Trends in Morbidity for Lymphatic Filariasis in the Most Affected Area
of Bangladesh
Midori Morioka1, Hossain Moazzem2, Kazuhiko Moji3, Yukiko Wagatsuma1
1University of Tsukuba, Department of Clinical Trial and Clinical Epidemiology, 2Institute of Allergy and C l inical Immunology of Bangladesh,
3Research Institute for Humanity and Nature
1-2 / September / 2012, 3th NTD Conference
2
Epidemiology:* Infection: 120 million people in 72 countries (WHO,2010)
* Low human development index of 94% of those countries (Cristine Bonfim et al, 2009)
* Second biggest factor related to impairment (WHO, 1995)
Situation in Bangladesh:* Endemic area: 34 of 64 districts* Risk of infection: 70 million people* Infection: 20 million people (MOHFW Bangladesh, 2010)
Background
Figure1) Map of endemic areas in Bangladesh
3
Symptom of LF: 1. Asymptomatic microfilariaemia
2. Acute manifestation Acute episodic Adenolymphangitis (ADL) a) Acute filarial lymphangitis (AFL) b) Acute dermatolymphangioadenitis (ADLA)
3. Chronic manifestation Lymphedema, Elephantiasis, Hydrocele
4. Occult Filariasis etc
Background
4
Acute manifestation:
Background
5
Chronic manifestation:
Background
6Background
Eliminate LF by 2020 as started in the WHO initiative
Prevention Treatment
To interrupt transmission of infection by Mass Drug
administration (MDA)
To alleviate and prevent both the suffering and disability by morbidity
control (MC)
Elimination of LF by 2015Elimination of LF by 2015in Bangladeshin Bangladesh
Study area:
7Methods
Nilphamari
Jaldhaka selected from6 upazilas
Paurashava and Kanthali union selected from
12 unites
Paurashava:Ward2,3,6
Kanthali:Ward2,4
5 wards randomly selected
Figure2) Map of Jaldhaka upazila
Study sample: * Patients who had filarial acute or/and chronic manifestations* Patients aged less than 10 years - only registered, not interviewed chronic manifestationa) lymphedema with lower limbb) lymphedema with upper limbc) hydroceled) lymphedema with breaste) lymphedema with sex organf) other filarial symptoms
8Methods
9Methods
Date collection: * Screened all households in 5 ward by 8 trained research assistants * Structure interview: socio-demographic information, medical and treatment history a) acute – ADL within previous and previous 12 months b) chronic – Dreyer staging system
* Checked the validation by supervisor
Data analysis: * Basic characteristics to show the distribution of lymphatic filariasis
10Results
Flow chart of sampling:
4,584 households728 residents listed
540 residents interviewedas patients
536 patients analyzed
149 residents not directly observed
8 residents refused to join
31 residents aged less than 10 years
4 patients excluded because of misclassification
11Results
Graph1. Disease Distribution
n= 557 because 21 patients suffer from lymphatic filariasis with 2 parts.Child patients aged less than 10 years are not included.
12Results
Table1. Sex distribution
9 male patients suffer from lymphatic filariasis with 2 parts.12 female patients suffer from lymphatic filariasis with 2 parts.Child patients aged less than 10 years are not included.
sex affected parttotal
(n=536)
lymphedema with lower limb 20
lymphedema with upper limb 1
hydrocele 410
total 422
mean age(±SD) 43.9 (±17.0)
lymphedema with lower limb 90
lymphedema with upper limb 3
lymphedema with breast 29
lymphedema with sex organ 4
total 114
mean age(±SD) 47.5 (±14.4)
male
female
13Results
Graph2. Age distribution
21 patients suffer from lymphatic filariasis with 2 parts.Child patients aged less than 10 years are not included.
14Results
Table2. Disease distribution of child case aged 10-14 years
sex affected parttotal (family
history)(n=24)
lymphedema with upper limb 1 (1)
hydrocele 22 (11)
total 23 (12)
lymphedema with lower limb 1 (0)
total 1 (0)
male
female
length of illnessmean (±SD):5.2 (±3.4) years
31 child patients aged less than 10 years, that means to born after MDA, were also registered.
15Results
Graph3. Distribution of length of illness
21 patients suffer from lymphatic filariasis with 2 parts.The longest period is adopted for the patients affetced with both of right and left part.One is excluded because of only pain after hydrocele operation.Child patients aged less than 10 years are not included.
after MDA before MDA
Earlier age is adopted for the patients affected with both of right and left part.One is excluded because of only pain after hydrocele operation.
16Results
Graph4. Age of onset (clinical manifestation) - before and after MDA
lymphedema with lower limb hydrocele
0-9 years: increased after MDA because of 31 child cases
Mean age(±SD)
30.7 years (±12.7)
24.6years(±13.7)
37.0years(±13.5)
29.7years(±16.5)
17Discussion and Conclusion
* Disease magnitude (number of patients) hydrocele > lymphedema with limb sampling bias: working- aged male with hydrocele
* Child case with hydrocele, family history
* New case (chronic manifestation) despite of MDA, but not increasing* Age on onset getting higher after MDA, but increasing child case aged less than 10 years?? recall bias: before MDA
* Further clinical assessment and statistical analysis especially focused on child hydrocele after MDA
Thank you for
listening
AcknowledgementAcknowledgementDr. Moazzem and IACIB,
Prof Moji, Prof Wagatsuma,
Field research assistants and Patients