Lymphatic filariasis: managing morbidity and preventing disability
An aide-mémoire for national programmes managers
A significant proportion of the public health problem represented by lymphatic filariasis is due to impairment and disability related to lymphoedema (elephantiasis) and hydrocoele. Therefore, national programmes must focus on managing morbidity and preventing disability. These activities will not only help lymphatic filariasis patients but can improve coverage with drugs.
Management of morbidity and disability in lymphatic filariasis require a broad strategy involving both secondary and tertiary prevention. Secondary prevention includes simple hygiene measures, such as basic skin care, to prevent acute dermatolymphangioadenitis and progression of lymphoedema to elephantiasis. For management of hydrocoele, surgery may be appropriate. Tertiary prevention includes psychological and socioeconomic support for people with disabling conditions to ensure that they have equal access to rehabilitation services and opportunities for health, education and income. Activities beyond medical care and rehabilitation include promoting positive attitudes towards people with disabilities, preventing the causes of disabilities, providing education and training, supporting local initiatives, and supporting micro- and macro-income-generating schemes. The activities can also include education of families and communities, to help patients with lymphatic filariasis to fulfil their roles in society. Thus, vocational training and appropriate psychological support may be necessary for overcoming the depression and economic loss associated with the disease.
Morbidity management and disability prevention must be continued in endemic communities after mass drug administration has stopped and after surveillance and verification of interruption of transmission, as chronically affected patients are likely to remain in these communities.