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 !  Filaria Journal

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.

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Recently published articles in Filaria Journal
Volume 6

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

(Published: 17 February 2007)

Background: 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 elimination programmes.

Summary: 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

(Published: 15 February 2007)

The 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.

Qualitative 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
(Published: 1 January 2007)

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 study.
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 of disease.
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.


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