Integrated morbidity management for lymphatic filariasis and podoconiosis, Ethiopia

Abstract

ProblemLymphatic filariasis and podoconiosis are the major causes of tropical lymphoedema in Ethiopia. The diseases require a similar provision of care, but until recently the Ethiopian health system did not integrate the morbidity management.ApproachTo establish health-care services for integrated lymphoedema morbidity management, the health ministry and partners used existing governmental structures. Integrated disease mapping was done in 659 out of the 817 districts, to identify endemic districts. To inform resource allocation, trained health extension workers carried out integrated disease burden assessments in 56 districts with a high clinical burden. To ensure standard provision of care, the health ministry developed an integrated lymphatic filariasis and podoconiosis morbidity management guideline, containing a treatment algorithm and a defined package of care. Experienced professionals on lymphoedema management trained government-employed health workers on integrated morbidity management. To monitor the integration, an indicator on the number of lymphoedema-treated patients was included in the national health management information system.Local settingIn 2014, only 24% (87) of the 363 health facilities surveyed provided lymphatic filariasis services, while 12% (44) provided podoconiosis services.Relevant changesTo date, 542 health workers from 53 health centres in 24 districts have been trained on integrated morbidity management. Between July 2013 and June 2016, the national health management information system has recorded 46 487 treated patients from 189 districts.Lessons learntIn Ethiopia, an integrated approach for lymphatic filariasis and podoconiosis morbidity management was feasible. The processes used could be applicable in other settings where these diseases are co-endemic.

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

“…LF and podoconiosis morbidity management and disability prevention (MMDP) programmes largely consist of limb hygiene and self-care activities, which are paramount to alleviate suffering and to reduce the occurrence of ADLAs [37]. It is pragmatic, cost-effective and efficient to integrate the LF and podoconiosis MMDP programmes where possible [38].…”

“…This study, therefore, aimed to determine the socio-economic impact on caregivers for patients with leg lymphoedema in Ethiopia, where an estimated 5.6 million individuals are at risk of LF and 34.9 million individuals are at risk of podoconiosis [38]. A cross-sectional survey in a co-endemic district highlighted caregiver socio-demographic characteristics, types of care provided, QoL, and productivity, with key indicators compared in the presence and absence of patients' ADLAs.…”

“Buruli ulcer and leprosy, they are intertwined”: Patient experiences of integrated case management of skin neglected tropical diseases in Liberia

“…While integrated approaches to the case management of skin NTDs have been implemented in co-endemic areas, few health systems have documented actual experiences of implementation [25]. A case study in Ethiopia reported the managerial feasibility of integrating morbidity management of tropical lymphedema caused by lymphatic filariasis (LF) and podoconiosis [26]. Patient experiences of integrated care for leprosy and BU in Cote d'Ivoire [25], LF and leprosy in Nepal [27], and multiple skin NTDs in Liberia [18] have been explored in community settings, but studies investigating the social experience of integrated case management in facility settings are lacking.…”

Predicting the Environmental Suitability and Population at Risk of Podoconiosis in Africa

“…Areas where the LF programme has already advanced, the existing platform and programme activities such as the transmission assessment surveys (TAS) can be used to integrate podoconiosis mapping. Once the mapping is completed integrated morbidity movement services can be provided to all cases, as has been found to be feasible in Ethiopia 62 .…”