Lymphatic filariasis patient identification in a large urban area of Tanzania: An application of a community-led mHealth system.

Upendo Mwingira,Alpha Malishee,Irene Mremi,Michelle C Stanton,Mwele Malecela,Cecilia Uisso,Maria Chikawe,Wilfred Lazarus Mandara,Louise A Kelly-Hope,Hayley E Mableson,Charles D Mackenzie,Sabine Specht

doi:10.1371/journal.pntd.0005748

Abstract

BackgroundLymphatic 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 findingsA 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/SignificanceThis 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.

Highlights

Lymphatic filariasis (LF) is a neglected tropical disease (NTD) that can have a devastating impact on affected individuals, with clinical symptoms such as acute dermatolymphangioadenitis (ADLA, “acute attacks”), lymphoedema and elephantiasis, and hydrocoele, causing physical, mental and economic distress [1,2,3,4,5,6]
The World Health Organization’s (WHO) Global Programme to Eliminate Lymphatic Filariasis (GPELF) requires that countries wishing to be recognised as having eliminated LF are required to prove that disease transmission has been interrupted through mass drug administration (MDA), but that they are alleviating the suffering of those affected by providing a minimum package of care to each person with lymphoedema/elephantiasis (LE) and hydrocoele in LF endemic areas [7]
Whilst it is recognised that there may be some false positives in these reports, and further that some patients may have been missed from the survey, the verification survey results give the national LF elimination programme confidence that these numbers are representative of the true burden

Summary

Introduction

Lymphatic filariasis (LF) is a neglected tropical disease (NTD) that can have a devastating impact on affected individuals, with clinical symptoms such as acute dermatolymphangioadenitis (ADLA, “acute attacks”), lymphoedema and elephantiasis, and hydrocoele, causing physical, mental and economic distress [1,2,3,4,5,6]. The World Health Organization’s (WHO) Global Programme to Eliminate Lymphatic Filariasis (GPELF) requires that countries wishing to be recognised as having eliminated LF are required to prove that disease transmission has been interrupted through mass drug administration (MDA), but that they are alleviating the suffering of those affected by providing a minimum package of care to each person with lymphoedema/elephantiasis (LE) and hydrocoele in LF endemic areas [7] This package includes (i) surgery for hydrocoele [8,9], (ii) support for episodes of ADLA [10,11], and (iii) management of LE to prevent disease progression. Methods of locating these patients, knowing their true number and providing care for them, remains a challenge for national medical systems, when the endemic zone is a large urban area

Objectives

Methods

Results

Discussion

Conclusion