Socio-cultural aspects of lymphatic filariasis and the role of communities in its control in Ghana

Lymphatic Filariasis (LF) is one of the worlds most debilitating and disfiguring tropical
diseases. The World Health Organization estimates that there are about one billion people
at risk in about 80 countries worldwide. It is the world’s second leading cause of
permanent long-term disability and its prevalence continues to increase. The World Bank
development report indicates that the global burden for the disease was estimated at
850,000 DALY’s lost which represents only 0.23% of the global burden. In Africa, it is
estimated that some 4.6million cases of lymphoedema and over 10 million cases of
hydrocele occur. This represents 40% of the global burden of LF. In 1993, an independent international task force for disease eradication identified LF as
one of the only six eliminable infectious diseases. LF was selected because of recent
dramatic advances in treatment methods, both for controlling transmission and for
managing the disease along with remarkable improvement in techniques for diagnosing
filarial infections. The principal strategy for interrupting transmission then was to identify
areas in which LF is endemic and implement community wide programs to treat the
entire at risk population. In terms of managing the disease, the Global Program for the
Elimination of Lymphatic Filariasis (GPELF) plans that individuals already suffering
from elephantiasis will be taught effective hygiene measures that can easily be carried out
in the home. For men with hydrocele, surgery is the treatment choice and guidelines will
be developed and disseminated on good practical surgical procedures. The overall goal of the study was to determine the social and economic impact of LF and
examine the role communities can play in its control in a country where till recently, the
disease has been very low on the National Health Agenda. A number of studies were
conducted in four districts in Northern and Southern Ghana that were found to be
prevalent for Filariasis after a national Filariasis survey was conducted in the country in
1994. The overall prevalence in the North ranged between 20-40% and in the South
between 10-20%. There were no prior studies on Filariasis neither was there a National
control program in place before the conduct of these studies. The goal of these studies was achieved using a multi-disciplinary approach, to determine
how people recognize and perceive LF and the social and economic impact of the
disease. This involved extensive ethnographic work, and a morbidity and economic
surveillance. The information from the ethnographic phase was then used to develop
Information Education and Communication techniques with the help of community
members through the training of community workers and community leaders as
facilitators to guide the process. To develop effective and practical methods for
sustainable mass treatment of LF, two different methods of mass treatment of lymphatic
Filariasis with a single dose of Ivermectin were tried. Finally, the potential role of
traditional health care providers in the management of elephantiasis was investigated.
Focus group discussions, observation, key informant interviews, case studies and
structured questionnaires were used to elicit information from health care providers,
affected and unaffected individuals. The results indicate that, § LF is recognized as a problem in the study areas and there are specific local terms
used to describe the various manifestations.
§ There is the need to pay more attention to the needs of men with hydrocele.
§ Each of the ethnic groups studied have different conceptions and health care seeking
practices for the disease. This has implications for health education.
§ Communities are capable of developing their own IEC messages with the proper
guidance and building on their perceptions about the disease.
§ Community directed treatment for Filariasis achieved 75% treatment coverage and
can be effectively implemented through the regular health system
§ By building on positive existing local treatment practices, traditional healers can be a
useful resource in the management of lymphoedema through effective hygiene
measures. All these studies have been carried out in research settings. What is needed now is to
come up with practical ways of up-scaling and implementing these studies in the other
endemic districts in the country. This is the first time that in one report lymphatic
Filariasis has been looked at from lay perceptions to practical implementations. The
results contribute knowledge to the understanding of the disease in general and draws
attention to the fact that the male gender also needs to be paid attention to in tropical
disease research. It also raises the importance of including psychosocial aspects of
disease burden in the calculation of DALY’s and adds to the body of knowledge the
importance of traditional healers in particular and community effort in the global
program for the elimination of LF as a public health problem. The contribution of
anthropology in the study of the LF and the importance of the discipline in the study of emerging and re-emerging infectious diseases are discussed. There are however a
number of issues that need further research and they include
1. Advocacy strategies to increase awareness about the disease and to ensure sustained
demand supply and distribution of Ivermectin at the National, Regional and District
level for the control of the disease
2. Stigma and the burden of filariasis especially in urban areas where LF is increasingly
becoming a problem.
3. We have recommended that the ComDT approach be implemented on a large scale
but there is the need to address issues on how cost effective will this kind of
intervention be?