1
|
Ipa M, Astuti EP, Wahono T, Laksono AD, Cahyati Y, Dhewantara PW. Factors Influencing Drug Compliance Among Adult with Lymphatic Filariasis in Indonesia: Findings From Nationwide Population-Based Health Survey. Asia Pac J Public Health 2023; 35:445-448. [PMID: 37649276 DOI: 10.1177/10105395231197916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Mara Ipa
- Research Organization for Health, National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
| | - Endang Puji Astuti
- Research Organization for Health, National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
| | - Tri Wahono
- Research Organization for Health, National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
| | - Agung Dwi Laksono
- Research Organization for Health, National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
| | - Yanti Cahyati
- Tasikmalaya Health Polytechnic, Ministry of Health Republic of Indonesia, Tasikmalaya, Indonesia
| | - Pandji Wibawa Dhewantara
- Research Organization for Health, National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
| |
Collapse
|
2
|
Kalinga A, Munga M, Ngenya A, John W, Kisoka W, Oriyo N, Mutalemwa P, Mandara W, Masagati L, Ogondiek J, Korir P, Klarmann-Schulz U, Horn S, Kroidl I, Debrah A, Hoerauf A, Mwingira U. The viability of utilising phone-based text messages in data capture and reporting morbidities due to lymphatic Filariasis by community health workers: a qualitative study in Kilwa district, Tanzania. BMC Health Serv Res 2022; 22:924. [PMID: 35854308 PMCID: PMC9295502 DOI: 10.1186/s12913-022-08256-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Globally, there is recognition of the value of using mobile phones among health providers in improving health systems performance. However, in many Low- and Middle-income countries where there is shortage of health providers, Community Health Workers have assumed some responsibilities especially relating to identifying and reporting on health problems within their communities. Despite the known benefits of using mobile phone technology to deliver health services, there is limited information on the extent to which Community Health Workers are able to effectively use the technology in data collection and reporting. The aim of this study was to determine the feasibility of utilizing phone-based text messages on Lymphatic Filariasis morbidity surveillance by Community Health Workers. Methods This was a cross sectional study whose data was collected through key informant interviews and focused group discussions among community health workers, health providers and staff of neglected tropical diseases control program. Collected transcripts were analysed through Thematic content analysis as it allowed for the identification of data codes through inductive reasoning. Results The use of mobile phone-based text messages in data collection and reporting lymphatic filariasis morbidity cases by Community Health Workers was perceived by study participants to be a relevant tool and feasible due to the ease of use of the technology. The tool was reported by end-users to significantly increase their performance and efficiency was gained in terms of reduced paper work, increased the number of patients accessing health care services and the ability to report in real-time. All respondents were confident that Community Health Workers were the right persons to interact with communities in tracking and reporting morbidity cases using mobile technology. Conclusion Mobile phone-based text messages have proven to be effective in routine workflows such as, data collection and reporting on Lymphatic Filariasis morbidity cases, patient to provider communication, decision making and supportive supervision. Mobile phones have also improved efficiency and general performance of end users in terms of increased number of cases identified and efficiency gained in terms of reduced paper work and the ability to collect and report in real-time.
Collapse
Affiliation(s)
- Akili Kalinga
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania.
| | - Michael Munga
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Abdallah Ngenya
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Winfrida John
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - William Kisoka
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Ndekya Oriyo
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Prince Mutalemwa
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Wilfred Mandara
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Leonard Masagati
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - John Ogondiek
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania
| | - Patricia Korir
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), Bonn, Germany
| | - Ute Klarmann-Schulz
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), Bonn, Germany
| | - Sacha Horn
- Division of Infectious Diseases and Tropical Medicine, University Hospital Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany.,German Centre for Infection Research (DZIF), Neglected Tropical Diseases, Partner Site, Munich, Germany
| | - Inge Kroidl
- Division of Infectious Diseases and Tropical Medicine, University Hospital Munich, Ludwig-Maximilians-Universität (LMU), Munich, Germany.,German Centre for Infection Research (DZIF), Neglected Tropical Diseases, Partner Site, Munich, Germany
| | - Alex Debrah
- Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), Bonn, Germany
| | - Upendo Mwingira
- National Institute for Medical Research (NIMR), Headquarters, Dar es Salaam, Tanzania.,Research Triangle Institute (RTI), International, Washington DC, USA
| |
Collapse
|
3
|
John W, Mushi V, Tarimo D, Mwingira U. Prevalence and management of filarial lymphoedema and its associated factors in Lindi district, Tanzania: A community-based cross-sectional study. Trop Med Int Health 2022; 27:678-685. [PMID: 35700223 DOI: 10.1111/tmi.13792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the burden and management of filarial lymphoedema and its associated factors in Lindi district, Tanzania. METHODS Cross-sectional study involving 954 community members who were screened for filarial lymphoedema by using a checklist. Moreover, lymphoedema patients were examined for the presence of entry lesions, staging of disease, and interviewed on acute dermatolymphangioadenitis (ADLA) attacks, and their current practices on lymphoedema management. Descriptive statistics and logistic regression analyses were performed. A p < 0.05 was considered statistically significant. RESULTS The prevalence of filarial lymphoedema was 7.8%, with the majority in the early stage of lymphoedema (78.4%). The large majority (98.6%) of the patients had lower limb lymphoedema and 46% of lymphoedema patients had entry lesions. More than a half (60.8%) of those lymphoedema patients had experienced ADLA attacks; close to two-thirds (64.8%) had one or two attacks in the past 6 months. Generally, patients had inappropriate hygiene care practices for filarial lymphoedema management. Inappropriate hygiene care practice for lymphoedema management was associated with an increased risk for the development of advance stage of lymphoedema (adjusted odds ratio = 7.379, 95%, confidence interval: 3.535-16.018, p = 0.04). CONCLUSION Though lymphatic filariasis transmission has drastically declined, chronic manifestations of lymphoedema persist in Lindi district. The recommended disease management practices are deficient, which calls for a programmatic approach for mapping the burden of lymphoedema and implementing its management.
Collapse
Affiliation(s)
- Winfrida John
- National Institute for Medical Research, Dar es Salaam, Tanzania.,Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Vivian Mushi
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Donath Tarimo
- Department of Parasitology and Medical Entomology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Upendo Mwingira
- National Institute for Medical Research, Dar es Salaam, Tanzania.,Research Triangle Institute International, Research Triange Park, North Carolina, USA
| |
Collapse
|
4
|
Krishnasastry ST, Mackenzie CD, Sadanandan R. Scaling-up filariasis lymphoedema management into the primary health care system in Kerala State, Southern India: a case study in healthcare equity. Infect Dis Poverty 2022; 11:9. [PMID: 35042539 PMCID: PMC8764796 DOI: 10.1186/s40249-022-00936-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) remains one of the world's most debilitating parasitic infections and is a major contributor to poor health in many endemic countries. The provision of continuing care for all those affected by LF and its consequences is an important component of the United Nations' Sustainable Development Goals. The aim of this study is to integrate lymphedema care into the primary health care system of the State by developing lymphedema clinics at each district, through training of health personnel to fulfill WHO recommendation for morbidity management and disability prevention. METHODS Selected health care providers from all the districts in Kerala State of India participated in intensive training sessions endorsed by the State's health administration. The six training sessions (from 5 June 2017 to 25 May 2018) included appropriate self-care information and development of individual plans for each participating institution to provide instruction and care for their lymphoedema patients. The learning achieved by attendees was assessed by pre- and post-training tests. The number of lymphoedema patients receiving care and instruction from the post-training activities of each participating institution was assessed from local records, 6 months after the conclusion of the training sessions. RESULTS One hundred and eighty-four medical personnel (91 doctors and 93 nurses) from 82 medical institutions were trained which quickly led to the establishment of active lymphoedema clinics providing the essential package of care (EPC) for lymphoedema patients at all the participating institutions. Six months after the training sessions the number of previously unidentified lymphoedema patients registered and receiving care at these clinics ranged from 296 to almost 400 per clinic, with a total of 3,477 new patients receiving training in EPC. CONCLUSIONS Generalist health personnel, when appropriately trained, can provide quality lymphoedema care in public health settings and patients when provided services close to their home, are willing to access them. This is a feasible strategy for integrating long term care for LF patients into the national health system, and is a clear example of moving towards equity in health care for the medically underserved, and thus successfully addresses a major goal of the global program to eliminate lymphatic filariasis.
Collapse
Affiliation(s)
- Suma T Krishnasastry
- Filariasis Research Unit, WHO Collaborating Center for LF MMDP, Lymphatic Filariasis Morbidity Management and Disability Prevention, Department of Internal Medicine, Govt. T. D. Medical College Hospital, Kerala University of Health Sciences, Alappuzha, 688005, India.
| | | | | |
Collapse
|
5
|
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.
Collapse
Affiliation(s)
| | - Ahmed Jamsheed Mohamed
- Depa rtment of Communicable Diseases, WHO Regional Office for South-East Asia, New Delhi 110002, India
| |
Collapse
|
6
|
Lama Yonzon C, Padmawati RS, Subedi RK, Paudel S, Ghimire A, Murhandarwati EH. Exploring determinants of hydrocele surgery coverage related to Lymphatic Filariasis in Nepal: An implementation research study. PLoS One 2021; 16:e0244664. [PMID: 33635870 PMCID: PMC7909642 DOI: 10.1371/journal.pone.0244664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/15/2020] [Indexed: 12/04/2022] Open
Abstract
Background Hydrocele is a chronic condition in males in which there is an excessive collection of straw-colored fluid, which leads to enlargement of the scrotum. It is a common manifestation of lymphatic filariasis (LF) affecting nearly 25 million men worldwide. Surgery is the recommended treatment for hydrocele and is available free of cost in all government hospitals in Nepal. This research explored patient, provider, and community factors related to accessing hydrocele surgery services by the patients. Methods This study employed a qualitative method. The research was conducted in two LF endemic districts, namely Kanchanpur and Dhading, which are reported to have the highest number of hydrocele cases during morbidity mapping conducted in 2016. In addition to five key informant interviews with the LF focal persons (one national and 4 district-level), nine in-depth interviews were conducted with hydrocele patients (5 of whom had undergone surgery and 4 who had not undergone surgery) and with 3 family members, and two focus group discussions with the female community health volunteers. Results Most of the respondents did not have knowledge of hydrocele as one of the clinical manifestations of LF nor that it is transmitted through a mosquito bite. Although perceived as treatable with surgery, most of the patients interviewed believed in as well as practiced home remedies. Meanwhile, fear of surgery, embarrassment, lack of money, along with no knowledge of the free hydrocele surgery acted as barriers for accessing the surgery. On the other hand, financial support, flexible guidelines enabling the hospital to conduct surgery, decentralization and scaling up of morbidity mapping along with free hydrocele surgery camps in any remaining endemic districts were identified as enablers for accessing surgery. Conclusion Hydrocele surgery coverage could be improved if the program further addresses community awareness. There is a need for more focus on information dissemination about hydrocele and hydrocele surgery.
Collapse
Affiliation(s)
- Choden Lama Yonzon
- Department of Health Behavior, Environment, and Social Medicine and Centre of Health Behavior and Promotion, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- * E-mail:
| | - Retna Siwi Padmawati
- Department of Health Behavior, Environment, and Social Medicine and Centre of Health Behavior and Promotion, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Sagun Paudel
- Department of Health Behavior, Environment, and Social Medicine and Centre of Health Behavior and Promotion, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ashmita Ghimire
- Department of Health Behavior, Environment, and Social Medicine and Centre of Health Behavior and Promotion, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Elsa Herdiana Murhandarwati
- Postgraduate Program of Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| |
Collapse
|
7
|
Maritim P, Silumbwe A, Zulu JM, Sichone G, Michelo C. Health beliefs and health seeking behavior towards lymphatic filariasis morbidity management and disability prevention services in Luangwa District, Zambia: Community and provider perspectives. PLoS Negl Trop Dis 2021; 15:e0009075. [PMID: 33617551 PMCID: PMC7932505 DOI: 10.1371/journal.pntd.0009075] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/04/2021] [Accepted: 12/15/2020] [Indexed: 11/19/2022] Open
Abstract
Background 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. Methods 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. Results 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. Conclusion 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. Lymphatic filariasis (LF) infection if untreated results in fluid accumulation in the limbs or breasts (lymphedema) or genitalia (hydrocele) that is painful and causes great discomfort. Morbidity management and disability prevention (MMDP) strategies such as surgery for hydrocele, treatment of acute attacks and management of lymphedema are necessary for the management of the advanced stages of LF. However, very few countries including Zambia, have adequate information on the health beliefs and health seeking behavior of communities living in endemic areas towards MMDP services for LF. This study sought to explore community and health provider perspectives towards MMDP services for LF in a highly endemic region, Luangwa District, Zambia, between February and April 2019. Some of the perceived causes of lymphedema and hydrocele were; contact with animal faeces, use of traditional herbal aphrodisiacs (mutoto), witchcraft and sexual contact with women who were menstruating or had miscarried. There was limited knowledge of home-based and facility-based care strategies for lymphoedema. Nevertheless, patients would often go to health facilities after visiting traditional healers and observing no improvement. Barriers to accessing healthcare included; long distances to the health facilities, lack of awareness of existing MMDP services, perceived costs of accessing healthcare services, gender and social norms and fear of stigmatization.
Collapse
Affiliation(s)
- Patricia Maritim
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
- * E-mail:
| | - Adam Silumbwe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Joseph Mumba Zulu
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - George Sichone
- Participatory Research and Innovations Management (PRIM), Lusaka, Zambia
| | - Charles Michelo
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia Lusaka, Zambia
| |
Collapse
|
8
|
Das L, Mathiarasan L, Krishnakumari A. Assessment of the impact of morbidity management and disability prevention for lymphatic filariasis on the disease burden in villupuram district of Tamil Nadu, India. Indian J Community Med 2021; 46:657-661. [PMID: 35068729 PMCID: PMC8729271 DOI: 10.4103/ijcm.ijcm_12_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background: The global program to eliminate lymphatic filariasis (GPELF) was started in 2003 with two strategies: the mass drug administration (MDA) to interrupt disease transmission and the morbidity management and disability prevention (MMDP) to provide the basic hygienic care to filariasis lymphedema patients. Among the two strategies, the MDA is well advanced and got the desired results, but the MMDP is lagging due to poor execution. Objectives: To assess the awareness of MMDP and ongoing morbidity management practices by lymphedema patients and to estimate the impacts of the MMDP on the prevalence and severity of lymphedema. Materials and Methods: This study was conducted among 100 lymphedema patients in 7 filariasis endemic villages of Villupuram district, Tamil Nadu, India through interviews using a structured, pretested questionnaire. The grading and adenolymphangitis (ADL) attack determination were done by a clinician. The impact was assessed in terms of changes in the lymphedema grades, frequency of ADL attacks, and changes in the burden. Results: Of the 100 patients, 70% were aware of the program and among them, only 48% were practising MMDP regularly (i.e. two times per day). The majority of them (80%) were taking treatment during ADL attacks. The overall lymphedema grades reversal and progression were observed in 13% and 52% of cases, respectively. Conclusion: This study has revealed that the second arm of the GPELF, “MMDP” has not yielded the desired results as evidenced by the incidence of frequent ADL attacks and advancement of lymphedema grades.
Collapse
|
9
|
De Britto L, Kamaraj P, Vijayalakshmi G, Das LK, Krishnakumari A, Anbusivam S, Supriya VK, Yuvaraj J. Clinical Benefits of Supervised Home Care of the Morbidity Management and Disability Prevention Under National Filariasis Elimination Programme. Lymphat Res Biol 2020; 18:517-525. [PMID: 32584670 DOI: 10.1089/lrb.2019.0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Mass drug administration and morbidity management and disability prevention (MMDP) though considered as two pillars of global program for elimination of filariasis, implementation of MMDP was disregarded in several endemic countries. Limb hygiene is the main component of MMDP and to address its overall clinical benefits, a community-based study was undertaken in three sets of populations. Materials and Methods: After obtaining written informed consent, clinical, quality of life (QoL) assessments were carried out and lymphedema volume was measured for three groups of lymphedema patients at intake, at 6, and 12 months follow-up. Filarial lymphedema patients from three sets of villages categorized as "Previous VCRC MMDP," "State MMDP," and "Current VCRC MMDP" were considered for the study. Clinical examination and QoL assessment were carried out independently by a medical officer and a sociologist, respectively. Whoever available at the time of three field visits were registered and included in the study. In total, 67, 63, 66 and 75, 74 and 63 lymphedema (LE) patients completed clinical evaluation and QoL assessment from these groups, respectively. Results: Assessment of repeated measures of clinical parameters at baseline and two time points of follow-up by Friedman's test showed significant clinical improvements in skin color, texture, moisture, and ulcer (p > 0.05), in nails score and intertrigo score (p > 0.01). Assessed by Wilcoxon signed-rank test showed a significant reduction in the frequency Acute Dermato-Lymphangio-Adenitis episodes at 12 months follow-up in all the three MMDP groups (p < 0.001). However, the reduction of LE volume was significant (p = 0.009) only in the current Vector Control Research Centre (VCRC) MMDP group. There was no significant improvement in the QoL in all three groups. Conclusions: To achieve the desired clinical benefits by MMDP home care practices for the filarial lymphedema patients, regular monitoring by the auxiliary health workers is essential. National programs must consider monthly supervision through an integrated approach.
Collapse
Affiliation(s)
- Lourduraj De Britto
- Unit of Clinical Epidemiology and Chemotherapy, Vector Control Research Centre, Indian Council of Medical Research (ICMR), Indira Nagar, Pondicherry, India
| | - Pattabi Kamaraj
- Division of Epidemiology and Biostatistics, National Institute of Epidemiology, ICMR, TNHB, Chennai, India
| | - Gnanasekaran Vijayalakshmi
- Unit of Clinical Epidemiology and Chemotherapy, Vector Control Research Centre, Indian Council of Medical Research (ICMR), Indira Nagar, Pondicherry, India
| | - Lalit Kumar Das
- Unit of Clinical Epidemiology and Chemotherapy, Vector Control Research Centre, Indian Council of Medical Research (ICMR), Indira Nagar, Pondicherry, India
| | - A Krishnakumari
- Unit of Clinical Epidemiology and Chemotherapy, Vector Control Research Centre, Indian Council of Medical Research (ICMR), Indira Nagar, Pondicherry, India
| | - Sadhasivam Anbusivam
- Unit of Clinical Epidemiology and Chemotherapy, Vector Control Research Centre, Indian Council of Medical Research (ICMR), Indira Nagar, Pondicherry, India
| | - Vinod K Supriya
- College of Physiotherapy, Mother Theresa Post Gradate and Research Institute of Health Sciences, Pondicherry, India
| | - Jayaram Yuvaraj
- Division of Epidemiology and Biostatistics, National Institute of Epidemiology, ICMR, TNHB, Chennai, India
| |
Collapse
|
10
|
Zhou C, Yahathugoda C, De Silva L, Rathnapala U, Owen G, Weerasooriya M, Rao RU, Weil GJ, Budge PJ. Portable infrared imaging for longitudinal limb volume monitoring in patients with lymphatic filariasis. PLoS Negl Trop Dis 2019; 13:e0007762. [PMID: 31584959 PMCID: PMC6795459 DOI: 10.1371/journal.pntd.0007762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/16/2019] [Accepted: 09/08/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Global Programme to Eliminate Lymphatic Filariasis (LF) emphasizes hygiene, exercise, and other measures to reduce morbidity and disability related to LF. We recently reported that a portable, three-dimensional, infrared imaging system (3DIS) provides accurate limb volume measurements in patients with filarial lymphedema. To assess the practical utility of repeated 3DIS measurements for longitudinal lymphedema management, we examined intraday and day-to-day leg volume changes in adults with filarial lymphedema in southern Sri Lanka. METHODOLOGY AND PRINCIPAL FINDINGS We assessed 41 participants with lower extremity lymphedema (stages 1-6) in their homes in the mornings (6:00-9:00 AM) and afternoons (2:00-6:00 PM) of three days within one calendar week. Two examiners performed replicate 3DIS volume measurements at each visit. Median coefficient of variation among replicate volume measurements was 1.7% (IQR 1.1% - 2.3%) for left legs and 2.2% (IQR 1.6% - 2.8%) for right legs. Median intraday volume increase was 3.0%. Range among daily volume measurements tended to be lower for afternoon measurements (median 2.25%, IQR 1.4%- 5.4%) than for morning measurements (median 3.0%, IQR 1.4% - 8.4%). CONCLUSIONS AND SIGNIFICANCE Limb volume measurements by 3DIS are accurate and reproducible, and this technique is feasible for use in patients' homes. We have developed practical suggestions for optimal outcomes with 3DIS. Duplicate measurements should be performed and repeat assessments should be done at approximately the same time of day to minimize bias. Duplicate measures that vary by more than 8% should prompt review of scanning technique with a repeat measurement. With proper training and attention to technique, 3DIS can be a valuable tool for healthcare workers who work with lymphedema patients.
Collapse
Affiliation(s)
- Celia Zhou
- Department of Biochemistry and Molecular Biology, Wake Forest University, Winston-Salem, North Carolina, United States of America
- Summer Research Program, Institute of Public Health, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Channa Yahathugoda
- Filariasis Research Training and Services Unit, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Lalindi De Silva
- Filariasis Research Training and Services Unit, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Upeksha Rathnapala
- Filariasis Research Training and Services Unit, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Grant Owen
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Mirani Weerasooriya
- Filariasis Research Training and Services Unit, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Ramakrishna U. Rao
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Gary J. Weil
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Philip J. Budge
- Infectious Diseases Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
| |
Collapse
|
11
|
Silva E, Xavier A, Silva E, Barbosa Júnior W, Rocha A, Freitas V, Oliveira P, Aguiar-Santos AM, Bonfim C, Medeiros Z. Evaluation of lymphatic filariasis in endemic area of Brazil where mass drug administration is not required. Pathog Glob Health 2019; 113:143-148. [PMID: 31138026 DOI: 10.1080/20477724.2019.1623546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Mass drug administration (MDA) is the main counter-transmission strategy of the Global Programme to Eliminate Lymphatic Filariasis. In endemic countries, there are areas where MDA is not required. However, there is no standard approach in these areas, and studies are important to evaluate the epidemiological status. This study aimed to investigate lymphatic filariasis and strategies developed for its control in an area where MDA is not required. Together with the 2018 morbidity evaluation, a survey was conducted using point-of-care immunochromatographic test-AD12 tests for diagnostic screening in an area where MDA is not required. The methodology also included desk research based on Health Department reports of the control activities for lymphatic filariasis during 2003-2016. Among the 934 cases investigated in 2018, there was a 0.64% prevalence of circulating filarial antigen positive, comprising five adults and one 2-year-old child. Six patients aged 39-63 years had filarial disease. Fourteen surveys have already been conducted as control activities, and since 2009, there have been no positive cases. This study showed that the prevalence of antigenemia decreased from 2.97% in 2003 to 0.64% in 2018. Moreover, the transmission of filariasis infection was under control in this area. Our study provides insights into the surveillance phase by identifying areas of low transmission and where MDA is not required. Although we have not identified cases of filarial infection, there is a need to provide services that will provide assist those already affected with morbidity and help reduce and prevent disability.
Collapse
Affiliation(s)
- Ellyda Silva
- a Programa de Pós-graduação em Biociências e Biotecnologia em Saúde , Instituto Aggeu Magalhães (IAM), Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil
| | - Amanda Xavier
- b Programa de Pós-graduação em Ciências da Saúde , Universidade de Pernambuco (UPE) , Recife , Pernambuco , Brasil
| | - Elis Silva
- a Programa de Pós-graduação em Biociências e Biotecnologia em Saúde , Instituto Aggeu Magalhães (IAM), Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil
| | - Walter Barbosa Júnior
- a Programa de Pós-graduação em Biociências e Biotecnologia em Saúde , Instituto Aggeu Magalhães (IAM), Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil
| | - Abraham Rocha
- c Serviço de Referencia Nacional em Filarioses, Departamento de Parasitologia , Instituto Aggeu Magalhães, Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil.,d Secretaria de Saúde do Estado de Pernambuco , Laboratório do Hospital Otávio de Freitas , Recife , Pernambuco , Brazil
| | - Vania Freitas
- e Secretária Municipal de Saúde de Jaboatão dos Guararapes , Diretoria de Vigilância em Saúde , Jaboatão dos Guararapes , Pernambuco , Brazil
| | - Paula Oliveira
- c Serviço de Referencia Nacional em Filarioses, Departamento de Parasitologia , Instituto Aggeu Magalhães, Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil
| | - Ana Maria Aguiar-Santos
- c Serviço de Referencia Nacional em Filarioses, Departamento de Parasitologia , Instituto Aggeu Magalhães, Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil
| | - Cristine Bonfim
- f Diretoria de Pesquisas Sociais, Núcleo de Estudos em Estatísticas Sociais , Fundação Joaquim Nabuco (FUNDAJ) , Recife , Pernambuco , Brasil.,g Programa de Pós-graduação em Saúde Coletiva , Universidade Federal de Pernambuco (UFPE) , Recife , Pernambuco , Brasil
| | - Zulma Medeiros
- a Programa de Pós-graduação em Biociências e Biotecnologia em Saúde , Instituto Aggeu Magalhães (IAM), Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil.,b Programa de Pós-graduação em Ciências da Saúde , Universidade de Pernambuco (UPE) , Recife , Pernambuco , Brasil.,c Serviço de Referencia Nacional em Filarioses, Departamento de Parasitologia , Instituto Aggeu Magalhães, Fundação Oswaldo Cruz (FIOCRUZ) , Recife , Pernambuco , Brasil
| |
Collapse
|
12
|
Abstract
Lymphatic filariasis (LF) is a parasitic infection that is spread by mosquitos infected with worm larvae. Several factors will affect the global prevalence of LF in the future. A growing body of evidence suggests that climate change will influence the spread of parasitic diseases and their vectors. Lymphatic filariasis is the leading cause of permanent disfigurement and the second most common cause of long-term disability in the world.
Collapse
Affiliation(s)
- Gayle B Lourens
- Michigan State University, 1355 Bogue Street, East Lansing, MI 48824, USA.
| | - Denise K Ferrell
- Michigan State University, 1355 Bogue Street, East Lansing, MI 48824, USA
| |
Collapse
|