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

Abstract

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.

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

“…The present survey results highlight a greater burden of lymphoedema cases compared to that of hydrocoele, with over 33 times as many leg lymphoedema cases reported than hydrocoele. These results differ to other studies on clinical case estimates in African LF-endemic countries including Malawi and Tanzania where the number of hydrocoele cases identified was almost double that of lymphoedema cases identified [ 28 , 29 ].This is likely to be related to the presence of podoconiosis in Ethiopia. Here we highlight that the vast majority of lymphoedema cases were bilateral; a manifestation more typically seen with non-filarial lymphoedema [ 9 ].…”

Environmental suitability for lymphatic filariasis in Nigeria

“…This drop may be explained by the absence of stable lights in uninhabited areas where the mosquito population is more likely to be of low abundance, or in more rural settings where stable lights are less likely to be present, as electricity is in short supply in large parts of rural Nigeria. Although LF has always been associated with more rural areas [ 66 – 68 ], a recent study in Tanzania has highlighted the burden of LF in urban settings [ 69 ], and corroborated in a study conducted in an urban Nigerian setting [ 68 ]. Studies have also illustrated that mosquitoes are more likely to aggregate around human populations [ 70 , 71 ].…”

The changing global landscape of health and disease: addressing challenges and opportunities for sustaining progress towards control and elimination of neglected tropical diseases (NTDs)

“…This enabled identification, recording and mapping of lymphatic filariasis patients increases the efficiency of planning appropriate morbidity management and disability prevention (MMDP) activities (Mwingira et al 2017). Similarly, the use of global positioning system data loggers is likely to become increasingly important to understand the movement of individuals and the dynamics of communities and individual behaviours and consequent transmission ecology (Brant et al 2018).…”