Abstract
BackgroundLymphedema is a public health problem in countries with lymphatic filariasis (LF) including Mali. We studied the epidemiology and clinical presentation of lymphedema in three previously LF-endemic health districts of Mali after at least five consecutive rounds of mass drug administration (MDA) with albendazole and ivermectin.MethodsFrom 2016 to 2018, we used passive and active case finding methods to identify lymphedema cases in three health districts with high pre-MDA LF prevalence: Kolondieba (66%), Bougouni (44%) and Kolokani (34%).ResultsThree hundred and thirty nine cases of lymphedema were identified, 235 (69.32%) through active case finding. Their median age was 56 years (range 2–90) and 286 (84.36%) were women. Lymphedema was reported in 226 (78.5%) people aged 41 years and older compared to 73 (21.5%) people below the age of 41 years (Chi2 = 17.28, df = 5, p = 0.004). One hundred and seventy five cases of lymphedema were found in Kolondieba (66 per 100,000 people), 116 in Bougouni (19 per 100,000) and 48 in Kolokani (16 per 100,000). Stage III lymphedema was observed in 131 (38.64%), stage II in 108 (31.86%), stage IV in 46 (13.57%), stage I in 23 (6.78%), stage V in 21 (6.19%) and stage VI in ten (2.95%). In the three study districts, lymphedema affected the legs in 281 (82.89%), the arms in 42 (12.39%) and both in 16 (4.72%) (Chi2 = 13.63, p = 0.008).ConclusionHealth districts in Mali with the highest pre-MDA LF prevalences had the highest prevalence of lymphedema. Efforts to actively identify lymphedema cases should be scaled up in previous LF-endemic areas, and should be supplemented by a morbidity management and disability prevention plan at the peripheral health system level.
Highlights
Lymphedema is a public health problem in countries with lymphatic filariasis (LF) including Mali
Lymphatic filariasis (LF)-related lymphedema is caused by three filarial species, namely Wuchereria bancrofti, Brugia malayi and Brugia timori [3]
As part of the country’s certification process for the elimination of lymphatic filariasis as Mali’s longterm objective, it is important to understand the burden of lymphedema and to manage this concern with the second goal of GPELF (MMDP) [3]
Summary
Lymphedema is a public health problem in countries with lymphatic filariasis (LF) including Mali. We studied the epidemiology and clinical presentation of lymphedema in three previously LF-endemic health districts of Mali after at least five consecutive rounds of mass drug administration (MDA) with albendazole and ivermectin. Lymphatic filariasis (LF)-related lymphedema is caused by three filarial species, namely Wuchereria bancrofti, Brugia malayi and Brugia timori [3]. Podoconiosis is another condition in Africa causing lymphedema. It occurs only in regions with both high altitude and significant rainfall and is considered not to occur in Mali [4, 5]. As part of the country’s certification process for the elimination of lymphatic filariasis as Mali’s longterm objective, it is important to understand the burden of lymphedema and to manage this concern with the second goal of GPELF (MMDP) [3]
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