reporting tool MeasureSMS-Morbidity was used to rapidly collate and monitor data on LF patients in real-time (location, sex, age, clinical condition) in Dar es Salaam, Tanzania. Each stage of the phased study carried out in the three urban districts of city consisted of a training period, a patient identification and reporting period, and a data verification period, with refinements to the system being made after each phase. A total of 6889 patients were reported (133.6 per 100,000 population), of which 4169 were reported to have hydrocoele (80.9 per 100,000), 2251 lymphoedema-elephantiasis (LE) (43.7 per 100,000) and 469 with both conditions (9.1 per 100,000). Kinondoni had the highest number of reported patients in absolute terms (2846, 138.9 per 100,000), followed by Temeke (2550, 157.3 per 100,000) and Ilala (1493, 100.5 per 100,000). The number of hydrocoele patients was almost twice that of LE in all three districts. Severe LE patients accounted for approximately a quarter (26.9%) of those reported, with the number of acute attacks increasing with reported LE severity (1.34 in mild cases, 1.78 in moderate cases, 2.52 in severe). Verification checks supported these findings. CONCLUSIONS/SIGNIFICANCE This system of identifying, recording and mapping patients affected by LF greatly assists in planning, locating and prioritising, as well as initiating, appropriate morbidity management and disability prevention (MMDP) activities. The approach is a feasible framework that could be used in other large urban environments in the LF endemic areas.
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Affiliation(s)
- Upendo Mwingira
- Neglected Tropical Diseases Control Programme, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Maria Chikawe
- Neglected Tropical Diseases Control Programme, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Wilfred Lazarus Mandara
- Neglected Tropical Diseases Control Programme, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Hayley E. Mableson
- Centre for Neglected Tropical Diseases (CNTD), Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Cecilia Uisso
- Neglected Tropical Diseases Control Programme, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Irene Mremi
- Neglected Tropical Diseases Control Programme, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Alpha Malishee
- Neglected Tropical Diseases Control Programme, Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Mwele Malecela
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Charles D. Mackenzie
- Centre for Neglected Tropical Diseases (CNTD), Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Pathobiology and Diagnostic Investigation, Michigan State University, Michigan, United States of America
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases (CNTD), Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Michelle C. Stanton
- Centre for Neglected Tropical Diseases (CNTD), Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Stanton MC, Yamauchi M, Mkwanda SZ, Ndhlovu P, Matipula DE, Mackenzie C, Kelly-Hope LA. Measuring the physical and economic impact of filarial lymphoedema in Chikwawa district, Malawi: a case-control study. Infect Dis Poverty 2017; 6:28. [PMID: 28366168 PMCID: PMC5376674 DOI: 10.1186/s40249-017-0241-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 01/11/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is one of the primary causes of lymphoedema in sub-Saharan Africa, and has a significant impact on the quality of life (QoL) of those affected. In this paper we assess the relative impact of lymphoedema on mobility and income in Chikwawa district, Malawi. METHODS A random sample of 31 people with lymphoedema and 31 matched controls completed a QoL questionnaire from which both an overall and a mobility-specific score were calculated. Two mobility tests were undertaken, namely the 10 m walking test [10MWT] and timed up and go [TUG] test, and a subset of 10 cases-control pairs wore GPS data loggers for 3 weeks to measure their mobility in a more natural setting. Retrospective economic data was collected from all 31 case-control pairs, and each participant undertaking the GPS activity recorded daily earnings and health expenditure throughout the observation period. RESULTS Cases had a significantly poorer overall QoL (cases = 32.2, controls = 6.0, P < 0.01) and mobility-specific (cases = 43.1, controls = 7.4, P < 0.01) scores in comparison to controls. Cases were also significantly slower (P < 0.01) at completing the timed mobility tests, e.g. mean 10MWT speed of 0.83 m/s in comparison to 1.10 m/s for controls. An inconsistent relationship was observed between mobility-specific QoL scores and the timed test results for cases (10MWT correlation = -0.06, 95% CI = (-0.41, 0.30)), indicating that their perceived disability differed from their measured disability, whereas the results were consistent for controls (10MWT correlation = -0.61, 95% CI = (-0.79, -0.34)). GPS summaries indicated that cases generally walk shorter distances at slower speeds than control, covering a smaller geographical area (median area by kernel smoothing: cases = 1.25 km2, controls = 2.10 km2, P = 0.16). Cases reported earning less than half that earned by controls per week (cases = $0.70, controls = $1.86, P = 0.064), with a smaller proportion of their earnings (16% vs 22%, P = 0.461) being spent on healthcare. CONCLUSIONS Those affected by lymphoedema are at a clear disadvantage to their unaffected peers, experiencing a lower QoL as confirmed by both subjective and objective mobility measures, and lower income. This study also indicates that objective measures of mobility may be a useful supplement to self-assessed QoL questionnaires when assessing the future impact of lymphoedema management interventions.
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Affiliation(s)
- Michelle C Stanton
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Masato Yamauchi
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Paul Ndhlovu
- Chikwawa District Health Office, Chikwawa, Malawi
| | | | - Charles Mackenzie
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, USA
| | - Louise A Kelly-Hope
- Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
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Hafiz I, Graves P, Haq R, Flora MS, Kelly-Hope LA. Clinical case estimates of lymphatic filariasis in an endemic district of Bangladesh after a decade of mass drug administration. Trans R Soc Trop Med Hyg 2016; 109:700-9. [PMID: 26464232 DOI: 10.1093/trstmh/trv084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Bangladesh has a high burden of lymphatic filariasis (LF) disease. This survey estimated the current number of clinical cases in a historically endemic district after a decade of mass drug administration (MDA). METHODS A cluster survey was conducted in 30 villages of Nilphamari District. Ten households per village were randomly selected, and individuals with LF clinical conditions identified. Hydrocoele and lymphoedema (leg, arm, breast) cases were quantified and mapped, and differences by sex, age, severity of disease and episodes of acute dermatolymphangioadenitis attacks (ADLA) examined. RESULTS From 1242 surveyed >10 years old 55 individuals (4.4%) with LF clinical conditions were identified. Males were mostly affected by hydrocoeles, and females by leg lymphoedema. Higher prevalence and more advanced stages of disease were found in older age groups. CONCLUSIONS Overall low prevalence of severe clinical disease was found, which has positive implications for the elimination goal. Future planning of MMDP strategies will need to address the varying clinical conditions, severity of disease and impact of ADLAs affecting different sub-groups of the population. It will also be important to monitor for new cases, and examine the shift in age distribution of cases over time.
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Affiliation(s)
- Israt Hafiz
- Filarial Programmes Support Unit-Liverpool School of Tropical Medicine, Liverpool, UK
| | - Patricia Graves
- Australian Institute of Tropical Health and Medicine and College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia
| | - Rouseli Haq
- Filariasis Elimination Program, Directorate General of Health Services, Dhaka, Bangladesh
| | | | - Louise A Kelly-Hope
- Filarial Programmes Support Unit-Liverpool School of Tropical Medicine, Liverpool, UK Australian Institute of Tropical Health and Medicine and College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Australia
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Walsh V, Little K, Wiegand R, Rout J, Fox LM. Evaluating the Burden of Lymphedema Due to Lymphatic Filariasis in 2005 in Khurda District, Odisha State, India. PLoS Negl Trop Dis 2016; 10:e0004917. [PMID: 27548382 PMCID: PMC4993435 DOI: 10.1371/journal.pntd.0004917] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/21/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over 1.1 billion people worldwide are at risk for lymphatic filariasis (LF), and the global burden of LF-associated lymphedema is estimated at 16 million affected people, yet country-specific estimates are poor. METHODOLOGY/PRINCIPAL FINDINGS A house-to-house morbidity census was conducted to assess the burden and severity of lymphedema in a population of 1,298,576 persons living in the LF-endemic district of Khurda in Odisha State, India. The burden of lymphedema in Khurda is widespread geographically, and 1.3% (17,036) of the total population report lymphedema. 51.3% of the patients reporting lymphedema were female, mean age 49.4 years (1-99). Early lymphedema (Dreyer stages 1 & 2) was reported in two-thirds of the patients. Poisson regression analysis was conducted in order to determine risk factors for advanced lymphedema (Dreyer stages 4-7). Increasing age was significantly associated with advanced lymphedema, and persons 70 years and older had a prevalence three times greater than individuals ages 15-29 (aPR: 3.21, 95% CI 2.45, 4.21). The number of adenolymphangitis (ADL) episodes reported in the previous year was also significantly associated with advanced lymphedema (aPR 4.65, 95% CI 2.97-7.30). This analysis is one of the first to look at potential risk factors for advanced lymphedema using morbidity census data from an entire district in Odisha State, India. SIGNIFICANCE These data highlight the magnitude of lymphedema in LF-endemic areas and emphasize the need to develop robust estimates of numbers of individuals with lymphedema in order to identify the extent of lymphedema management services needed in these regions.
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Affiliation(s)
- Victoria Walsh
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kristen Little
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ryan Wiegand
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | | | - LeAnne M. Fox
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Stanton MC, Mkwanda SZ, Debrah AY, Batsa L, Biritwum NK, Hoerauf A, Cliffe M, Best A, Molineux A, Kelly-Hope LA. Developing a community-led SMS reporting tool for the rapid assessment of lymphatic filariasis morbidity burden: case studies from Malawi and Ghana. BMC Infect Dis 2015; 15:214. [PMID: 25981497 PMCID: PMC4455607 DOI: 10.1186/s12879-015-0946-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 05/06/2015] [Indexed: 11/10/2022] Open
Abstract
Background Lymphoedema and hydrocoele are the two most common clinical manifestations of lymphatic filariasis (LF). In order to effectively target morbidity management strategies, more information is rapidly needed on morbidity burden across all endemic countries. The purpose of this study was to develop and test an SMS tool (MeasureSMS) which enables trained community-based health workers to report basic information on all cases they identified. Methods The tool was trialled in Chikwawa district, Malawi and Ahanta West district, Ghana in 2014. Salaried health surveillance assistants (HSAs) identified and reported cases in Malawi whereas volunteer community health workers (CHWs) were used in Ghana. Health workers were trained in recognising lymphoedema and hydrocoeles and submitting individual case data using MeasureSMS, after which they undertook a LF morbidity survey. After the reporting period, a random sample of reported cases was visited by a physician to verify the health workers’ diagnoses. The proportion of correctly diagnosed cases i.e. the positive predictive value (PPV) was then calculated. Results HSAs in Malawi successfully reported 256 unique cases by SMS from 107 communities (166 hydrocoele, 88 lymphoedema, 2 with both), resulting in an estimated adult prevalence of 17.7 per 10,000 and 33.0 per 10,000 for lymphoedema and hydrocoele respectively. In Ghana, despite being less experienced in using SMS, CHWs successfully reported 360 unique cases by SMS from 33 communities (169 hydrocoele, 185 lymphoedema, 6 with both), resulting in an estimated adult prevalence of 76.9 per 10,000 and 70.5 per 10,000 adults for lymphoedema and hydrocoele respectively. The verification exercise resulted in a PPV for lymphoedema and hydrocoele diagnosis of 90 % (n = 42, 95 % CI 76.5 – 96.9) and 92 % (n = 49, 95 % CI 79.5 – 97.4) in Malawi and 94 % (n = 34, 95 % CI 78.9 %–99.0 %) and 47 % (n = 59, 35.1 %–61.7 %) in Ghana, indicating that non-invasive methods for diagnosing hydrocoeles needed to be further emphasised. Conclusions The study concludes that given the appropriate education and tools, community-based health workers are exceptionally well-placed to participate in quantifying LF morbidity burden, and other NTDs with observable symptoms. This concept has the potential to enable national programmes to more effectively monitor their community impact in an efficient, timely and cost-effective way. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0946-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle C Stanton
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Square Z Mkwanda
- National Lymphatic Filariasis Elimination Programme, Ministry of Health, Lilongwe, Malawi.
| | | | - Linda Batsa
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Nana-Kwadwo Biritwum
- National Neglected Tropical Diseases Programme, Ghana Health Service, Kumasi, Ghana.
| | | | - Matthew Cliffe
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Abigail Best
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.
| | | | - Louise A Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK.
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Becker SL, Fürst T, Addiss DG, Utzinger J. Assessing numbers and faces: a prerequisite for improving access to lymphatic filariasis morbidity care. Trans R Soc Trop Med Hyg 2015; 109:357-9. [PMID: 25778735 DOI: 10.1093/trstmh/trv022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 02/23/2015] [Indexed: 11/12/2022] Open
Abstract
Concerted efforts to eliminate lymphatic filariasis worldwide have registered success; multiple rounds of mass drug administration have led to the interruption of transmission in many previously endemic areas. However, the management of patients with established clinical disease (e.g., lymphoedema, hydrocoele and acute dermatolymphangioadenitis) has not been addressed sufficiently. Two recent studies from Malawi underscore the need for accurate epidemiological and clinical data, and comprehensive morbidity assessments across various domains of daily life. Addressing these issues will guide the implementation of programmes to improve access to treatment and disability prevention for affected individuals in Malawi and beyond.
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Affiliation(s)
- Sören L Becker
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland University of Basel, P.O. Box, CH-4003 Basel, Switzerland Institute of Medical Microbiology and Hygiene, Saarland University Medical Center, Kirrberger Straße, Building 43, D-66421 Homburg/Saar, Germany
| | - Thomas Fürst
- Centre for Health Policy and Department of Infectious Disease Epidemiology, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - David G Addiss
- Children Without Worms, Task Force for Global Health, 325 Swanton Way, Decatur, GA 30030, USA
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, CH-4002 Basel, Switzerland University of Basel, P.O. Box, CH-4003 Basel, Switzerland
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Stanton MC, Smith EL, Martindale S, Mkwanda SZ, Kelly-Hope LA. Exploring hydrocoele surgery accessibility and impact in a lymphatic filariasis endemic area of southern Malawi. Trans R Soc Trop Med Hyg 2015; 109:252-61. [PMID: 25673628 DOI: 10.1093/trstmh/trv009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hydrocoele surgery is the recommended treatment for the common clinical manifestation of lymphatic filariasis in men. This study determined the geographical differences in surgery accessibility, and improvements in the quality of life of patients in Chikwawa district, Malawi. METHODS Surgery records from Chikwawa District Hospital (CDH), between 2008 and 2013, were used to map surgery rates by village, spatial dependence by census enumeration area and relationship of distance (kilometres) to CDH. A subset of patients were selected to quantify and compare their physical and socio-economic well-being and level of disability pre- and post-surgery using a standardised questionnaire. RESULTS A total of 476 hydrocoele surgical cases were identified with 260 cases geo-referenced and mapped. A significant negative relationship between village-level surgery rates and distance to CDH (r=-0.137; 95% CI: -0.47 to -0.26) was found, and clusters of enumeration areas with high surgery rates identified around the CDH. Significant improvements in patients' ability to walk and work were found and the overall level of disability was reduced post-surgery. CONCLUSIONS Hydrocoele surgery positively impacted on patients, improving their physical and socio-economic output. Surgical services need to scale-up and expand to reach cases that have less access to the best treatment currently available.
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Affiliation(s)
- Michelle C Stanton
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Emma L Smith
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sarah Martindale
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Square Z Mkwanda
- Lymphatic Filariasis Elimination Programme, Ministry of Health, Lilongwe, Malawi
| | - Louise A Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, UK
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