Developing the first national database and map of lymphatic filariasis clinical cases in Bangladesh: Another step closer to the elimination goals

Abstract

Background The Bangladesh Lymphatic Filariasis (LF) Elimination Programme has made significant progress in interrupting transmission through mass drug administration (MDA) and has now focussed its efforts on scaling up managing morbidity and preventing disability (MMDP) activities to deliver the minimum package of care to people affected by LF clinical conditions. This paper highlights the Bangladesh LF Programme’s success in conducting a large-scale cross-sectional survey to determine the number of people affected by lymphoedema and hydrocoele, which enabled clinical risk maps to be developed for targeted interventions across the 34 endemic districts (19 high endemic; 15 low endemic). Methodology/Principal findings In the 19 high endemic districts, 8,145 community clinic staff were trained to identify and report patients in their catchment area. In the 15 low endemic districts, a team of 10 trained field assistants conducted active case finding with cases reported via a SMS mHealth tool. Disease burden and prevalence maps were developed, with morbidity hotspots identified at sub-district level based on a combination of the highest prevalence rates per 100,000 and case-density rates per square kilometre (km 2 ). The relationship between morbidity and baseline microfilaria (mf) prevalence was also examined. In total 43,678 cases were identified in the 19 high endemic districts; 30,616 limb lymphoedema (70.1%; female 55.3%), 12,824 hydrocoele (29.4%), and 238 breast/female genital swelling (0.5%). Rangpur Division reported the highest cases numbers and prevalence of lymphoedema (26,781 cases, 195 per 100,000) and hydrocoele (11661 cases, 169.6 per 100,000), with lymphoedema predominately affecting females (n = 21,652). Rangpur and Lalmonirhat Districts reported the highest case numbers (n = 11,199), and prevalence (569 per 100,000) respectively, with five overlapping lymphoedema and hydrocoele sub-district hotspots. In the 15 low endemic districts, 732 cases were identified; 661 lymphoedema (90.2%; female 39.6%), 56 hydrocoele (7.8%), and 15 both conditions (2.0%). Spearman’s correlation analysis found morbidity and mf prevalence significantly positively correlated (r = 0.904; p<0.01). Conclusions/Significance The Bangladesh LF Programme has developed one of the largest, most comprehensive country databases on LF clinical conditions in the world. It provides an essential database for health workers to identify local morbidity hotspots, deliver the minimum package of care, and address the dossier elimination requirements.

Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial

“…A change of either ≥10% or ≥2 cm in circumference was considered clinically relevant, and a change of ≥10% was used for Indurometer scores [ 30 , 31 ]. All analyses were performed using Stata 15.1 (StataCorp, College Station, TX, USA) and a p -value of less than 0.05 was considered statistically significant.…”

“…These countries were chosen for their differing populations and stage of MMDP activities. Bangladesh is endemic for LF only and the LF MMDP program has been rolled out to all endemic regions at least once [ 30 ]. In Ethiopia, the national MMDP program is not yet scaled at national levels, and podoconiosis and LF are co-endemic in 29 of 70 LF endemic districts [ 31 ].…”

Caring for patients in the global programme to eliminate lymphatic filariasis

“…adequate oversight from health workers trained in treating LE, local hydrocoelectomy surgery camps). 16 , 17 New approaches have been used to obtain the burden of LF patients including digital methods 18 , 19 and the use of local clinics; in general, it has been found that in many countries an essential route to locating patients is via local health workers. 17 , 20 …”

Progress and impact of 20 years of a lymphatic filariasis elimination programme in South-East Asia

“… 13 , 14 As of 2018, 944 957 lymphoedema patients and 452 891 hydrocele patients were reported by the countries’ programmes. 10 Enlisting the patients in all IUs using robust methodologies 15 , 16 and expansion of the MMDP measures remains a priority for larger countries in the region. This has been well accomplished in Bangladesh, where more than 30 616 lymphoedema patients and 12 824 hydrocele patients were identified and are being provided with the recommended package of care.…”