Integrated morbidity mapping of lymphatic filariasis and podoconiosis cases in 20 co-endemic districts of Ethiopia

Abstract

BackgroundLymphatic filariasis (LF) and podoconiosis are neglected tropical diseases (NTDs) that pose a significant physical, social and economic burden to endemic communities. Patients affected by the clinical conditions of LF (lymphoedema and hydrocoele) and podoconiosis (lymphoedema) need access to morbidity management and disability prevention (MMDP) services. Clear estimates of the number and location of these patients are essential to the efficient and equitable implementation of MMDP services for both diseases.Methodology/Principle findingsA community-based cross-sectional study was conducted in Ethiopia using the Health Extension Worker (HEW) network to identify all cases of lymphoedema and hydrocoele in 20 woredas (districts) co-endemic for LF and podoconiosis. A total of 612 trained HEWs and 40 supervisors from 20 districts identified 26,123 cases of clinical morbidity. Of these, 24,908 (95.3%) reported cases had leg lymphoedema only, 751 (2.9%) had hydrocoele, 387 (1.5%) had both leg lymphoedema and hydrocoele, and 77 (0.3%) cases had breast lymphoedema. Of those reporting leg lymphoedema, 89.3% reported bilateral lymphoedema. Older age groups were more likely to have a severe stage of disease, have bilateral lymphoedema and to have experienced an acute attack in the last six months.Conclusions/SignificanceThis study represents the first community-wide, integrated clinical case mapping of both LF and podoconiosis in Ethiopia. It highlights the high number of cases, particularly of leg lymphoedema that could be attributed to either of these diseases. This key clinical information will assist and guide the allocation of resources to where they are needed most.

Quantifying the socio-economic impact of leg lymphoedema on patient caregivers in a lymphatic filariasis and podoconiosis co-endemic district of Ethiopia

“…However, differential diagnosis may be important in certain circumstances, and previous studies have utilised tests such as filarial antigen testing, filarial antibody testing and parasitological examination to exclude an LF diagnosis in LF and podoconiosis co-endemic areas [15]. All patients experienced frequent ADLAs, with a higher frequency of ADLAs in patients with severe stage lymphoedema [6,7,42], which contribute to the progression of disease and are key predictors of disability [8][9][10]. Whilst recall bias may have influenced the number of ADLAs reported, patients with mild/moderate and severe lymphoedema experienced an average of 6 and 10 respectively, which may be broadly extrapolated to 12 to 20 ADLAs per year.…”

“…Information on the burden of leg lymphoedema was obtained from a community-based integrated morbidity mapping survey conducted in 2015 where the severity of lymphoedema, caused by LF or podoconiosis, was staged as mild, moderate or severe using WHO guidelines [42]. The South Ari district recorded 2,277 lymphoedema patients with mild (n = 1,588, 66.8%), moderate (n = 655, 27.5%) or severe (n = 135, 5.7%) conditions [42]. The Gazer and Metzer health catchment areas were selected for the current study due to the high number of lymphoedema patients.…”

Lymphedema in three previously Wuchereria bancrofti-endemic health districts in Mali after cessation of mass drug administration

“…In tropical countries, LF and podoconiosis are the most frequent causes of acquired lymphedema as opposed to European countries and in the United States where cancer-related treatment is the most frequent cause [23]. Medical record review of 511 patients with lymphedema attending a dermatological clinic in Tigray, Ethiopia between 2005 and 9, revealed that 9.2% of them were people with LF related lymphedema [24]. Intergrated morbidity mapping of LF and podoconiosis in 20 co-endemic districts in Ethiopia in 2018 detected 26,123 cases of lymphedema, 89.3% with bilateral lymphedema [25].…”

The Skin—A Common Pathway for Integrating Diagnosis and Management of NTDs

“…The authors reported that using an integrated process was cost-effective and enabled rapid mapping of a larger geographical area than would otherwise have been achieved by using an individual disease survey. Recently, an integrated mapping exercise was conducted in Ethiopia, in 20 districts co-endemic for LF and podoconiosis, to identify all cases of lymphoedema [ 30 ]. More than 26,000 cases of lymphoedema and/or hydrocele were identified, and the majority of cases (>95%) had leg lymphoedema only, which could be due to LF or podoconiosis.…”