LF Morbidity Control
The Global Programme to Eliminate LF highlights two key pillars for achieving the elimination of LF:
- Interruption of transmission through yearly high coverage mass drug administration; and
- Alleviation of suffering due to complications associated with LF morbidity.
The second of these pillars, morbidity control, has to date been largely neglected in LF elimination programs the world over. Whilst historical records describe significant levels of LF morbidity throughout the Pacific (i.e., cases of elephantiasis and hydrocele) such morbidity was thought to be of minimal concern in the present.
In 2009 the Pacific Program to Eliminate LF recruited a Morbidity Control Officer with the financial assistance of the Pacific Leprosy Foundation (PLF). The first task identified for this officer was to gather detailed information on the prevalence of LF morbidity in the Pacific. To date (June 2009) the Officer has focused on collecting data from Fiji.
Findings to date in Fiji
As of June 1st 2009, the Morbidity Control Officer had travelled throughout the Central Division and part of the Western Division of Fiji. With relatively little knowledge of LF morbidity cases within the health system, much of the information was collected from the village health workers, village headman, taxi drivers and other community members. People suffering from LF morbidity were often a rich source of information regarding other people suffering from LF morbidity in their area. Table 1 below summarizes the findings. So far a total of 97 cases of elephantiasis and hydrocele have been found in the two divisions of Fiji. The majority of the cases found were living along the coastal part of the Central Division, often with poor socio economic status, although the most severe cases were found in the urban areas. There were more Fijians than Indo-Fijians affected and most cases in males were hydrocele. Because of the stigma associated with disease people were more reluctant to reveal their status which made identifying cases even more difficult. More data are expected to come from these divisions and the two remaining divisions will be covered in the next few months. The images below are an example of the severity of cases found.
Table 1: Summary of morbidity cases in the Central and Western Divisions of Fiji (June 1st, 2009).