Evaluating the Burden of Lymphedema Due to Lymphatic Filariasis in 2005 in Khurda District, Odisha State, India

Walsh, Victoria L.; Little, Kristen; Wiegand, Ryan E.; Rout, Jonathan; Fox, LeAnne M.

doi:10.1371/journal.pntd.0004917

Cited by 13 publications

(13 citation statements)

References 23 publications

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“…Lymphedema was found predominantly among those in the older age group (median age 56 years); most cases occured in women (84%). The preponderance of lymphedema among women is in line with observations in other LF endemic countries [12,14,15]. The age and gender distribution is different from what has been reported in podoconiosis which is mainly observed in individuals between 10 and 30 years old without any gender predominance [4,13,16].…”

Section: Discussionsupporting

confidence: 81%

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

et al. 2020

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Background: Lymphedema is a public health problem in countries with lymphatic filariasis (LF) including Mali. We studied the epidemiology and clinical presentation of lymphedema in three previously LF-endemic health districts of Mali after at least five consecutive rounds of mass drug administration (MDA) with albendazole and ivermectin. Methods: From 2016 to 2018, we used passive and active case finding methods to identify lymphedema cases in three health districts with high pre-MDA LF prevalence: Kolondieba (66%), Bougouni (44%) and Kolokani (34%). Results: Three hundred and thirty nine cases of lymphedema were identified, 235 (69.32%) through active case finding. Their median age was 56 years (range 2-90) and 286 (84.36%) were women. Lymphedema was reported in 226 (78.5%) people aged 41 years and older compared to 73 (21.5%) people below the age of 41 years (Chi 2 = 17.28, df = 5, p = 0.004). One hundred and seventy five cases of lymphedema were found in Kolondieba (66 per 100,000 people), 116 in Bougouni (19 per 100,000) and 48 in Kolokani (16 per 100,000). Stage III lymphedema was observed in 131 (38.64%), stage II in 108 (31.86%), stage IV in 46 (13.57%), stage I in 23 (6.78%), stage V in 21 (6.19%) and stage VI in ten (2.95%). In the three study districts, lymphedema affected the legs in 281 (82.89%), the arms in 42 (12.39%) and both in 16 (4.72%) (Chi2 = 13.63, p = 0.008). Conclusion: Health districts in Mali with the highest pre-MDA LF prevalences had the highest prevalence of lymphedema. Efforts to actively identify lymphedema cases should be scaled up in previous LF-endemic areas, and should be supplemented by a morbidity management and disability prevention plan at the peripheral health system level.

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Section: Discussionsupporting

confidence: 81%

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

et al. 2020

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“…Our dataset was based on a morbidity census that was taken by visiting every household in the rural and peri-urban areas of Khurda District and found more than 17,000 persons with some degree of lower-limb lymphedema, 1.3% of the regional population. 55 Two-thirds of persons with lymphedema, however, were in stage 1 or 2. These results suggest the possible invisibility of persons in other locations who have subclinical lymphatic damage due to LF infection, early-stage lymphedema, or infrequent episodes of ADLA and who remain at risk for worsening ADLA, advanced lymphedema, and disability.…”

Section: Discussionmentioning

confidence: 99%

“…In 2005, 40 local NGOs conducted a house-to-house census of 1.3 million persons in the rural and peri-urban areas of Khurda District in Odisha State, an LF-endemic area, and identified all residents with lower-limb lymphedema, recording age, gender, lymphedema stage, and number of ADLA episodes in the previous year. 53 – 55 From 2007 to 2010, CASA provided services to more than 21,000 persons identified in 1,447 villages in a community-based program utilizing community health workers to train LF patients in leg washing and use of topical antibiotic and antifungal treatments. 54 In 2009 to 2011, 370 patients from villages not yet enrolled in the CASA program in Khurda were recruited in a prospective cohort study examining the effectiveness of the lymphedema management program.…”

Section: A Community-based Program In Khurda District Odisha State mentioning

confidence: 99%

Economic Costs and Benefits of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State, India

Stillwaggon

Sawers

Rout³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Lymphatic filariasis afflicts 68 million people in 73 countries, including 17 million persons living with chronic lymphedema. The Global Programme to Eliminate Lymphatic Filariasis aims to stop new infections and to provide care for persons already affected, but morbidity management programs have been initiated in only 24 endemic countries. We examine the economic costs and benefits of alleviating chronic lymphedema and its effects through a simple limb-care program. For Khurda District, Odisha State, India, we estimated lifetime medical costs and earnings losses due to chronic lymphedema and acute dermatolymphangioadenitis (ADLA) with and without a community-based limb-care program. The program would reduce economic costs of lymphedema and ADLA over 60 years by 55%. Savings of US$1,648 for each affected person in the workforce are equivalent to 1,258 days of labor. Per-person savings are more than 130 times the per-person cost of the program. Chronic lymphedema and ADLA impose a substantial physical and economic burden on the population in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication for infection are effective in reducing the number of ADLA episodes and stopping progression of disabling and disfiguring lymphedema. With reduced disability, people are able to work longer hours, more days per year, and in more strenuous, higher-paying jobs, resulting in an important economic benefit to themselves, their families, and their communities. Mitigating the severity of lymphedema and ADLA also reduces out-of-pocket medical expense.

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“…Patients also reported losing 2.5 fewer work days per month after 1 year in the program. 30,36,39 In another study of the 370 patients in the limb-care program, ADLA episodes decreased 34% over 24 months, and there was both a drop in the percentage of persons whose lymphedema progressed (worsened) and an increase in the percentage of those whose lymphedema regressed (improved). 30 The context of a national public health policy in India.…”

Section: Nature Of the Diseasementioning

confidence: 99%

Economic Costs and Benefits of Community-Based Lymphedema-Management Programs for Lymphatic Filariasis in India

Sawers

Stillwaggon

2020

The American Journal of Tropical Medicine and Hygiene

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Lymphatic filariasis (LF) is endemic in 72 countries; 15 million persons live with chronic filarial lymphedema. It can be a disabling condition, frequently painful, leading to reduced mobility, social exclusion, and depression. The Global Program to Eliminate Lymphatic Filariasis aims to stop new infections and care for affected persons, but morbidity management has been initiated in only 38 countries. We examine economic costs and benefits of alleviating chronic lymphedema and its effects through simple limb care. We use economic and epidemiological data from 12 Indian states in which 99% of Indians with filariasis reside. Using census data, we calculate the age distribution of filarial lymphedema and predict the burden of morbidity of infected persons. We estimate lifetime medical costs and lost earnings due to lymphedema and acute dermatolymphangioadenitis (ADLA) with and without community-based limb-care programs. Programs of community-based limb care in all Indian endemic areas would reduce costs of disability by 52%, saving a per person average of US$2,721, equivalent to 703 workdays. Per-person savings are 185 times the program's per-person cost. Chronic lymphedema and ADLA impose a substantial physical and economic burden in filariasis-endemic areas. Low-cost programs for lymphedema management based on limb washing and topical medication are effective in reducing the number of ADLA episodes and stopping progression of disabling lymphedema. With reduced disability, people can work longer hours per day, more days per year, and in more strenuous, higher paying jobs, resulting in important economic benefits to themselves, their families, and their communities. Author's Dedication. Eileen Stillwaggon passed away not long after this paper was accepted for publication by the AJTMH. Eileen's participation in this project exemplifies qualities that she brought to all of her scholarship. She applied her skills as an economist to show that curing or preventing disease could be far cheaper than failing to do so. From her first piece of published research to her last, she worked to undermine racial and gender discrimination. A recurrent theme in her research were efforts to expose how racism distorts medical research and thus health policy. Her passion to make the world a better place will be sorely missed.

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Evaluating the Burden of Lymphedema Due to Lymphatic Filariasis in 2005 in Khurda District, Odisha State, India

Cited by 13 publications

References 23 publications

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

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

Economic Costs and Benefits of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State, India

Economic Costs and Benefits of Community-Based Lymphedema-Management Programs for Lymphatic Filariasis in India

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