Integrated morbidity management for lymphatic filariasis and podoconiosis, Ethiopia

Problem Lymphatic filariasis and podoconiosis are the major causes of tropical lymphoedema in Ethiopia. The diseases require a similar provision of care, but until recently the Ethiopian health system did not integrate the morbidity management. Approach To establish health-care services for integrated lymphoedema morbidity management, the health ministry and partners used existing governmental structures. Integrated disease mapping was done in 659 out of the 817 districts, to identify endemic districts. To inform resource allocation, trained health extension workers carried out integrated disease burden assessments in 56 districts with a high clinical burden. To ensure standard provision of care, the health ministry developed an integrated lymphatic filariasis and podoconiosis morbidity management guideline, containing a treatment algorithm and a defined package of care. Experienced professionals on lymphoedema management trained government-employed health workers on integrated morbidity management. To monitor the integration, an indicator on the number of lymphoedema-treated patients was included in the national health management information system.Local setting In 2014, only 24% (87) of the 363 health facilities surveyed provided lymphatic filariasis services, while 12% (44) provided podoconiosis services.Relevant changes To date, 542 health workers from 53 health centres in 24 districts have been trained on integrated morbidity management. Between July 2013 and June 2016, the national health management information system has recorded 46 487 treated patients from 189 districts.Lessons learnt In Ethiopia, an integrated approach for lymphatic filariasis and podoconiosis morbidity management was feasible. The processes used could be applicable in other settings where these diseases are co-endemic

Scrotal elephantiasis: a first case report from Bahrain

Scrotal elephantiasis is a disease that is rarely seen outside the tropical sectors of Africa, Asia, Central and South America. Unlike those endemic regions, where the disease is caused mostly by a filariasis; in developed countries, it is usually secondary to other non-infectious conditions or rarely hereditary. A seventy-eight year old patient presented to the urology clinic with a painful gross scrotal swelling for more than 6 years. The disease proved to be inflammatory and was assumed to be due to filariasis. Subtotal scrotectomy was undertaken followed by scrotal reconstruction with satisfactory cosmetic and functional outcome. To our knowledge, this is the first case of inflammatory probably infectious scrotal elephantiasis to be reported from Bahrain