By Adrianna Opong
I used to think Lymphatic Filariasis – also known as elephantiasis – was a curse from the gods and hereditary, until I started working in health research. One day in my new job, I had a chat with Mr Samuel Odoom, the senior technical officer for the Neglected tropical Diseases Programme in the Ghana health service. He explained this to me:
Lymphatic Filariasis (LF) or elephantiasis is caused by infection from the filarial worm (a thread-like worm), which is transmitted from human to human via the female mosquito. The mosquito feeds on the blood of an infected person and then when it later bites an uninfected person, the worms are able to infect a new person. The filarial worms are in their third stage of development when they penetrate the bite wound of the uninfected person. They later become adults that live in the human’s lymphatic systems. This is a problem because the lymphatic system maintains the body’s fluid balance and also fights infections.
Mr Odoom told me that although the parasites damage the lymphatic system, most LF cases do not show clinical symptoms. However, a small proportion of infected people develop complications in the acute stages. It leads to lymphedema which is fluid collection and swelling of some parts of the body such as legs, arms, breast, genitalia. Affected people also have more bacterial infections in the lymph and skin and experience hardening and thickening of the skin. Hydrocele or swelling of the scrotum is very common in men. The complications of LF such as swelling of the legs and arms can only be managed, not cured.
Lymphedema can be prevented from getting worse by:
- Carefully wash the affected/swollen areas thoroughly with soap and clean water every day
- Wash in-between folds/toes with a piece of cloth
- Dry the affected/swollen area with a clean piece of cloth
- Disinfect any wounds and sores, use antibiotic (antifungal or anti bacterial) ointment/cream if necessary
- Elevate and exercise the affected/swollen areas to move the fluid and improve the lymph flow.
Hydrocele can only be corrected through surgery. In 2002 Samuel Odoom, together with NTDP, set up a lymphedema clinic to manage the burden of LF complications. Mr Odoom said, “ NTDP trained a consultant who goes around the regions in the country and some other African countries to train physicians on how to do hydrocele surgeries”. Now in Ghana, there are 12 health facilities that conduct hydrocele surgeries.
Prevention and control
LF is endemic in nine out of the ten regions in Ghana, so it is a serious health issue. It can of course be prevented by avoiding mosquito bites. Mosquitoes that carry the filarial worms usually bite between 5pm to 5am. The advice for people in endemic communities is to sleep under a treated mosquito net, use mosquito repellent on exposed skin and wear clothes that cover all the body. Yet for people in communities, preventing mosquito bites is not always possible.
In endemic communities, LF can be controlled or even eliminated with Mass Drug Administration of a single drug (ivermectin) through the Preventive Chemotherapy programme. The NTDP introduced the Mass Drug Administration in the year 2000, but only in a few districts. Today the programme has been able to cover all endemic districts in Ghana. But there are still some communities with a high prevalence of LF and some populations are still hard to reach.
It is with this in mind, that the COUNTDOWN research consortium is putting effort into investigating cost-effective, scale-up and sustainable solutions. In Ghana, the research is exploring how different factors within the health system hinder the scale up of the MDA and aims to integrate additional strategies to complement the MDAs in the control and elimination of LF by 2020.
I have now spent a year working with COUNTDOWN, embedded with the NTDP. I have come to the realisation that LF can affect anybody living in an endemic community, who does not or cannot protect themselves from mosquito bites. It is also very clear that we need to put more resources and research into finding sustainable solutions so that all communities in Ghana will be free from LF now and in the future.