Mapping lymphatic filariasis morbidities in 24 endemic districts of Ethiopia
Authors: Bisrat Haileleuel , H/Kiros Fikre , Jemberie Mebratu Mitku , Mengiste Asrat , Mekonnon Merga , Seife Fikre , Oljira Birhanu , Terefe Haileyesus , Bekele Tamrat , Manyazewal Tsegahun 
Published: September 2024

Abstract

Background
The core strategy for achieving the second goal of the Global Program to Eliminate Lymphatic Filariasis (GPELF), which is to alleviate the suffering of affected populations, is Morbidity management and disability prevention (MMDP). Effectively registering and locating individuals suffering from LF remain critical gap in many LF-endemic settings for planning and ensuring access to MMDP services. This study aims to map the geographical distribution of LF morbidities across 24 endemic districts in Ethiopia.
Methods
A community-based cross-sectional study was conducted to identify individuals suffering from LF in 24 endemic districts. Using primary health care units (PHCUs), the study involved 946 trained Health Extension Workers (HEWs) who conducted house-to-house visits to identify and register individuals with lymphoedema and hydrocoele. Additionally, 77 trained supervisors and 87 team leaders coordinated the morbidity mapping in their respective districts and PHCUs. Surgeons performed confirmatory evaluations of individuals with lymphedema and hydrocele randomly sampled from selected districts. Statistical analysis of data, including severity of lymphoedema and acute attacks, was performed using STATA 17.
Results
A total of 15,527 cases of LF morbidities were identified. Among these, 14,946 (96.3%) were cases of limb lymphoedema, wile 581 (3.7%) were hydrocele. Of those with lymphedema, 8,396 (54.1%) were women. Additionally, 13,731 (88.4%) of cases resided in rural areas where access to preventive and curative services is limited. Of 14,591 cases with recorded information about acute attack, 10710 (73.4%) reported experiencing at least one acute attack in the last six months related to their lymphoedema, with a higher percentage of males reported (74.5%; n = 4981/6686). Out of 12,680 recorded cases of leg lymphedema, the percentage of reported acute attacks rose with severity: mild cases 64% (n = 5,618), moderate 68% (n = 5,169), and severe 70% (n = 1,893). Most patients, 64%, reported swollen legs for 1 to 10 years, indicating a high prevalence of recent cases. In contrast, only 25% of patients had swollen legs for 10 to 20 years, suggesting a decline in cases over this longer period. The HEW-surgeon confirmatory evaluation showed that 80% of hydrocele cases and 95% of lymphedema cases matched the HEWs' assessments, indicating strong agreement.
Conclusion
Using the existing Health Extension Program platform, this study identified a substantial number of lymphedema and hydrocele cases across 24 LF-endemic districts in Ethiopia, with strong agreement between HEWs and surgeons in their case assessments. Cases were predominantly recent lymphoedema, affecting mostly women and individuals in rural areas. PHCUs proved instrumental in identifying LF cases, as HEWs were well-positioned to engage with and support the communities they serve.