The development of a capacity-strengthening program to promote self-care practices among people with lymphatic filariasis-related lymphedema in the Upper West Region of Ghana

Abstract

Background The Upper West region of Ghana is mostly made up of rural communities and is highly endemic for lymphatic filariasis (LF), with a significant burden of disability due to lymphedema and hydrocele. The aim of this paper is to describe an enhanced, evidence-based cascading training program for integrated lymphedema management in this region, and to present some initial outcomes. Main text A baseline evaluation in the Upper West Region was carried out in 2019. A cascaded training program was designed and implemented, followed by a roll-out of self-care activities in all 72 sub-districts of the Upper West Region. A post implementation evaluation in 2020 showed that patients practiced self-care more frequently and with more correct techniques than before the training program; they were supported in this by health staff and family members. Conclusions Self-care for lymphedema is feasible and a program of short workshops in this cascaded training program led to significant improvements. Efforts to maintain momentum and sustain what has been achieved so far, will include regular training and supervision to improve coverage, the provision of adequate resources for limb care at home, and the maintenance of district registers of lymphedema cases, which must be updated regularly.

Zambia: A Narrative Review of Success and Challenges in Lymphatic Filariasis Elimination

“…This is based on the number of 1696 hydroceles and 1871 lymphoedema cases identified between 2015 and 2021 for which surgeries have not yet been performed [ 40 ]. The next step in ensuring that the surgeries are conducted for hydroceles and lymphedemas is training for surgeons, nurses, community health workers, patients, and family members to LF patients [ 52 ]. Coordination between local health facilities and NTD program managers is essential to ensure patient care is safely and equitably handed off.…”

“…As temperatures in more equatorial countries exceed the ideal, we may see co-infections of onchocerciasis and LF in Zambia. As such, many have advocated for the closer, albeit nimble, integration of LF and other tropical diseases [ 52 , 67 ].…”

Ghana’s path towards eliminating lymphatic filariasis

“…Following the 1997 World Health Assembly (WHA) Resolution WHA 50.29, which called for LF eradication efforts, the GPELF was launched in 2000 with a goal to eliminate LF by 2020 [11]. Its strategies included halting LF transmission via mass drug administration (MDA) to at-risk populations and managing LF's health impacts by providing a basic care package [13][14][15].…”

“…By 2018, global LF infection dropped to 51 million, a 74% decline, with around 692 million people no longer requiring preventive treatment [6]. Despite these achievements, some countries, particularly in Sub-Saharan Africa like Ghana, struggle to meet GPELF's objectives [12][13][14]. In response, GPELF has outlined new targets in the 2020 NTD Road Map for further LF elimination efforts [6,15].…”

Improving access to lymphatic filariasis MMDP services through an enhanced evidence-based, cascaded training model for health worker capacity strengthening in Ghana: an evaluation study

“…Chronic lymphedema is a lifelong condition predominantly occurring in LF-endemic areas with a high level of poverty and poor access to healthcare services, making the burden of care fall heavily on patients and their family members. This therefore requires some training in self-care strategies to empower patients to handle some basic but important self-care protocols, especially those with moderate to severe lymphedema (3,10,11). The proposed selfcare protocol covers areas such as: hygiene (which incorporates washing and drying, attending to skin lesions, use of medicated cream, and trimming nails), exercise (which includes standing, seating, and laying exercises; day-and night-time elevation of the affected limb, walking, and deep breathing), and massage (which includes mobilizing skin and tissues through lymphatic massage).…”