Photo Credit: Helen Keller International

Lymphatic Filariasis 101

In a college biology class, I recall my professor spending one lecture on parasitic diseases, showing an image of a man carrying his scrotum – which was as large and heavy as his own body – in a wheelbarrow.  We learned that the intense swelling he was living with, a “hydrocele”, came from  a mosquito-borne disease common in the tropics called lymphatic filariasis (LF) caused by tiny threadlike worms that live in a person’s lymphatic vessels, often in the legs and groin.  Over time, these worms can cause problems in the lymphatic system leading to swelling of the lower limbs and scrotum, as well as skin thickening and lesions that are opportunistic for bacterial and fungal infections.

Seeing the Effects of the Disease In Real Life

Just under a decade later, as an epidemiology graduate student, I was studying Neglected Tropical Diseases, like LF, in Sierra Leone.  After a visit to a village a few hours outside of Freetown, I met a young mother with both legs so swollen and disfigured it was almost impossible for her to move on her own.  Her skin had become rough, with many folds, knobs, and open lesions.  She told us she experienced sudden fever and pain in her limbs every few weeks.  In addition to the physical pain, she shared that her condition made it difficult to contribute to her family’s income and that she felt socially ostracized.

Progress Made, But a Long Way to Go

Fast forward to present day, to the immense success of the Global Program to Eliminate Lymphatic Filariasis (GPELF).  Data from 2019 alone shows 70% geographic coverage with treatments of medicine (called “preventive chemotherapy”), advancement of surveys to track the disease, and 17 countries having achieved validation of elimination as a public health problem by the World Health Organization.  However, as great progress is being made on the reduction of transmission, the same is not happening for those suffering from the chronic, long-term problems (called “morbidity”) associated with the disease.  Individuals with long term health problems like chronic swelling of the leg or groin need to be provided the LF essential package of care to appropriately manage their condition.  But there are information gaps in endemic countries that make this challenging, such as identifying where LF patients are located, and understanding the strengths and gaps of services they currently have access to through the health system.

A New Tool in the Tool Belt for LF Implementers

Without ample attention given to care and treatment, the morbidity caused by LF can lower the overall health and productivity of individuals, families, communities, and nations.  But, a new and improved resource is available to help address these concerns. The second edition of the Lymphatic Filariasis MMDP Aide-Memoire for National Programme Managers published this week by the World Health Organization aims to reach program managers, healthcare workers, academic researchers, and other partners with the tools necessary for sustained provision of the essential package of care for LF, a key legacy of the GPELF.

The web annexes include critical methods and tools, such as the Situation Analysis Tool and Direct Inspection Protocol, that have been developed to help countries quantify the estimated number of LF patients and gather information to help plan for and assess LF Morbidity Management and Disability Prevention (MMDP) services.  The USAID NTD Division has also published a technical brief to complement WHO’s publication and share the experiences and key learnings of 12 National NTD Programs on their use of these tools.

As we enter 2021, we are approaching an era where generations of people to come will not experience the disability and suffering of LF.   But for those who experience it now, such as the man carrying his hydrocele in a wheelbarrow, or the young mother with elephantiasis in both legs, we must ensure they are not left behind or forgotten as we continue our work to eliminate this ancient disease.

By: Emily Toubali, USAID’s Lymphatic Filariasis Technical Advisor