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