dyton mupawaenda
Rumbidzayi Zinyuke-Health Buzz
At some point in our lives, we have all seen someone with abnormally swollen feet or arms, struggling to walk or do any of the usual duties they may want to do.
Of course, for most people the first thing that comes to mind is witchcraft.
Even the ones suffering from the condition usually chalk it up to being bewitched.
Sadly, we never think that this could be a disease that can be prevented and treated.
Lymphatic Filariasis, which is commonly known as elephantiasis, is one of 20 Neglected Tropical Diseases (NTD) that have been identified by the World Health Organisation.
These are a diverse group of conditions that are mainly prevalent in tropical zones, where they affect people who live in impoverished communities.
They are caused by a variety of pathogens including viruses, bacteria, parasites, fungi and toxins. These diseases cause devastating health, social and economic consequences to more than one billion people in the world.
According to experts, lymphatic filariasis is a chemotherapy preventable NTD of public health importance in Zimbabwe and many other countries, along with others such as bilharzia, rabies, anthrax, snakebites, leprosy, sleeping sickness and scabies.
These are diseases which have been around since time immemorial. We all know them.
But it sometimes seems like we forget about them because there have been many other conditions that have demanded more attention and resources from our Governments. Talk about HIV, Malaria, Covid-19, Cancer, the list goes on and on.
It, therefore, remains important to keep educating the public about these NTDs to ensure that people know what is affecting them and how they can get treatment early.
Lymphatic filariasis impairs the lymphatic system and can lead to the abnormal enlargement of body parts, causing pain, severe disability and social stigma.
Over 882 million people in 44 countries worldwide remain threatened by lymphatic filariasis and require preventive chemotherapy to stop the spread of this parasitic infection.
Infection occurs when filarial parasites are transmitted to humans through mosquitoes. Infection is usually acquired in childhood and causes hidden damage to the lymphatic system.
The painful and profoundly disfiguring visible manifestations of the disease – lymphoedema, elephantiasis and scrotal swelling – occur later in life and can lead to permanent disability. People who are affected are not only physically disabled, but suffer mental, social and financial losses contributing to stigma and poverty.
The global baseline estimate of people affected by lymphatic filariasis was 25 million men with hydrocele (swelling of the scrotum) and over 15 million people with lymphoedema. At least 36 million people remain with these chronic disease manifestations.
The National Institute of Health Research director Dr Nicholas Midzi recently said in Zimbabwe, at least seven districts had been confirmed to be endemic to lymphatic filariasis following research done to determine how widespread the problem was.
“Zimbabwe conducted lymphatic filariasis mapping in 2014 using WHO approved rapid diagnostic test kits. The objective was to determine endemicity and geographic spread of the disease or where there was active transmission requiring MDA. After the baseline survey, 39 districts were declared endemic. A confirmatory survey was done in 2018 and mapping done to get precisely endemic districts to be able to channel the limited resources to eliminate the disease. Almost all provinces had a positive case but seven districts were confirmed to actually be endemic, requiring treatment to eliminate the disease,” said Dr Midzi.
Cause and transmission
Lymphatic filariasis is caused by infection with parasites classified as nematodes (roundworms). Adult worms nest in the lymphatic vessels and disrupt the normal function of the lymphatic system.
The worms can live for approximately 6–8 years and, during their lifetime, produce millions of microfilariae (immature larvae) that circulate in the blood.
Mosquitoes are infected with microfilariae by ingesting blood when biting an infected host. When infected mosquitoes bite people, mature parasite larvae are deposited on the skin, from where they can enter the body.
The larvae then migrate to the lymphatic vessels where they develop into adult worms, thus continuing a cycle of transmission.
Symptoms
The majority of lymphatic filariasis infections are asymptomatic, showing no external signs of infection while contributing to the transmission of the parasite. These asymptomatic infections still cause damage to the lymphatic system and the kidneys and alter the body’s immune system.
When lymphatic filariasis develops into chronic conditions it leads to lymphoedema (tissue swelling) or elephantiasis (skin/tissue thickening) of limbs and hydrocele (scrotal swelling). The swelling of breasts and genital organs is also common.
Such body deformities often lead to social stigma and sub-optimal mental health, loss of income-earning opportunities and increased medical expenses for patients and their caretakers. The socio-economic burdens of isolation and poverty are immense.
Elimination of lymphatic filariasis is key
The elimination of lymphatic filariasis is possible by stopping the spread of the infection through preventive chemotherapy. The WHO-recommended preventive chemotherapy strategy for lymphatic filariasis elimination is mass drug administration (MDA).
This involves administering an annual dose of medicines to the entire at-risk population. The medicines used have a limited effect on adult parasites but effectively reduce the density of immature larvae in the bloodstream and prevent the spread of parasites to mosquitoes.
The WHO approved regimens for treating LF include the use of between one and three combination medicines to treat the diseases.
“Zimbabwe switched to triple therapy where the use of three medicines was implemented to kill the micro-filarial worms within two years,” said Dr Midzi.
The World Health Assembly resolution WHA50.29 encourages Member States to eliminate lymphatic filariasis as a public health problem.
The WHO launched its Global Programme to Eliminate Lymphatic Filariasis (GPELF) in 2000.
The global body’s strategy is based on two key components which include stopping the spread of infection through large-scale annual treatment of all eligible people in an area or region where infection is present and alleviating the suffering caused by lymphatic filariasis through provision of the recommended essential package of care.
Zimbabwe is already working towards this and while there is still a long way to go, progress has been made.
“The country has targets to eliminate LF as a public health threat, start Mass Drug Administration in all endemic districts, implement appropriate interventions like triple therapy where applicable. It also seeks to improve diagnostic capacity,” said Dr Midzi.”
With an NTD roadmap already in place, there is a need now to educate the public about these diseases to ensure uptake of programmes aimed at eliminating them.
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