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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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Barrett C, Chiphwanya J, Chaponda L, Matipula DE, Turner JD, Taylor MJ, Read JM, Kelly-Hope LA. Mental health conditions in people affected by filarial lymphoedema in Malawi: prevalence, associated risk factors and the impact of an enhanced self-care intervention. Int Health 2023; 15:iii14-iii27. [PMID: 38118160 PMCID: PMC10732670 DOI: 10.1093/inthealth/ihad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/18/2023] [Accepted: 09/05/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND This study aimed to determine the key mental health indicators affecting people affected by lymphatic filariasis (LF) lymphoedema by assessing the prevalence of depressive symptoms and quality of life (QOL), identifying associated sociodemographic and clinical risk factors, and evaluating the impact of an enhanced self-care intervention for lymphoedema management. METHODS A prospective cohort study of adults with filarial lymphoedema from two regions of Malawi was conducted over six months in 2021. Depressive symptoms and QOL were assessed using Patient Health Questionnaire (PHQ-9) and LF Specific QOL Questionnaire, respectively, at baseline (pre-intervention), 3- and 6-months (postintervention). Beta regression analysis identified risk factors, and assessed the impact of the intervention. RESULTS Three hundred eleven affected individuals were surveyed with 23% (95% CI 18%-29%) reporting mild/moderate depressive symptoms and 31% (95% CI 26%-37%) reporting moderately low/low QOL. Higher depressive symptom scores were associated with high frequency of acute filarial attack episodes. Individuals with higher depressive symptoms (Adjusted Odds Ratios (AOR) 0.93, 95% CI 0.93-0.93) and lower QOL (AOR 0.98, 0.98-0.98) showed greatest improvement in mental health indicators over 3-months but was not sustained to the same level at 6-months. CONCLUSIONS Sustained morbidity management and psychological support is recommended for affected persons to ensure long-term positive mental health and clinical outcomes. CONTEXTE Cette étude vise à déterminer les principaux indicateurs de santé mentale affectant les personnes atteintes de lymphœdème dû à la filariose lymphatique (FL) en évaluant la prévalence des symptômes dépressifs et la qualité de vie (QV), en identifiant les facteurs de risque sociodémographiques et cliniques associés, et en évaluant l'impact d'une intervention améliorée d'autosoins pour la gestion du lymphœdème. MÉTHODES Une étude de cohorte prospective d'adultes atteints de lymphoedème filaire dans deux régions du Malawi a été menée pendant six mois en 2021. Les symptômes dépressifs et la qualité de vie ont été évalués à l'aide du questionnaire sur la santé des patients (PHQ-9) et du questionnaire sur la qualité de vie spécifique au lymphœdème, respectivement, au début de l'étude (avant l'intervention), et à 3 puis 6 mois après l'intervention. Une analyse de régression beta a permis d'identifier les facteurs de risque et d'évaluer l'impact de l'intervention. RÉSULTATS Trois cent onze personnes affectées ont été interrogées, dont 23% (95% CI 18%-29%) ont déclaré des symptômes dépressifs légers/modérés et 31% (95% CI 26%-37%) ont déclaré une qualité de vie modérément faible/faible. Des scores élevés de symptômes dépressifs ont été associés à une fréquence élevée d'épisodes de crises filariennes aiguës. Les personnes présentant des symptômes dépressifs plus élevés (rapport de cotes ajusté (RCA) 0.93, IC à 95 % 0.93-0.93) et une qualité de vie plus faible (RCA 0.98, 0.98-0.98) ont montré la plus grande amélioration des indicateurs de santé mentale au cours des trois mois, mais cette amélioration ne s'est pas maintenue au même niveau au cours des six mois suivants. CONCLUSION Gestion de la morbidité et soutien psychologique sont des éléments clés pour garantir une santé mentale et des résultats cliniques satisfaisants de personnes atteintes sur le long terme. ANTECEDENTES Este estudio tuvo como objetivo determinar los indicadores clave de salud mental que afectan a las personas afectadas por linfedema por filariasis linfática (FL) mediante la evaluación de la prevalencia de síntomas depresivos y calidad de vida (CdV), la identificación de factores de riesgo sociodemográficos y clínicos asociados, y la evaluación del impacto de una intervención de autocuidado mejorada para el manejo del linfedema. MÉTODOS Se realizó un estudio prospectivo de cohortes de adultos con linfedema filarial de dos regiones de Malawi durante seis meses en 2021. Los síntomas depresivos y la calidad de vida se evaluaron mediante el Cuestionario de Salud del Paciente (PHQ-9) y el Cuestionario de Calidad de Vida específico para el LF Cuestionario, respectivamente, al inicio (preintervención) y a los 3 y 6 meses (posintervención). El análisis de regresión beta identificó los factores de riesgo y evaluó el impacto de la intervención. RESULTADOS Se encuestó a 311 afectados, de los cuales el 23% (IC 95%, 18%-29%) presentaba síntomas depresivos leves/moderados y el 31% (IC 95%, 26%-37%) una CdV moderadamente baja/baja CdV. Las puntuaciones más altas de síntomas depresivos se asociaron con una alta frecuencia de episodios de ataques agudos de filarias. Los individuos con mayores síntomas depresivos (Odds Ratios Ajustados [ORA] 0.93; IC 95%: 0.93-0.93) y menor CdV (ORA 0.98; 0.98-0.98) mostraron la mayor mejoría en los indicadores de salud mental a los 3 meses, pero no se mantuvo al mismo nivel a los 6 meses. CONCLUSIONES Se recomienda el manejo sostenido de la morbilidad y el apoyo psicológico a las personas afectadas para garantizar resultados clínicos y de salud mental positivos a largo plazo.
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Affiliation(s)
- Carrie Barrett
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - John Chiphwanya
- National Lymphatic Filariasis Elimination Programme, Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi
| | - Limbikani Chaponda
- National Lymphatic Filariasis Elimination Programme, Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi
| | - Dorothy E Matipula
- National Lymphatic Filariasis Elimination Programme, Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi
| | - Joseph D Turner
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Mark J Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Jonathan M Read
- Lancaster Medical School, South West Drive, Bailrigg, Lancaster, LA1 4ZP, UK
| | - Louise A Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, 146 Brownlow Hill, Liverpool, L3 5RF, UK
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An Ayurvedic approach to sustaining and pampering the feet of healthcare workers. JOURNAL OF INTERPROFESSIONAL EDUCATION & PRACTICE 2022; 29:100576. [PMID: 36440089 PMCID: PMC9676917 DOI: 10.1016/j.xjep.2022.100576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/26/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022]
Abstract
The COVID-19 pandemic caused imbalances in the lives of healthcare workers to a great degree, leading to long hours on the feet without time for sustained rest and rejuvenation. Ayurvedic wisdom provides a holistic lens from which to view the importance of footcare, which ultimately affects the systemic being. To reduce suffering on all levels, it is important to dedicate time, daily, to the use of doshic-specific self-care techniques. This article offers a daily footcare ritual in support of mind, body, and spiritual health through application of oiling, massage, gratitude, and a yoga-based inversion.
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Esubalew H, Wubie M, Tafere Y, Gietaneh W, Endalew B, Habtegiorgis SD, Gebre T, Tesfaw E, Abiy H, Telayneh AT. Self-Care Practice and Its Associated Factors Among Podoconiosis Patients in East Gojjam Zone, North West Ethiopia. Patient Prefer Adherence 2022; 16:1971-1981. [PMID: 35958889 PMCID: PMC9362903 DOI: 10.2147/ppa.s376557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Podoconiosis is endemic non-filarial elephantiasis of the lower legs swelling caused by barefoot exposure to red clay soil. The burden of disability occurs among the poorest populations. Self-care practice is the most cost-effective prevention strategy practiced at home to improve lymphedema, working functionality, and quality of life. Despite this, there is a scarce of knowledge about self-care practices and associated factors among podoconiosis patients in Ethiopia. OBJECTIVE To determine self-care practice and its associated factors among podoconiosis patients in East Gojjam zone North West, Ethiopia. METHODS Community-based cross-sectional study design was used among 633 podoconiosis patients. Computer-generated simple random sampling technique was used to recruit participants. All patients who started podoconiosis treatment were the source population. Data were entered using Epidata version 3.1 and exported to SPSS version 25 for cleaning and analysis. Variables with 95% CI corresponding AOR were used to identify statistically significant factors for self-care practice. RESULTS In this study, the self-care practice of podoconiosis patient was 64%. Females [AOR: 0.38 (95% CI: 0.22, 0.65)], 55-65 years age [AOR: 0.41 (95% CI: 0.22, 0.74)], above 65 years age [AOR: 0.22 (95% CI: 0.11, 0.450)], 4-6 km distance from water source [AOR: 0.06 (95% CI: 0.03, 0.12)], above 6 km distance from water source [AOR: 0.03 (95% CI: 0.01, 0.09)], educational level [AOR: 0.05 (95% CI: 0.01, 0.40)], marital status [AOR: 5.40 (95% CI: 2.30, 12.90)], and distance from health institution [AOR: 0.35 (95% CI: 0.23, 0.54)] were statistically identified associated factors for self-care practice of podoconiosis patient. CONCLUSION In this study, the self-care practice of podoconiosis patients was not well practiced. Socio-demographic factors are identified as associated factors for self-care practice. Strengthening health education and behavioral changes are required to improve self-care practice.
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Affiliation(s)
| | - Moges Wubie
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Yilkal Tafere
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Wodaje Gietaneh
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Bekalu Endalew
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | | | - Tsige Gebre
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Eyerus Tesfaw
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Hailemariam Abiy
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Animut Takele Telayneh
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- Correspondence: Animut Takele Telayneh, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia, Tel +251918215993, Email
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Bergmann A, Baiocchi JMT, de Andrade MFC. Conservative treatment of lymphedema: the state of the art. J Vasc Bras 2021; 20:e20200091. [PMID: 34777487 PMCID: PMC8565523 DOI: 10.1590/1677-5449.200091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/08/2020] [Indexed: 11/22/2022] Open
Abstract
This article aims to discuss the possibilities of conservative and non-pharmacological treatments for lymphedema. A non-systematic review of the literature was carried out, including studies involving human subjects with different types of lymphedema. Several approaches to lymphedema treatment have been reported and Complex Decongestive Therapy (CDT) has been considered the most effective treatment for limb lymphedema. Other conservative treatments have been proposed such as Taping, Extracorporeal Shock Wave Therapy, Acupuncture, Photobiomodulation Therapy, Endermologie, Intermittent Pneumatic Compression, and Low-frequency, Low-intensity Electrotherapy. The choice of the therapeutic approach to be employed should consider lymphedema characteristics, the therapist's experience, and the patient's wishes. In addition, since this is a chronic condition, the patient must adhere to the treatment. To this end, the therapeutic proposal may be the key to better control of limb volume.
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Affiliation(s)
- Anke Bergmann
- Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brasil
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Shetye JV, Jain AS, Kachpile ST, Patil EN. A model for self-management of chronic filarial lymphoedema with acute dermato-lymphangio-adenitis. BMJ Case Rep 2021; 14:e244721. [PMID: 34772676 PMCID: PMC8593613 DOI: 10.1136/bcr-2021-244721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 11/04/2022] Open
Abstract
Secondary lymphoedema due to filariasis is a leading cause of morbidity in India. We present a case of a 54-year-old female with lymphatic filariasis for 18 years, with three to four episodes of acute dermato-lymphangio-adenitis (ADLA) every year. The patient had voluntarily restricted social interaction and community participation. A combination of interventions provided in 17 physiotherapy sessions over a period of 20 days showed notable improvement, by reducing limb volume and ADLA episodes and by improving limb shape, functional capacity and quality of life. Interventions included aerobic exercise, decongestion therapy with faradism under pressure and exercises with elevation. This gain was maintained throughout the 8 months of the pandemic. Patient education and counselling along with home programme of self-bandaging and self-limb hygiene played a major role in the recovery of the patient. Self-reliance in management was important because of the pandemic, which restricted the patient from attending the outpatient department.
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Affiliation(s)
- Jaimala Vijay Shetye
- Physiotherapy School & Center, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Anjali Suresh Jain
- Physiotherapy School & Center, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Sheral Thomas Kachpile
- Physiotherapy School & Center, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Ekta Nitin Patil
- Physiotherapy School & Center, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Dellar R, Ali O, Kinfe M, Tesfaye A, Fekadu A, Davey G, Semrau M, Bremner S. Knowledge, attitudes and practices of health professionals towards people living with lymphoedema caused by lymphatic filariasis, podoconiosis and leprosy in northern Ethiopia. Int Health 2021; 14:530-536. [PMID: 34634104 PMCID: PMC9450644 DOI: 10.1093/inthealth/ihab067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/12/2021] [Accepted: 09/23/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Podoconiosis, lymphatic filariasis and leprosy are highly stigmatised neglected tropical diseases that cause lymphoedema. Their enormous impacts on health-related quality of life, mental health and economic productivity can be significantly reduced by morbidity management and disability prevention (MMDP) services, but to deliver such services requires appropriate training of healthcare professionals. The aim of this study was to assess the knowledge, attitudes and practices (KAP) of rural Ethiopian healthcare professionals towards people with lymphoedema as a way to assess training needs. METHODS This study used questionnaires to quantitatively assess KAP towards people with lymphoedema among rural healthcare professionals in northwest Ethiopia before and 12 months after a short training intervention. RESULTS Questionnaires were administered to 14 health professionals at baseline and 21 at follow-up. At baseline, 71% (10/14) were found to hold at least one stigmatising attitude towards lymphoedema patients, compared with 66% (14/21) at follow-up. Large gaps in knowledge were noted, with many unable to identify ways of treating/preventing the diseases. CONCLUSIONS This study showed high proportions of healthcare workers holding stigmatising views and lacking essential knowledge about lymphoedema. To maximise the impact of MMDP interventions, further research is urgently needed to understand how to address these issues.
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Affiliation(s)
- Rachael Dellar
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Oumer Ali
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Mersha Kinfe
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraham Tesfaye
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maya Semrau
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Stephen Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
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Douglass J, Martindale S, Mableson H, Jhara ST, Karim MJ, Rahman MM, Kawsar AA, Khair A, Mahmood ASMS, Rahman AKMF, Chowdhury SM, Hailekiros F, Tamiru M, Seife F, Bishaw T, Nigussie M, Meribo K, Agidew G, Betts H, Taylor MJ, Kelly-Hope LA. Insights on Lymphedema Self-Care Knowledge and Practice in Filariasis and Podoconiosis-Endemic Communities in Bangladesh and Ethiopia. FRONTIERS IN TROPICAL DISEASES 2021. [DOI: 10.3389/fitd.2021.767045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Lymphedema is a life-long sequelae to several neglected tropical diseases (NTD). In Bangladesh the main cause is lymphatic filariasis (LF) and Ethiopia is endemic for both LF and podoconiosis. The World Health Organization (WHO) recommends daily self-care including meticulous washing and drying of affected skin and attention to entry lesions, limb exercises and elevation. Adherence to this regime reduces secondary infections which cause disabling episodes of acute dermato-lymphangitis (ADL). Self-care practices must be integrated into family life, supported by community and monitored by health staff; however, little is known about the influence of personal and socio-demographic factors on adherence. People affected by lymphedema (n=272), adult caregivers (n=272), and health workers (n=68) in Bangladesh and Ethiopia were trained in lymphedema management according to WHO recommendations. Surveys on the causes and management of lymphedema were collected at baseline and 24-weeks, and patients completed a daily journal of self-care activities and symptoms. At baseline knowledge on causes and management of lymphedema was greater among health workers (>70%) than patients and caregivers (<20%) in both countries, and there were significant between-country differences in patient reported use of limb washing (Bangladesh = 7.7%. Ethiopia = 51.1%, p = 0.001). At 24-weeks knowledge on lymphedema causes and management had increased significantly among patients and caregivers, there was <70% adherence to limb washing and exercises, but lesser use of limb elevation in both countries. A range of patient characteristics were associated with significant variation in self-care, except for limb washing. Performance of fewer leg exercises was significantly associated with increased age or severe lymphedema in Bangladesh, and with being female or in paid work in Ethiopia. Patient journals recorded ADL symptoms and working days lost due to lymphedema more frequently than were reported by recall during the 24-week survey. Core elements of lymphedema self-care education, training and monitoring are the same for multiple etiologies. This creates opportunities for cross-cutting implementation of integrated service delivery across several skin NTDs. Sustainability will depend on community level ownership and research on factors affecting adherence to lymphedema self-care are urgently needed.
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Infrared Thermal Imaging as a Novel Non-Invasive Point-of-Care Tool to Assess Filarial Lymphoedema. J Clin Med 2021; 10:jcm10112301. [PMID: 34070599 PMCID: PMC8198125 DOI: 10.3390/jcm10112301] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 12/13/2022] Open
Abstract
Lymphatic filariasis causes disfiguring and disabling lymphoedema, which is commonly and frequently exacerbated by acute dermatolymphangioadenitis (ADLA). Affected people require long-term care and monitoring but health workers lack objective assessment tools. We examine the use of an infrared thermal imaging camera as a novel non-invasive point-of-care tool for filarial lower-limb lymphoedema in 153 affected adults from a highly endemic area of Bangladesh. Temperature differences by lymphoedema stage (mild, moderate, severe) and ADLA history were visualised and quantified using descriptive statistics and regression models. Temperatures were found to increase by severity and captured subclinical differences between no lymphoedema and mild lymphoedema, and differences between moderate and severe stages. Toes and ankle temperatures detected significant differences between all stages other than between mild and moderate stages. Significantly higher temperatures, best captured by heel and calf measures, were found in participants with a history of ADLA, compared to participants who never had ADLA, regardless of the lymphoedema stage. This novel tool has great potential to be used by health workers to detect subclinical cases, predict progression of disease and ADLA status, and monitor pathological tissue changes and stage severity following enhanced care packages or other interventions in people affected by lymphoedema.
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Kapa DR, Mohamed AJ. Progress and impact of 20 years of a lymphatic filariasis elimination programme in South-East Asia. Int Health 2021; 13:S17-S21. [PMID: 33349881 PMCID: PMC7753165 DOI: 10.1093/inthealth/ihaa056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/21/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023] Open
Abstract
Background The South-East Asia regional programme to eliminate lymphatic filariasis (LF) was launched in 2000. This study presents the progress and impact of the programme in the region. Methods Mass drug administration (MDA) and morbidity management data were accessed from the WHO preventive chemotherapy databank. The status of the programme in the nine South-East Asia countries was reviewed and progress was assessed. The impact of the programme on LF disease burden was estimated on the basis of the effectiveness of the MDA drugs against microfilaraemia and chronic disease. Results Under the MDA programme, 8.1 billion treatments were delivered in nine countries and 5.7 billion treatments were consumed by the target population during 2001–2018. Three of nine countries eliminated LF. Bangladesh is poised to reach its elimination goal by 2021. In the other five countries, 38–76% of intervention units completed intervention and surveillance is in progress. The MDA programme prevented or cured 74.9 million infections, equivalent to an 84.2% reduction. Close to 1 million lymphoedema patients and 0.5 million hydrocele patients were reported and are being provided with the minimum package of care. Conclusions The South-East Asia region's LF elimination programme reduced the burden of LF appreciably and is moving towards achieving the elimination goal in the next 8–10 y.
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Affiliation(s)
| | - Ahmed Jamsheed Mohamed
- Depa rtment of Communicable Diseases, WHO Regional Office for South-East Asia, New Delhi 110002, India
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Atinbire SA, Marfo B, Alomatu B, Ahorlu C, Saunderson P, Weiland S. The development of a capacity-strengthening program to promote self-care practices among people with lymphatic filariasis-related lymphedema in the Upper West Region of Ghana. Infect Dis Poverty 2021; 10:64. [PMID: 33962684 PMCID: PMC8103668 DOI: 10.1186/s40249-021-00846-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Upper West region of Ghana is mostly made up of rural communities and is highly endemic for lymphatic filariasis (LF), with a significant burden of disability due to lymphedema and hydrocele. The aim of this paper is to describe an enhanced, evidence-based cascading training program for integrated lymphedema management in this region, and to present some initial outcomes. MAIN TEXT A baseline evaluation in the Upper West Region was carried out in 2019. A cascaded training program was designed and implemented, followed by a roll-out of self-care activities in all 72 sub-districts of the Upper West Region. A post implementation evaluation in 2020 showed that patients practiced self-care more frequently and with more correct techniques than before the training program; they were supported in this by health staff and family members. CONCLUSIONS Self-care for lymphedema is feasible and a program of short workshops in this cascaded training program led to significant improvements. Efforts to maintain momentum and sustain what has been achieved so far, will include regular training and supervision to improve coverage, the provision of adequate resources for limb care at home, and the maintenance of district registers of lymphedema cases, which must be updated regularly.
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Affiliation(s)
| | | | | | - Collins Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Paul Saunderson
- AIM Initiative-American Leprosy Missions, Greenville, SC, USA
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Douglass J, Hailekiros F, Martindale S, Mableson H, Seife F, Bishaw T, Nigussie M, Meribo K, Tamiru M, Agidew G, Kim S, Betts H, Taylor M, Kelly-Hope L. Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial. J Clin Med 2020; 9:jcm9124077. [PMID: 33348721 PMCID: PMC7766500 DOI: 10.3390/jcm9124077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 01/13/2023] Open
Abstract
Lymphedema causes disability and exacerbates poverty in many countries. The management of lymphatic filariasis (LF) and podoconiosis-related lymphedema involves daily hygiene to reduce secondary infections, but self-massage and deep-breathing, which have proven beneficial in cancer-related lymphedema, are not included. A cluster randomized trial in northern Ethiopia investigated the effects of lymphatic stimulation for people affected by moderate to severe lymphedema. Participants were allocated to either standard (control n = 59) or enhanced (intervention n = 67) self-care groups. Primary outcomes were lymphedema stage, mid-calf circumference, and tissue compressibility. Secondary outcomes were the frequency and duration of acute attacks. After 24 weeks, fewer patients were assessed as severe (control −37.8%, intervention −42.4%, p = 0.15) and there were clinically relevant changes in mid-calf tissue compressibility but not circumference. There was a significant between-group difference in patients who reported any acute attacks over the study period (control n = 22 (38%), intervention n = 7 (12%), p = 0.014). Daily lymphedema self-care resulted in meaningful benefits for all participants with a greater reduction in acute episodes among people performing lymphatic stimulation. Observations of a change in lymphedema status support earlier findings in Bangladesh and extend the demonstrated benefits of enhanced self-care to people affected by podoconiosis.
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Affiliation(s)
- Jan Douglass
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (S.M.); (H.M.); (H.B.); (M.T.); (L.K.-H.)
- Correspondence:
| | - Fikre Hailekiros
- National Podoconiosis Action Network, Addis Ababa 1000, Ethiopia;
| | - Sarah Martindale
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (S.M.); (H.M.); (H.B.); (M.T.); (L.K.-H.)
| | - Hayley Mableson
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (S.M.); (H.M.); (H.B.); (M.T.); (L.K.-H.)
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Fikre Seife
- Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia; (F.S.); (T.B.); (M.N.); (K.M.); (M.T.); (G.A.)
| | - Tesfahun Bishaw
- Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia; (F.S.); (T.B.); (M.N.); (K.M.); (M.T.); (G.A.)
| | - Mekdes Nigussie
- Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia; (F.S.); (T.B.); (M.N.); (K.M.); (M.T.); (G.A.)
| | - Kadu Meribo
- Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia; (F.S.); (T.B.); (M.N.); (K.M.); (M.T.); (G.A.)
| | - Mossie Tamiru
- Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia; (F.S.); (T.B.); (M.N.); (K.M.); (M.T.); (G.A.)
| | - Getnet Agidew
- Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa 1000, Ethiopia; (F.S.); (T.B.); (M.N.); (K.M.); (M.T.); (G.A.)
| | - Susan Kim
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
| | - Hannah Betts
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (S.M.); (H.M.); (H.B.); (M.T.); (L.K.-H.)
| | - Mark Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (S.M.); (H.M.); (H.B.); (M.T.); (L.K.-H.)
| | - Louise Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (S.M.); (H.M.); (H.B.); (M.T.); (L.K.-H.)
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Hounsome N, Kinfe M, Semrau M, Ali O, Tesfaye A, Mengiste A, Bremner S, Ahmed A, Fekadu A, Davey G. Economic assessment of a community-based care package for people with lower limb disorder caused by lymphatic filariasis, podoconiosis and leprosy in Ethiopia. Trans R Soc Trop Med Hyg 2020; 114:1021-1034. [PMID: 33169165 PMCID: PMC7738652 DOI: 10.1093/trstmh/traa111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/17/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022] Open
Abstract
We conducted an implementation research study to integrate a holistic package of physical health, mental health and psychosocial care for podoconiosis, lymphatic filariasis and leprosy into routine healthcare in Gusha cluster, Guagusa Shikudad district, northwest Ethiopia. The healthcare package included training patients in lower limb hygiene and skin care and provision of shoes, hygiene supplies and medication. The implementation activities included training events, workshops, awareness raising, self-help groups, supportive supervision, staff secondments and advisory board meetings. The cost of implementing the care package in Gusha cluster, with a population of 30 558 people, was 802 655 Ethiopian birr (ETB) (£48 159) and the cost of delivering care to 235 participants was 204 388 ETB (£12 263), or 870 ETB (£52) per person. There was a 35% decrease in the mean disability scores (measured using the World Health Organization Disability Assessment Schedule 2.0) and a 45% improvement in the dermatology-specific quality of life (measured using the Dermatology Life Quality Index) at the 3-month follow-up compared with baseline. There were reductions in the number of days with symptoms, days off usual activities/work and days with reduced activity due to illness, all of which were statistically significant. Our pilot suggests that integration of the care package into routine healthcare in Ethiopia may be effective in improving health-related quality of life and disability and reducing time out of economic activity due to illness.
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Affiliation(s)
- Natalia Hounsome
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Mersha Kinfe
- Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maya Semrau
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Oumer Ali
- Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraham Tesfaye
- Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asrat Mengiste
- Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | - Stephen Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Abdulkadir Ahmed
- Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Douglass J, Mableson H, Martindale S, Jhara ST, Karim MJ, Rahman MM, Kawsar AA, Khair A, Mahmood ASMS, Rahman AKMF, Chowdhury SM, Kim S, Betts H, Taylor M, Kelly-Hope L. Effect of an Enhanced Self-Care Protocol on Lymphedema Status among People Affected by Moderate to Severe Lower-Limb Lymphedema in Bangladesh, a Cluster Randomized Controlled Trial. J Clin Med 2020; 9:jcm9082444. [PMID: 32751676 PMCID: PMC7464742 DOI: 10.3390/jcm9082444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Lymphatic filariasis (LF) is a major cause of lymphedema, affecting over 16 million people globally. A daily, hygiene-centered self-care protocol is recommended and effective in reducing acute attacks caused by secondary infections. It may also reverse lymphedema status in early stages, but less so as lymphedema advances. Lymphatic stimulating activities such as self-massage and deep-breathing have proven beneficial for cancer-related lymphedema, but have not been tested in LF-settings. Therefore, an enhanced self-care protocol was trialed among people affected by moderate to severe LF-related lymphedema in northern Bangladesh. Methods: Cluster randomization was used to allocate participants to either standard- or enhanced-self-care groups. Lymphedema status was determined by lymphedema stage, mid-calf circumference, and mid-calf tissue compressibility. Results: There were 71 patients in each group and at 24 weeks, both groups had experienced significant improvement in lymphedema status and reduction in acute attacks. There was a significant and clinically relevant between-group difference in mid-calf tissue compressibility with the biggest change observed on legs affected by severe lymphedema in the enhanced self-care group (∆ 21.5%, −0.68 (−0.91, −0.45), p < 0.001). Conclusion: This study offers the first evidence for including lymphatic stimulating activities in recommended self-care for people affected by moderate and severe LF-related lymphedema.
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Affiliation(s)
- Janet Douglass
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (H.M.); (S.M.); (H.B.); (M.T.); (L.K.-H.)
- Correspondence:
| | - Hayley Mableson
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (H.M.); (S.M.); (H.B.); (M.T.); (L.K.-H.)
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Sarah Martindale
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (H.M.); (S.M.); (H.B.); (M.T.); (L.K.-H.)
| | - Sanya Tahmina Jhara
- Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh; (S.T.J.); (M.J.K.); (M.M.R.); (A.A.K.); (A.K.); (A.S.M.)
| | - Mohammad Jahirul Karim
- Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh; (S.T.J.); (M.J.K.); (M.M.R.); (A.A.K.); (A.K.); (A.S.M.)
| | - Muhammad Mujibur Rahman
- Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh; (S.T.J.); (M.J.K.); (M.M.R.); (A.A.K.); (A.K.); (A.S.M.)
| | - Abdullah Al Kawsar
- Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh; (S.T.J.); (M.J.K.); (M.M.R.); (A.A.K.); (A.K.); (A.S.M.)
| | - Abul Khair
- Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh; (S.T.J.); (M.J.K.); (M.M.R.); (A.A.K.); (A.K.); (A.S.M.)
| | - ASM Sultan Mahmood
- Filariasis Elimination and STH Control Program, Ministry of Health and Family Welfare, Dhaka 1000, Bangladesh; (S.T.J.); (M.J.K.); (M.M.R.); (A.A.K.); (A.K.); (A.S.M.)
| | - AKM Fazlur Rahman
- Centre for Injury Prevention and Research Bangladesh, Dhaka 1206, Bangladesh; (A.F.R.); (S.M.C.)
| | - Salim Mahmud Chowdhury
- Centre for Injury Prevention and Research Bangladesh, Dhaka 1206, Bangladesh; (A.F.R.); (S.M.C.)
| | - Susan Kim
- College of Medicine and Public Health, Flinders University, Bedford Park SA 5042, Australia;
| | - Hannah Betts
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (H.M.); (S.M.); (H.B.); (M.T.); (L.K.-H.)
| | - Mark Taylor
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (H.M.); (S.M.); (H.B.); (M.T.); (L.K.-H.)
| | - Louise Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK; (H.M.); (S.M.); (H.B.); (M.T.); (L.K.-H.)
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