This part of the site
mirrors up-to-date PDF content from Filaria Journal, an open access journal
addressing biology, infections, disease and control of filariasis, onchocerciasis
and guinea worm.
articles in Filaria Journal
Socio-cultural insights and lymphatic filariasis
control - lessons from the Pacific
Shona Wynd, David N Durrheim, Jaime Carron, Billy Selve, J P Chaine,
Peter A Leggat, Wayne Melrose
Sustainable and equitable health programmes require a grounded understanding
of the context in which they are being implemented. This socio-cultural
understanding is pivotal for effective delivery of elimination programmes.
Standardised valid methods are needed for gathering authentic socio-cultural
insights. The currently recommended protocol for collecting Lymphatic
Filariasis (LF) related socio-cultural data, while moving in the
right direction, is inadequate. To collect data which provides an
understanding of local health beliefs and practices, and communities'
understanding of LF, techniques must be developed that are both
valid and time efficient. An approach developed in the Pacific provides
a basic snapshot of socio-cultural insights which are crucial to
the development of relevant and sustainable health education and
The increasing interest in socio-cultural LF research presents a
unique opportunity for coupling socio-cultural and bio-medical understandings
of LF. To address the backlog in the socio-cultural sphere will
require investment of time and effort to integrate valid qualitative
approaches into current data collection methodologies.
Morbidity management in the Global Programme
to Eliminate Lymphatic Filariasis: a review of the scientific literature
David G Addiss, Molly A Brady
Global Programme to Eliminate Lymphatic Filariasis (GPELF) has two
major goals: to interrupt transmission of the parasite and to provide
care for those who already suffer the devastating clinical manifestations
of the disease (morbidity control). This latter goal addresses three
filariasis-related conditions: acute inflammatory episodes; lymphoedema;
and hydrocele. Current lymphoedema management strategies in filariasis-endemic
areas are based on the central role of acute inflammatory episodes,
known as acute dermatolymphangioadenitis (ADLA), in lymphoedema progression.
Simple intervention packages that are currently in use have resulted
in dramatic reductions in ADLA rates, decreased chronic inflammation
in the dermis and subdermis, and improved quality of life. During
the past decade, the socioeconomic impact of ADLA and lymphoedema
in filariasis-endemic areas has received increased attention. Numerous
operational research questions regarding how best to optimize, scale
up, monitor, and evaluate lymphoedema management programmes remain
to be answered. Of the clinical manifestations targeted by the GPELF,
hydrocele has been the focus of least attention. Basic information
is lacking on the effectiveness and complications of hydrocele surgery
and risk of post-operative hydrocele recurrence in filariasis-endemic
areas. Data on the impact of mass administration of antifilarial drugs
on filarial morbidity are inconsistent. Several studies report reductions
in acute inflammatory episodes, lymphoedema, and/or hydrocele following
mass drug administration, but other studies report no such association.
Assessing the public health impact of mass treatment with antifilarial
drugs is important for programme advocacy and morbidity control strategies.
Thus, although our knowledge of filariasis-related morbidity and its
treatment has expanded significantly in recent years, much work remains
to be done to address the needs of more than 40 million persons worldwide
who suffer from these conditions.
analysis of the impact of a lymphatic filariasis elimination programme
using mass drug administration on Misima Island, Papua New Guinea
Shona Wynd, Jaime Carron, Billy Selve, Peter A Leggat, Wayne Melrose,
David N Durrheim
1 January 2007)
Background: Papua New Guinea is the only endemic country
in the Western Pacific Region that has not yet introduced a countrywide
programme to eliminate lymphatic filariasis. However, on Misima
Island in Milne Bay Province, government and private sectors have
collaborated to implement a pilot elimination programme. Although
interim evaluation indicated that the programme has been parasitologically
successful, an appreciation that sustainable health gains depend
on understanding and accommodating local beliefs prompted this qualitative
Methods: We investigated Misima community members
knowledge and attitudes about lymphatic filariasis and the elimination
programme. A combination of focus groups and key informant interviews
were used to explore participants perceptions of health; knowledge
of the aetiology and symptoms of filariasis, elephantiasis and hydrocele;
attitudes towards the disease and mass drug distribution; and the
social structure and decision-making protocols within the villages.
Results: Focus group discussions proved inferior
to key informant interviews for gathering rich data. Study participants
did not consider lymphatic filariasis ("pom") a major
health problem but were generally positive about mass drug administration
campaigns. A variety of conditions were frequently and incorrectly
attributed to filariasis. Participants expressed the belief that
individuals infected with filariasis always had visible manifestations
A common misconception was that taking drugs during campaigns provided
long-term immunity against disease. The role of mosquito vectors
in transmission was not generally appreciated and certain clinical
presentations, particularly hydrocele, were associated with supernatural
forces. Multiple adverse events were associated with mass drug administration
campaigns and most study participants mentioned community members
who did not participate in campaigns.
Conclusion: Important issues requiring educational
intervention and elimination activity modification in the Misima
region were identified during this study. Research outcomes should
assist Papua New Guinea in developing and implementing a national
elimination strategy and inform discussions regarding the appropriateness
of current elimination strategies.
you may need to use this site
on this site are made available as a Portable Document Format (PDF).
To view these
files make sure you have the latest version of the free Adobe
Reader by clicking here (or clicking on the logo below) and following
the instructions on the Adobe website.