Lymphatic Filariasis Patients Research Articles

IJCM_284A: A Community based Cross-sectional study to assess the foot care practice and its associated factors among Lymphatic Filariasis patients in rural areas of Chengalpattu district, 2023.

Background: Lymphatic filariasis (LF) is a neglected tropical diseases, in which India has 40% of the world’s burden. LF patients suffering from disability, social stigma and severe morbidity remains as a significant public health concern. Patients to avoid acute attacks of lymphadenitis and to alleviate lymphoedema progression should have meticulous foot care practices. Objectives: 1. To assess the foot care practices and its associated factors among lymphatic filariasis patients in rural areas of Chengalpattu. 2. To determine the association between sociodemographic characteristics and clinical foot care practice among lymphatic filariasis patients in rural areas of Chengalpattu. Methodology: A community based cross-sectional study was conducted in rural area of Chengalpattu by multi-stage random sampling method among 185 participants with lymphedema using a semi-structured questionnaire for regular foot care by interview. Data was collected by Epi-collect 5 software and analyzed using SPSS v 16. Results: Among 190 participants - 50.5% were above 60 years, 63.2% were females, 59.4% had education up to middle school, 56.8% were unemployed, 70% were from upper lower class and below. 68.4% (95% CI: 61.3-75) had good practice on foot care based on 8 recommended foot care measures. A significant association was found between good foot care practices and those above upper lower socioeconomic class [OR=3.9(1.71-8.90)], with chronic illness [OR=1.9(1.01-3.71)], with water supply at home [OR=3.64(1.23-10.7)], experiencing acute lymphadenitis attack [OR=0.345(0.14-0.82)], patient worn foot wear regularly [OR=3.51(1.26-9.74)], wearing shoes and slippers [OR=0.134(0.35- 0.51)], patient seeking OP services for filariasis regularly [OR=3.18(1.56- 6.47)] had health education[OR=3.31(1.36-8.08)] and attended training programme [OR=2.86(1.50-5.45)]. Conclusion: Study indicated that people living with lymphoedema in rural areas of Chengalpattu district had good foot care practices. But more than one fourth of people had bad foot care practice, which can be improved by strengthening the patient follow-up, health education, training programme for patients and health care workers on foot care practice and morbidity management.

Five years of post-validation surveillance of lymphatic filariasis in Thailand

BackgroundThe World Health Organization (WHO) validated Thailand in 2017 as having eliminated lymphatic filariasis (LF) as a public health problem with recommendations for continued surveillance. This article describes measures and progress made in Thailand with post-validation surveillance (PVS) of LF from 2018 until 2022.MethodsThe implementation unit (IU) is a sub-village in 11 former LF endemic provinces. Human blood surveys are targeted in 10% of IUs each year. In Wuchereria bancrofti areas, filaria antigen test strips (FTS) are used, and in Brugia malayi areas, antibody test kits (Filaria DIAG RAPID) are used. Positive cases are confirmed by thick blood film (TBF) and polymerase chain reaction (PCR). Vector surveys for mosquito species identification and dissection for microfilaria (Mf)/filarial larvae are done in 1% of IUs where human blood surveys are conducted. Human blood surveys using FTS are conducted among migrants in five provinces. Surveillance of cats is done in areas that previously recorded > 1.0% Mf rate among cats. Morbidity management and disability prevention (MMDP) are done every 2 years in LF-endemic areas where chronic disease patients reside.ResultsFrom 2018 to 2022, in a total of 357 IUs in 11 provinces, human blood surveys were conducted in 145 IUs (41%) with an average population coverage of 81%. A total of 22,468 FTS and 27,741 FilariaDIAG RAPID were performed. 27 cases were detected: 3 cases of W. bancrofti in Kanchanaburi province and 24 cases of B. malayi in Narathiwat province. 4 cases of W. bancrofti were detected in two provinces through routine public health surveillance. Vector surveys in 47 IUs detected B. malayi Mf filarial larvae only in Narathiwat province. Chronic LF patients reduced from 114 in 2017 to 76 in 2022. Surveys among 7633 unregistered migrants yielded 12 cases of W. bancrofti. Mf rate among cats in Narathiwat province declined from 1.9% in 2018 to 0.7% in 2022. MMDP assessments revealed gaps in healthcare provider’s management of chronic cases due to staff turnover.ConclusionsIn 2022, after 5 years of PVS, Thailand re-surveyed 41% of its previously endemic IUs and demonstrated ongoing transmission in only one province of Narathiwat, where Mf prevalence is below the WHO provisional transmission threshold of 1%. This study highlights the importance of continued disease surveillance measures and vigilance among health care providers in LF receptive areas.Graphical

“Whenever I tell her to wear slippers, she turns a deaf ear. She never listens”: a qualitative descriptive research on the barriers to basic lymphedema management and quality of life in lymphatic filariasis patients in a rural block of eastern India

BackgroundChronic lymphatic filariasis patients in Bihar, India, need management of lymphedema to live a disability-free life. For patients who have recurrent attacks of acute dermato-lymphangio-adenitis (ADLA), World Health Organization (WHO) has recommended simple home-based measures that include maintaining hygiene, skin care, and limb movement. However, patients in rural areas are unable to adopt them, resulting in a vicious cycle of ADLA attacks. There might be multiple realities from patients’ and healthcare workers’ perspectives that were unexplored. Qualitative research was deemed best suitable to identify the barriers to carrying out home-based lymphedema practices that adversely affected quality of life.MethodsThe qualitative descriptive study was conducted in two villages in the rural field practice area under a tertiary care hospital in Bihar. Researchers purposively selected ten participants, including patients affected by lymphedema, their caregivers, the grassroots healthcare workers, and the block health manager. In-depth interviews were conducted using a semi-structured interview guide. Data were entered into QDA Miner Lite, where researchers did attribute, in-vivo, process, descriptive, emotion, and holistic coding, followed by content analysis, where categories and themes emerged from the codes.ResultsThree themes emerged: the inherent nature of disease, patient-related factors, and healthcare system-related factors. The fifteen identified barriers were low awareness, low adherence, low health-seeking behavior, poor personal hygiene, and categories like signs and symptoms, seasonal factors, hampered activities of daily living, hopelessness from not getting cured, psychosocial difficulty, lack of capacity building and receipt of incentives by healthcare workers, unavailability of laboratory diagnosis and management of complications at the facility, inconsistent drug supply, and no financial assistance.ConclusionsAccessibility to WaSH, regular training of home-based care, increasing the capacity and motivation of grassroots workers, and the generation of in-depth awareness among the patients are required to achieve the elimination of filariasis, with MMDP as a key component of that strategy for endemic districts across the whole country.Graphical

Knowledge and perceptions of lymphatic filariasis patients in selectedhotspot endemic communities in southern Ghana.

Lymphatic filariasis (LF) is a mosquito-borne neglected tropical disease that is one of the leading global causes of permanent disability. To date, LF interventions have been largely biomedical, focusing on drug treatments to disrupt parasite transmission and manage disease morbidity. Although important, these Mass Drug Administration (MDA) programs neglect the significance of socio-economic burden to the health of LF patients, which are compounded by social stigmatization, discrimination and associated depressive illnesses. The MDA program also typically fails to engage with local community beliefs and perceptions of LF, which may differ markedly from biomedical explanations and may have fueled non-compliance to treatments which is one of the major challenges of the Mass Drug Administration program. LF is not only a biomedical issue but also a social issue and LF interventions need to understand people's world views and the contexts through which they interpret bodily maladies. Hence, an effective LF intervention must bring together both the biomedical and the social components. The goal of this exploratory study was to assist in refining a large qualitative study (currently underway) that seeks to integrate culturally appropriate LF interventions into current LF control programs in Ghana. In this paper, we discuss the findings of a pre-intervention, exploratory study aimed at gaining a baseline grasp of a local culturally informed understanding of lymphatic filariasis and the knowledge gaps looking at three endemic Ghanaian communities in the Ahanta West District. A structured questionnaire was employed to assess the wellbeing, social inclusion, and cultural understanding of LF with a geographic focus within LF-endemic areas in Ghana. Interestingly, 45.8% of the 72 participants reported to have received information about LF from health care providers and the MDA program but only 5 out of the 72 (6.9%) respondents believed that LF was transmitted by mosquitos. This baseline study revealed several alternative interpretations and misconceptions about the disease, as well as the social and economic impacts, and importantly, the need to integrate qualitative research to develop culturally appropriate interventions and increase engagement with existing control programs.

Spatial Analysis of Lymphatic Filariasis Case and Mosquito Resting Place in Rural Area of Brebes Regency, Indonesia

Brebes Regency is an endemic area of Lymphatic Filariasis (LF) and has the highest number of LF cases in Central Java Province, Indonesia. Despite it is located in the coastal region, which is already known as one of the risk factors of LF, the LF case is distributed more in rural areas, away from the shoreline. Adult mosquitoes need a particular site, called a resting place, to rest after and before biting for a blood meal. The purpose of this study was to analyze spatially the distribution of LF cases and mosquito resting places in three subdistricts whose highest LF case is in the Brebes Regency. The three subdistricts are rural areas. The observed resting places were cattle pens, unmaintained bushes, and maintained bushes. The data of LF patients were obtained from the Health Office of Brebes Regency, which stood at 14 patients. Spatial mapping of LF case and mosquito resting place distribution was composed. 4 patients were located in the mosquito flight radius from unmaintained bushes, 3 patients were located in the mosquito flight radius from cattle pen, and 7 patients were located in the mosquito flight radius from both unmaintained bushes and cattle pen. It indicated unmaintained bushes, together with cattle pen, are the favorable resting place contributing to LF transmission.

Stigma and stigma-induced stress in filarial lymphoedema patients in Puducherry, India

Introduction: The morbidity management and disability prevention (MMDP) strategy for elimination of lymphatic filariasis (ELF) focuses on alleviating the sufferings of about 36 million filariasis patients living in 49 endemic countries. At present, available quality of life questionnaires are not adequate to address the stigma and stress of filarial lymphoedema (FLE) patients. Therefore, a comprehensive and a robust stigma and stress assessment tool needs to be developed. Methods: We developed 49 item SARI-FLE-Version-2 questionnaire for stigma assessment and 20 item PSS-FLE-Version-2 questionnaire for stress assessment and tested it among different grades of FLE patients. We followed the Likert scale scoring system and conducted a statistical analysis using SPSS IBM version 25.0. Results: Of the 80 lymphatic filariasis (LF) patients assessed, 35.0%, 42.5%, and 22.5% had grades 2, 3, and 4 LE of the lower extremity, respectively. The developed stigma tool had an excellent internal consistency, as indicated by high Cronbach alpha values for all six domains. There was a significant correlation (p < 0.05) between different stigma domains. In three domains (cognitive function, social stigma, and experienced stigma), the mean stigma scores were significantly higher for the grade 4 patients compared to grade 2 patients (p < 0.02). Conclusion: Stigma and stress assessment tools in the form of 49 item SARI-FLE-Version-2 and 20 item PSS-FLE-Version-2 questionnaires are reliable in quantifying the stigma and stress of LF patients. There is a scope to incorporate these tools in the MMD

Self-care practices and quality of life of filariasis patients in a gram panchayat of Paschim Burdwan district, West Bengal, India.

Self-care management is one of the important components in the goal of elimination of lymphatic filariasis (LF) and Quality of Life (QoL) has become an important deliverable in the present day health care system. The objective was to assess the self-care management of the affected limb and to find out the quality of life who were suffering from lymphoedema. This was a community-based cross-sectional epidemiological study conducted during 2019-2020 in a Gourbazar gram panchayat area of Paschim Burdwan district of West Bengal, India. QoL was assessed by Lymphatic Filariasis Specific Quality of life Questionnaire (LFSQQ). Total 115 LF patients were identified with a mean age of 53.9 years. About 26.1% correctly knew the management of the affected area. Out of the 33 patients having cracked skin, around 39.4% used to take care of the affected skin. Overall, median quality of life score was found to be 77.84 (65.90-89.20). Age-wise, median score gradually decreased with increase in age except in the age group of 50-60 years. Males had higher score compared to females (79.54 vs. 76.13). Activity domain score was found to be lowest followed by mobility score, while social and psychological domain score was found to be good. Self-care practice is not known to the affected patients. Time has also come to integrate measures like rehabilitation, psychological intervention, social assistance in addition to self-care management to put up a holistic approach of the existing program.

Multi-drug resistant bacteria isolates from lymphatic filariasis patients in the Ahanta West District, Ghana

BackgroundAntimicrobial resistance is associated with increased morbidity in secondary infections and is a global threat owning to the ubiquitous nature of resistance genes in the environment. Recent estimate put the deaths associated with bacterial antimicrobial resistance in 2019 at 4.95 million worldwide. Lymphatic filariasis (LF), a Neglected Tropical Disease (NTD), is associated with the poor living in the tropical regions of the world. LF patients are prone to developing acute dermatolymphangioadenitis (ADLA), a condition that puts them at risk of developing secondary bacterial infections due to skin peeling. ADLA particularly worsens the prognosis of patients leading to usage of antibiotics as a therapeutic intervention. This may result in inappropriate usage of antibiotics due to self-medication and non-compliance; exacerbating antimicrobial resistance in LF patients. In this perspective, we assessed the possibilities of antimicrobial resistance in LF patients. We focused on antibiotic usage, antibiotic resistance in Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa isolates and looked at genes (mecA and Extended-spectrum beta-lactamase [blaCTX-M, blaSHV and blaTEM]) coding for resistance in multi-drug resistant (MDR) bacterial isolates.ResultsOf the sixty (60) participants, fifty-four (n = 54, 90%) were within 31–60 years of age, twenty (n = 20, 33.33%) were unemployed and thirty-eight (n = 38, 50.67%) had wounds aged seven (7) months and above. Amoxicillin (54%) and chloramphenicol (22%) were the most frequently used antibiotics for self-medication. Staphylococcus aureus isolates (n = 26) were mostly resistant to penicillin (n = 23, 88.46%) and least resistant to erythromycin (n = 2, 7.69%). Escherichia coli isolates (n = 5) were resistant to tetracycline (n = 5, 100%) and ampicillin (n = 5, 100%) but were sensitive to meropenem (n = 5, 100%). Pseudomonas aeruginosa isolates (n = 8) were most resistant to meropenem (n = 3, 37.50%) and to a lesser extent ciprofloxacin (n = 2, 25%), gentamicin (n = 2, 25%) and ceftazidime (n = 2, 25%). Multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA), cephalosporin resistant Escherichia coli and carbapenem resistant Pseudomonas aeruginosa were four (n = 4, 15.38%), two (n = 2, 40%) and two (n = 2, 25%) respectively. ESBL (blaCTX-M) and mecA genes were implicated in the resistance mechanism of Escherichia coli and MRSA, respectively.ConclusionThe findings show presence of MDR isolates from LF patients presenting with chronic wounds; thus, the need to prioritize resistance of MDR bacteria into treatment strategies optimizing morbidity management protocols. This could guide antibiotic selection for treating LF patients presenting with ADLA.

Assessing the Quality of the Life of Lymphatic Filariasis Patients with Elephantoid Legs in a Post Mass Drug Administration (MDA) Phase Residing in Cherthala Taluk, Alappuzha

Introduction: Elephantoid legs due to past LF infection are common in Cherthala, Alappuzha, Kerala. The physical disability refers to impairment of bodily functions and difficulties in performing daily chores. The study aims to assess the quality of life of filarial patients in the post MDA phase. Objectives: To assess the quality of life of lymphatic filariasis patients in the post MDA phase. Methodology: A cross sectional study was conducted at Thaickal and Chethy Panchayats of Cherthala through health camps with the help of the Accedited social health activists (ASHAs). People with lymphoedema living in these areas were considered eligible for the study after taking their consent. 114 chronic filarial patients were recruited for the study employing a validated questionnaire; Lymphatic Filariasis Specific Quality of Life Questionnaire (LFSQQ). The domain scores were expressed as mean with standard deviation. An independent t-test was used to compare the mean scores among various groups based on demographic characters. Results: Among the 7 domains,the least score was for the mobility domain indicating that mobility was the major concern affecting in their quality of life. The highest domain score was observed in the Psychological Health domain indicating that they have mentally adjusted to this condition. Conclusion: In the present study to assess the quality of life of LF patients, the least domain score was for mobility and the highest domain score was for Psychological Health.

Lymphatic filarial serum proteome profiling for identification and characterization of diagnostic biomarkers.

Lymphatic Filariasis (LF) affects more than 863 million people in tropical and subtropical areas of the world, causing high morbidity and long illnesses leading to social exclusion and loss of wages. A combination of drugs Ivermectin, Diethylcarbamazine citrate and Albendazole is recommended by WHO to accelerate the Global Programme to Eliminate Lymphatic Filariasis (GPELF). To assess the outcome of GPELF, to re-evaluate and to formulate further strategies there is an imperative need for high quality diagnostic markers. This study was undertaken to identify Lymphatic Filarial biomarkers which can detect LF infections in asymptomatic cases and would also serve as indicators for differentiating among different clinical stages of the disease. A combination of Fourier-transform infrared spectroscopy (FT-IR), MMP zymography, SDS-PAGE, classical 2DE along with MALDI-TOF/MS was done to identify LF biomarkers from serum samples of different stages of LF patients. FT-IR spectroscopy coupled with univariate and multivariate analysis of LF serum samples, revealed significant differences in peak intensity at 3300, 2950, 1645, 1540 and 1448 cm-1 (p<0.05). The proteomics analysis results showed that various proteins were differentially expressed (p<0.05), including C-reactive protein, α-1-antitrypsin, heterogeneous nuclear ribonucleoprotein D like, apolipoproteins A-I and A-IV in different LF clinical stages. Functional pathway analysis suggested the involvement of differentially expressed proteins in vital physiological pathways like acute phase response, hemostasis, complement and coagulation cascades. Furthermore, the differentiation between different stages of LF cases and biomarkers identified in this study clearly demonstrates the potential of the human serum profiling approach for LF detection. To our knowledge, this is the first report of comparative human serum profiling in different categories of LF patients.

Knowledge, Attitude, and Medicine Taking Behavior of Lymphatic Filariasis Patients in Two Villages in West Kotawaringin Regency

Kotawaringin Barat Regency carried out the lymphatic filariasis mass drug administration (LF MDA) and in 2016 it was declared to have passed the 3rd transmission assessment survey (TAS). One success factor of 3rd TAS is behavior of adherence to taking preventive drugs from community participated. The purpose of this article is to analyze the relationship between knowledge and attitude of adherence to taking filariasis prevention drugs in two villages in West Kotawaringin Regency. The study was conducted in 2017 using an observational design with a cross-sectional approach. The samples used were 273 people ≥ 15 years. The instrument is a questionnaire of knowledge, attitudes and behavior related to LF MDA. Respondent characteristics and knowledge description were analyzed descriptively. Then chi square test was carried out to determine the relationship between gender, age, education, knowledge and attitudes towards drug-taking behavior. The results of the study found that the percentage of respondents in West Kotawaringin Regency who had good knowledge is 58.2%, the number of respondents with good attitudes is 66.7% and 89.4% of them behaved obediently in taking preventive drugs filariasis. Gender (p = 0.794), age (p = 0.372), education (p = 0.263), knowledge (p = 0.536) and attitude (p = 0.765) were not significantly related adherence behavior to taking filariasis prevention drugs. The conclusion of the study is that there are other factors other than gender, age, education, knowledge and attitude that can affect the behavior of adherence to taking filariasis prevention drugs in two villages in West Kotawaringin Regency.

Health beliefs and health seeking behavior towards lymphatic filariasis morbidity management and disability prevention services in Luangwa District, Zambia: Community and provider perspectives.

Morbidity management and disability prevention (MMDP) services are essential for the management of chronic stages of lymphatic filariasis (LF) infection. However, there is limited information on health beliefs and health seeking behavior towards MMDP services for LF in endemic regions of Zambia. This study sought to document health beliefs and health seeking behavior towards MMDP services for LF in Luangwa District, Zambia. This was an exploratory qualitative study conducted with community members including LF patients, community health workers and healthcare providers. Data was collected through a series of four focus group discussions stratified by sex and 26 in-depth interviews. Data was analyzed by thematic analysis using NVivo software. The perceived causes of the chronic manifestations of LF included; contact with animal faeces, use of traditional herbal aphrodisiacs (mutoto), witchcraft and sexual contact with women who were menstruating or had miscarried. LF patients opted to visit traditional healers before going to health facilities. Hydrocele patients were afraid of hydrocelectomies as they were thought to cause infertility or death. Very few community members were able to identify any home and facility-based care strategies for lymphoedema. Health system and cultural barriers to seeking healthcare included; long distances to the health facilities, lack of awareness of existing MMDP services, perceived costs of accessing MMDP services, gender and social norms, and fear of stigmatization. Health seeking behavior for LF in the district is mainly driven by negative beliefs about the causes of the disease and lack of awareness of available MMDP services and homecare strategies. Lymphatic filariasis programs should promote strategies that seek to empower patients and community members with the required information to access and use the MMDP services at the health facilities, as well as adhere to self-care practices in their households.

Financial burden impact quality of life among lymphatic Filariasis patients

BackgroundHuman lymphatic filarial pathology is the leading cause of disability and poverty among people living with the infection. The second goal of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) is to manage the disease’s morbidity to improve patients’ quality of life. Consequently, the current study assessed the overall quality of life of lymphatic filariasis (LF) pathology patients in some selected endemic communities in rural Ghana.MethodIn the present study, the Lymphatic Filariasis Quality of Life Questionnaire (LFSQQ) was used to evaluate the effect of lymphatic filariasis on the quality of life of people, with the disease in nine (9) communities in the Ahanta West District of the Western Region of Ghana where mass drug administration is being implemented for the past twenty years. Pearson’s correlation, linear regression, and one-way analysis of variance (ANOVA) analyses were used to assess the associations between the LFSQQ instrument domains.ResultsOf the 155 study participants recruited, 115 (74.19%) were females, and 40 (25.81%) males. A greater proportion of the study participants (40, 25.8%) were presented with stage two (2) lymphoedema, while only two patients had stage seven (7) lymphoedema. The average of the overall quality of life scores of study participants was 68.24. There was a negative Pearson correlation (r = − 0.504, p-value < 0.001) between the stage of lymphoedema (severity of the disease) and the quality of life of the LF patients. In addition, a clear pattern of positive correlation (r = 0.71, p-value < 0.001) was observed between the disease burden and pain/discomfort domains of the study participants. Whereas the highest domain-specific score (85.03) was observed in the domain of self-care, we noted that the environmental domain, which consists of the financial status, was the lowest (45.94) among the study participants.ConclusionOur findings support previous works on the reduced quality of life among lymphatic filariasis patients with pathology. In this study, our results reveal a depressing financial condition among people presenting with late stages of LF pathologies, which eventually reduces their well-being.

New and sensitive HPLC-UV method for concomitant quantification of a combination of antifilariasis drugs in rat plasma and organs after simultaneous oral administration.

A combination treatment comprising ivermectin (IVM), albendazole (ABZ) and doxycycline (DOX) is often prescribed for lymphatic filariasis patients. Nevertheless, there has not been an analytical method established and documented to determine these compounds simultaneously. Herein, we report a new high-performance liquid chromatographic method coupled with a UV detector (HPLC-UV) to quantify these drugs in plasma and organs. This developed analytical method was validated according to the International Conference on Harmonization (ICH) and US Food and Drug Administration (FDA) guidelines. The validated method was successfully employed to analyze IVM, ABZ along with its metabolites (albendazole sulfoxide (ABZ-OX) and albendazole sulfone (ABZ-ON)), and DOX in the plasma and organs of Wistar rats after simultaneous oral administration. An Xselect CSH™ C18 HPLC column was utilized as a stationary phase, with a mobile phase consisting of 0.1% v/v trifluoracetic acid in water and acetonitrile with a run time of 20 min. The calibration curves in biological samples were found to be linear across the concentration range of 0.01-5 μg mL-1 for IVM, ABZ and ABZ metabolites, and 0.025-10 μg mL-1 for DOX with an R value ≥0.998 in each case. The validated method was found to be selective, precise and accurate. Finally, the method developed in this study was deployed to assess the pharmacokinetic profiles and biodistribution of the combination of drugs after oral administration to Wistar rats. The validated HPLC-UV method in this study provides an extensive range of prospective applications for pharmacokinetic-based studies, therapeutic drug monitoring and toxicology.

Development and assessment of the psychometric properties of a new scale (15 item PSB-CL) to monitor the psychosocial burden of chronic lymphoedema in filariasis

Introduction: Chronic lymphoedema (CL) of lymphatic filariasis causes severe psychosocial burdens (PSB) to its victims. Currently-established scales to measure PSB of CL are not culturally adaptable to Sri Lankan patients. In this study, we developed and assessed the psychometric properties of a disease-specific questionnaire (15 item PSB-CL). Methods and Results: A detailed literature search was done to identify scales related to PSB of CL patients. Questions were developed through collected expressions from semi-structured interviews with 46 CL patients. A response scale was developed from the collected pool of possible responses, and they were scored using a visual analogue scale. Face and content validity were carried out using an initial questionnaire (31 questions). They were reduced to 27 by removing unclear, ambiguous, double-stranded ones and those with value-laden words. This new questionnaire was administrated on 92 patients by a group of doctors for item reduction by the analysis of internal consistency (Cronbach’s alpha &gt; 0.7) and factor analysis (Principal Component Analysis; Eigenvalues &gt; 1). After the patient survey and factor analysis, the final questionnaire PSB-CL was formed with 15 questions that had four subscales (factors), physical, social, fear and humiliation. Patients (n=92) reported quite a large percentage (42% - 69%) of problems under each dimension. Conclusion: The scale to measure the psychosocial burden of chronic lymphoedema in lymphatic filariasis patients in Sri Lanka. Further validation of the tool is needed.

Cost of care and its impact on households due to lymphatic filariasis: Analysis of a national sample survey in India.

India is an endemic country for lymphatic filariasis (LF). There are no current estimates of the expenditure being borne by LF patients in case of outpatient care or hospitalisation and its impact on households. This study aimed to estimate the household out-of-pocket (OOP) expenditure due to hospitalization or outpatient care as a result of LF in India. Secondary analysis of nationally representative data for India collected by the National Sample Survey Organization in 2014 was performed, reporting on health service utilization and health care related OOP expenditure by income quintiles and by type of health facility (public or private). The median household OOP expenditure from hospitalization and outpatient care due to LF was US$ 178 and US$ 04, respectively; and was more than two times higher among the richest group compared to the poorest. There was a significantly higher proportion of households affected by catastrophic costs among the rich (30%) compared to the poor households (18%) due to hospitalization. Median private sector OOP hospitalization expenditure was nearly four times higher than the public sector. Less than one-fourth of outpatient visits (22%) were in the public sector. The median expenditure on medicines and indirect cost were US$ 32 (IQR: 17-84) and US$ 23 (IQR: 9-59), respectively in case of hospitalization due to LF; while in case of outpatient care these were US$ 1.5 (IQR: 0-5.8) and US$ 1.5 (IQR: 0-4), respectively. Households with LF incur huge cost of patient care, particularly those in the lowest income group and those seeking care in the private sector.

How elimination of lymphatic filariasis as a public health problem in the Kingdom of Cambodia was achieved

BackgroundEndemicity of lymphatic filariasis (LF) in Cambodia was proven in 1956 when microfilariae were detected in mosquitos in the Kratié province. In 2001, an extensive study confirmed the presence of both Brugia malayi and Wuchereria bancrofti microfilariae. In 2003, the Ministry of Health established a national task force to develop policies and strategies for controlling and eliminating neglected tropical diseases (NTDs), with the goal of eliminating LF by 2015. This article summarizes the work accomplished to eliminate LF as a public health problem in Cambodia.MethodsThe National Program to Eliminate Lymphatic Filariasis made excellent progress in the goal towards elimination due to strong collaboration between ministries, intensive supervision by national staff, and advocacy for mobilization of internal and external resources. Mass drug administration (MDA) with diethylcarbamazine citrate and albendazole was conducted in six implementation units, achieving > 70% epidemiological coverage for five consecutive rounds, from 2005 to 2009. In 2006, in 14 provinces, healthcare workers developed a line list of lymphedema and hydrocele patients, many of whom were > 40 years old and had been affected by LF for many years. The national program also trained healthcare workers and provincial and district staff in morbidity management and disability prevention, and designated health centers to provide care for lymphedema and acute attack. Two reference hospitals were designated to administer hydrocele surgery.ResultsEffectiveness of MDA was proven with transmission assessment surveys. These found that less than 1% of school children had antigenemia in 2010, which fell to 0% in both 2013 and 2015. A separate survey in one province in 2015 using Brugia Rapid tests to test for LF antibody found one child positive among 1677 children. The list of chronic LF patients was most recently updated and confirmed in 2011–2012, with 32 lymphoedema patients and 17 hydrocele patients listed. All lymphedema patients had been trained on self-management and all hydrocele patients had been offered free surgery.ConclusionsDue to the success of the MDA and the development of health center capacity for patient care, along with benefits gained from socioeconomic improvements and other interventions against vector-borne diseases and NTDs, Cambodia was validated by the World Health Organization as achieving LF elimination as a public health problem in 2016.

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

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.

A Study on Morbidity Management among Lymphatic Filariasis Patients in Udupi district, Karnataka, India

International Journal of Medicine and Public Health,2017,7,2,92-96.DOI:10.5530/ijmedph.2017.2.18Published:May 2017Type:Original ArticleA Study on Morbidity Management among Lymphatic Filariasis Patients in Udupi district, Karnataka, IndiaKataraki Basavaraj, Shetty K Bharatesh, Dhar Murali, Kamath Ramachandra, and Malamardi Sowmya Kataraki Basavaraj,1a Shetty K Bharatesh,2b Dhar Murali,3c Kamath Ramachandra,4a Malamardi Sowmya5a 1Current Affiliation: Regional Coordinator – Karnataka, DNRT, National AIDS Control Organisation, Ministry of Health and Family Welfare, Govt. of India. aAffiliation where the work was primarily carried out: Dept. of Public Health, Manipal University, Manipal, Karnataka, India. 2Current Affiliation: Additional Project Director, Karnataka Health Promotion Trust, Bengaluru, India. bAffiliation where the work was primarily carried out: Lecturer, Melaka Manipal Medical College, Manipal University, Manipal, Karnataka, India. 3Current Affiliation: Associate Professor, Department of Population Policies & Programmes, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai - 400088, India cAffiliation where the work was primarily carried out: Associate Professor, Department of Statistics, Manipal University, Manipal, Karnataka, India. 4Current Affiliation: Associate Professor, Dept. of Community Medicine, Melaka Manipal Medical College, Manipal University, Manipal, Karnataka, India. aAffiliation where the work was primarily carried out: Head of Dept, Dept. of Public Health, Manipal University, Manipal, Karnataka, India. 5Current Affiliation: Senior Project Consultant, Ernst & Young, Gurgaon, India. aAffiliation where the work was primarily carried out: Dept. of Public Health, Manipal University, Manipal, Karnataka, India. 1Current Affiliation: Regional Coordinator – Karnataka, DNRT, National AIDS Control Organisation, Ministry of Health and Family Welfare, Govt. of India. Abstract:Context: Morbidity management is one of the key aspects in the life of Lymphatic Filariasis (LF) patients. National Vector Borne Disease Control Programme (NVBDCP) is giving more emphasis by conducting morbidity management training camps every year since 2004 to help LF patients to manage and cope-up with the existing morbidity. Aim: To study the morbidity management among LF patients in Udupi district, Karnataka. Study Setting and Design: The study was conducted in Udupi district, Karnataka, India in 2013. The design was stratified random sampling with proportional allocation method. Materials and Methods: Community based cross sectional study, 178 subjects suffering from LF were selected using stratified random sampling with proportional allocation method. An interview based method was used to collect the data. Lympoedema Morbidity Management Questionnaire were designed based on the guidelines provided by National Vector Borne Disease Control Programme (NVBDCP). Results: Among 178 LF patients only about 34% had knowledge about the disease causation. About 98.3% had good hygiene practice towards affected area but only 30% of them regularly practiced one or the other exercise as recommended. Conclusion: The study clearly indicates the outreach focus on LF patients needs to be enhanced by grass root level health workers. The program has to ensure that all the LF patients will undergo morbidity management training and know how to take care of lymphoedema. Keywords:Lymphatic filariasis, mass drug administration, Morbidity ManagementView:PDF (165.44 KB) Full Text

“Unseen” Caregivers: The disproportionate gender balance and role of females in the home- based care of lymphatic filariasis patients in Malawi

Objective: This study examines the gender of home-based caregivers for people affected by lymphatic filariasis (LF) lymphoedema. Methods: In total, 69 LF lymphoedema cases in Malawi were questioned about the assistance they received with a focus on the gender of the caregiver and the type of support provided. Results: Of the 35 cases who required daily assistance, 27 indicated the gender of the caregiver, of which 20 were female (74.1%), and most commonly daughters, sisters or school-aged girls. This care was usually only provided during episodes of painful disabling acute-dermatolymphangioadenitis (ADLA) attacks. The males who provided care were most commonly husbands. Conclusion: The role of female caregivers is ‘unseen’ and this has considerable domestic, educational and economic implications. This gender imbalance also poses barriers to Goal 5 of the Sustainable Development Goals, specifically Target 5.4 that aims to recognize and value unpaid care and domestic work.