Lymphatic filariasis morbidity mapping: a comprehensive examination of lymphoedema burden in Chikwawa district, Malawi

Smith, Emma; Mkwanda, Square Z.; Martindale, Sarah L.; Kelly-Hope, Louise A.; Stanton, Michelle C.

doi:10.1093/trstmh/tru150

Cited by 23 publications

(28 citation statements)

References 28 publications

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Section: Introductionmentioning

confidence: 99%

“…Recent studies in Chikwawa district, Southern Region have focused on quantifying the number of people affected by the clinical symptoms of LF [13, 14], and measuring the self-assessed quality of life of those affected [15]. These studies involved classifying the severity of lymphoedema into three categories (mild, moderate, severe), corresponding to Dreyer stages 1–2, 3–5 and 5–7 respectively, according to the degree of swelling and the presence of skin folds [13, 16]. Whilst Martindale et al [15] provided a valuable insight into the burden placed on those affected by their condition, their study was limited to subjective measures of quality of life/disability, and no comparison was made between those affected and the remainder of the local population.…”

Section: Introductionmentioning

confidence: 99%

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Measuring the physical and economic impact of filarial lymphoedema in Chikwawa district, Malawi: a case-control study

et al. 2017

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BackgroundLymphatic filariasis (LF) is one of the primary causes of lymphoedema in sub-Saharan Africa, and has a significant impact on the quality of life (QoL) of those affected. In this paper we assess the relative impact of lymphoedema on mobility and income in Chikwawa district, Malawi.MethodsA random sample of 31 people with lymphoedema and 31 matched controls completed a QoL questionnaire from which both an overall and a mobility-specific score were calculated. Two mobility tests were undertaken, namely the 10 m walking test [10MWT] and timed up and go [TUG] test, and a subset of 10 cases-control pairs wore GPS data loggers for 3 weeks to measure their mobility in a more natural setting. Retrospective economic data was collected from all 31 case-control pairs, and each participant undertaking the GPS activity recorded daily earnings and health expenditure throughout the observation period.ResultsCases had a significantly poorer overall QoL (cases = 32.2, controls = 6.0, P < 0.01) and mobility-specific (cases = 43.1, controls = 7.4, P < 0.01) scores in comparison to controls. Cases were also significantly slower (P < 0.01) at completing the timed mobility tests, e.g. mean 10MWT speed of 0.83 m/s in comparison to 1.10 m/s for controls. An inconsistent relationship was observed between mobility-specific QoL scores and the timed test results for cases (10MWT correlation = −0.06, 95% CI = (−0.41, 0.30)), indicating that their perceived disability differed from their measured disability, whereas the results were consistent for controls (10MWT correlation = −0.61, 95% CI = (−0.79, −0.34)). GPS summaries indicated that cases generally walk shorter distances at slower speeds than control, covering a smaller geographical area (median area by kernel smoothing: cases = 1.25 km2, controls = 2.10 km2, P = 0.16). Cases reported earning less than half that earned by controls per week (cases = $0.70, controls = $1.86, P = 0.064), with a smaller proportion of their earnings (16% vs 22%, P = 0.461) being spent on healthcare.ConclusionsThose affected by lymphoedema are at a clear disadvantage to their unaffected peers, experiencing a lower QoL as confirmed by both subjective and objective mobility measures, and lower income. This study also indicates that objective measures of mobility may be a useful supplement to self-assessed QoL questionnaires when assessing the future impact of lymphoedema management interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-017-0241-2) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Measuring the physical and economic impact of filarial lymphoedema in Chikwawa district, Malawi: a case-control study

et al. 2017

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“…MDA campaigns have been occurring in India since 1997 and have progressed well with some areas having demonstrated interruption of transmission [3, 8, 9]. However, it is recognized that MDA does not treat the chronic clinical manifestations, specifically lymphedema, elephantiasis and hydrocele, seen in some LF-infected individuals [2, 10]. Therefore, for individuals with lymphedema and elephantiasis, lymphedema management programs are necessary to mitigate the symptoms associated with lymphedema, and to prevent the development of episodes of adenolymphangitis (ADL) known to lead to the worsening of lymphedema [11, 12].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, for individuals with lymphedema and elephantiasis, lymphedema management programs are necessary to mitigate the symptoms associated with lymphedema, and to prevent the development of episodes of adenolymphangitis (ADL) known to lead to the worsening of lymphedema [11, 12]. Accurate estimates of lymphedema and hydrocele patients are needed by national LF elimination programs to inform service provision, yet robust assessments have been rarely performed [10, 13]. An emphasis needs to be placed on obtaining accurate patient estimates in order to properly scale up morbidity management and disability prevention services for LF patients with clinical disease.…”

Section: Introductionmentioning

confidence: 99%

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

Walsh¹,

Little²,

Wiegand³

et al. 2016

PLoS Negl Trop Dis

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BackgroundOver 1.1 billion people worldwide are at risk for lymphatic filariasis (LF), and the global burden of LF-associated lymphedema is estimated at 16 million affected people, yet country-specific estimates are poor.Methodology/Principal FindingsA house-to-house morbidity census was conducted to assess the burden and severity of lymphedema in a population of 1,298,576 persons living in the LF-endemic district of Khurda in Odisha State, India. The burden of lymphedema in Khurda is widespread geographically, and 1.3% (17,036) of the total population report lymphedema. 51.3% of the patients reporting lymphedema were female, mean age 49.4 years (1–99). Early lymphedema (Dreyer stages 1 & 2) was reported in two-thirds of the patients. Poisson regression analysis was conducted in order to determine risk factors for advanced lymphedema (Dreyer stages 4–7). Increasing age was significantly associated with advanced lymphedema, and persons 70 years and older had a prevalence three times greater than individuals ages 15–29 (aPR: 3.21, 95% CI 2.45, 4.21). The number of adenolymphangitis (ADL) episodes reported in the previous year was also significantly associated with advanced lymphedema (aPR 4.65, 95% CI 2.97–7.30). This analysis is one of the first to look at potential risk factors for advanced lymphedema using morbidity census data from an entire district in Odisha State, India.SignificanceThese data highlight the magnitude of lymphedema in LF-endemic areas and emphasize the need to develop robust estimates of numbers of individuals with lymphedema in order to identify the extent of lymphedema management services needed in these regions.

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“…For example, where MDA is implemented using house-to-house delivery, it may be possible to collect patient data during the MDA registration or delivery (3,11). However, in IUs where community distribution posts are used to deliver treatments to the community, using the MDA to record patient data may result in under-reporting as it relies on the patients presenting at the distribution posts and reporting their conditions.…”

Section: Discussionmentioning

confidence: 99%

Community-based field implementation scenarios of a short message service reporting tool for lymphatic filariasis case estimates in Africa and Asia

Mableson

Martindale

Stanton

et al. 2017

mHealth

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Background: Lymphatic filariasis (LF) is a neglected tropical disease (NTD) targeted for global elimination by 2020. Currently there is considerable international effort to scale-up morbidity management activities in endemic countries, however there remains a need for rapid, cost-effective methods and adaptable tools for obtaining estimates of people presenting with clinical manifestations of LF, namely lymphoedema and hydrocele. The mHealth tool 'MeasureSMS-Morbidity' allows health workers in endemic areas to use their own mobile phones to send clinical information in a simple format using short message service (SMS). The experience gained through programmatic use of the tool in five endemic countries across a diversity of settings in Africa and Asia is used here to present implementation scenarios that are suitable for adapting the tool for use in a range of different programmatic, endemic, demographic and health system settings. Methods: A checklist of five key factors and sub-questions was used to determine and define specific community-based field implementation scenarios for using the MeasureSMS-Morbidity tool in a range of settings. These factors included: (I) tool feasibility (acceptability; community access and ownership); (II) LF endemicity (high; low prevalence); (III) population demography (urban; rural); (IV) health system structure (human resources; community access); and (V) integration with other diseases (co-endemicity). Results: Based on experiences in Bangladesh, Ethiopia, Malawi, Nepal and Tanzania, four implementation scenarios were identified as suitable for using the MeasureSMS-Morbidity tool for searching and reporting LF clinical case data across a range of programmatic, endemic, demographic and health system settings. These include: (I) urban, high endemic setting with two-tier reporting; (II) rural, high endemic setting with onetier reporting; (III) rural, high endemic setting with two-tier reporting; and (IV) low-endemic, urban and rural setting with one-tier reporting. Conclusions: A decision-making framework built from the key factors and questions, and the resulting four implementation scenarios is proposed as a means of using the MeasureSMS-Morbidity tool. This framework will help national LF programmes consider appropriate methods to implement a survey using this tool to improve estimates of the clinical burden of LF. Obtaining LF case estimates is a vital step towards the elimination of LF as a public health problem in endemic countries.

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Lymphatic filariasis morbidity mapping: a comprehensive examination of lymphoedema burden in Chikwawa district, Malawi

Abstract: Current case detection methods underestimate the burden of lymphoedema in Malawi. There is a continued need to develop new LF morbidity identification and surveillance approaches to ensure that future morbidity management strategies are effectively targeted.

Cited by 23 publications

References 28 publications

Measuring the physical and economic impact of filarial lymphoedema in Chikwawa district, Malawi: a case-control study

Measuring the physical and economic impact of filarial lymphoedema in Chikwawa district, Malawi: a case-control study

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

Community-based field implementation scenarios of a short message service reporting tool for lymphatic filariasis case estimates in Africa and Asia

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