Caring for patients in the global programme to eliminate lymphatic filariasis

Abstract

Clinical lymphatic filariasis (LF) is a debilitating, disfiguring medical condition with severe psychosocial consequences for patients and their families. Addressing these patients’ medical needs is a major component of the global programme to eliminate lymphatic filariasis (GPELF). In the 20 y of providing a minimal package of care many thousands of surgical operations to correct LF hydrocoeles been performed and national programmes in >90% of LF endemic countries have received the training needed to care for their patients. The creation of educational materials detailing appropriate patient care, together with increased funding, have been key catalysts in increasing awareness of clinical LF in recent years. Nevertheless, the implementation of care for these patients has often faced challenges that have led to delays in fully implementing the patient care component of GPELF; these include locating these often stigmatised individuals, maintaining provision of the necessary consumables (e.g. soaps and creams) and maintaining programme support within already overstretched national LF teams. As the LF global programme moves to achieve success by 2030 it will be vital to continue to focus efforts on the care and rehabilitation of those suffering from lymphoedema and hydrocoeles, learning from the experiences of the past 20 y.

Unlocking Trust in Community Health Systems: Lessons From the Lymphatic Filariasis Morbidity Management and Disability Prevention Pilot Project in Luangwa District, Zambia

“…3 Department of Community and Family Medicine, School of Public Health, The University of Zambia, Lusaka, Zambia. 4 Department of Environmental Health, School of Public Health, The University of Zambia, Lusaka, Zambia. 5 Participatory Research and Innovations Management (PRIM), Lusaka, Zambia.…”

“…2,3 Morbidity management and disability prevention (MMDP) services targeted towards hydrocele and lymphoedema patients form the second pillar of the Global Program for the Elimination of Lymphatic Filariasis. 4,5 The basic MMDP package includes treatment for LF infections and episodes of adenolymphangitis (acute attacks), management of lymphoedema to prevent acute attacks and disease progression to elephantiasis and surgery for hydrocele. 2,6,7 Zambia is one of the 34 countries in the African region in which LF is endemic, with up to 12 million people at risk of infection.…”

Scaling-up filariasis lymphoedema management into the primary health care system in Kerala State, Southern India: a case study in healthcare equity

“…This initiative includes alleviating the suffering in those who already have the disease through Morbidity Management and Disability Prevention (MMDP). In addition to providing an “essential package of care” (EPC) to those suffering from LF [ 7 , 8 ], there is the important additional recommendation for the integration of this medical support into the public health system of the endemic country. Such a goal is also in line with the global goals set out by the United Nations’ Sustainable Develop Goals (SDG) [ 9 ].…”

Alternative approaches to lymphoedema care in lymphatic filariasis

“…Caring for those clinically affected by lymphatic filariasis (LF) is increasingly being recognised as a central activity within the global effort to eliminate this debilitating infection. The World Health Organisation has specifically included this provision of care as an essential component of the global LF elimination program and as a requirement for achieving global success [1,2]. WHO recommends that a Minimum Package of Care (MPC) is made available to every LF patient with lymphoedema (LE) that includes the daily washing of the affected area, the use of topical creams for wounds and local infections, as well as the provision of therapeutic support for those suffering from the acute filarial attacks that commonly debilitate these patients [3].…”

“…Despite the advances in care for filariasis patients brought about by the instigation of the global filariasis elimination program [2], it is important that both new approaches to treatment and to the assessment of LE in filarial patients are developed. Recently, some newer techniques are being used to assess LE patients in filariasis-endemic areas taking the lessons from the procedures used in more advanced medical settings [20,21]: Infrared imaging, indurometry, and the detection of fluid content of the affected tissues are all now being implemented in early field studies, as is a more accurate means of measuring limb volume [22].…”