It is Possible: Availability of Lymphedema Case Management in each Health Facility in Togo. Program Description, Evaluation, and Lessons Learned

Abstract

Abstract. Lymphatic filariasis (LF) is a vector-borne parasitic disease that can clinically manifest as disabling lymphedema. Although the LF elimination program aims to reduce disability and to interrupt transmission, there has been a scarcity of disease morbidity management programs, particularly on a national scale. This report describes the implementation of the first nationwide LF lymphedema management program. The program, which was initiated in Togo in 2007, focuses on patient behavioral change. Its goal is two-fold: to achieve a sustainable program on a national-scale, and to serve as a model for other countries. The program has five major components: 1) train at least one health staff in lymphedema care in each health facility in Togo; 2) inform people with a swollen leg that care is available at their dispensary; 3) train patients on self-care; 4) provide a support system to motivate patients to continue self-care by training community health workers or family members and providing in home follow-up; and 5) integrate lymphedema management into the curriculum for medical staff. The program achieved the inclusion of lymphedema management in the routine healthcare package. The evaluation after three years estimated that 79% of persons with a swollen leg in Togo were enrolled in the program. The adherence rate to the proposed World Health Organization treatment of washing, exercise, and leg elevation was more than 70% after three years of the program, resulting in a stabilization of the lymphedema stage and a slight decrease in reported acute attacks among program participants. Health staff and patients consider the program successful in reaching and educating the patients. After the external funding ended, the morbidity management program is maintained through routine Ministry of Health activities.

Self-Care for Management of Secondary Lymphedema: A Systematic Review

“…Those studies which stipulated a published protocol for morbidity management of FR-LE followed the WHO Community Based Home Care guidelines [ 14 , 34 , 35 ] or the ‘New Hope for People with Lymphoedema’ booklet by Dreyer, Addiss [ 11 ] [ 32 ]. Six FR-LE and three CR-LE studies received printed instructions [ 14 , 36 , 37 , 40 , 41 , 49 ] [ 28 , 38 , 42 ] and two CR-LE studies delivered home support through digital media [ 31 , 38 ].…”

“…Participants in most FR-LE studies attended fortnightly or monthly home or clinic visits with extra, surprise field checks in five studies [ 24 , 25 , 30 , 36 , 48 ]. Some participants were able to access a clinic or health care worker as needed [ 41 , 50 ] while others recorded ADLA events in a log book [ 32 , 49 ]. Participants in all prospective CR-LE studies attended measurement clinics at intervals of between two and twelve weeks.…”

The Effect of Hygiene-Based Lymphedema Management in Lymphatic Filariasis-Endemic Areas: A Systematic Review and Meta-analysis

“…and M.P. Following this screening, 22 articles were determined to meet systematic review inclusion criteria ( Table 2 ) [ 13 , 14 , 16 – 18 , 26 – 42 ]. We conducted two meta-analyses.…”

Ongoing Surveillance for Lymphatic Filariasis in Togo: Assessment of Alternatives and Nationwide Reassessment of Transmission Status

“…Although the current report focuses on surveillance to ensure interruption of transmission, morbidity control efforts have also been an essential component of the LF control program in Togo and have recently been described elsewhere. 6,24 Because hydrocele and lymphedema are poor indicators of active filarial burden, 25 they are not currently used for surveillance of LF transmission in Togo; incorporation of these indicators of LF-related morbidity into ongoing surveillance should be considered.…”