Cognitive testing of the WHOQOL-BREF Bangladesh tool in a northern rural Bangladeshi population with lymphatic filariasis.

PURPOSE: The purpose of this study was to test the cultural suitability of the WHOQOL-BREF Bangladesh for a rural village population in Bangladesh. METHODS: Participants (n = 35) were purposefully stratified for age, gender, education level and location from the Nilphamari district in northern rural Bangladesh. Cognitive interviews were conducted via an emergent probing method to identify issues with language and constructs within the tool. Data were collected through note taking and recordings of interviews. A coding framework was used to identify key issues with questions, which were analysed using SPSS version 19 and Chi-square analysis using a Fisher's exact test to determine statistically significant variances within the sample. RESULTS: Twenty-two of the 26 questions in the tool were found to be problematic. The majority of problems with questions related to wording and conceptual difficulties. The majority of participants found the tool to be overly formal. Issues with translation appeared to affect the interpretation of a number of questions, and some concepts in the tool were found to be irrelevant in a village setting. There were statistically significant differences between those of different educational backgrounds and between genders. CONCLUSIONS: The study found that the WHOQOL-BREF Bangladesh as it currently stands is not culturally or linguistically suitable for use within a rural northern Bangladeshi population.

The impact of a national program to eliminate lymphatic filariasis in selected Myanmar immigrant communities in Bangkok and Ranong Province, Thailand.

Some immigrants from Myanmar to Thailand have brought Wuchereria bancrofti infections with them, causing a community health problem for Thai citizens. The seroprevalence of bancroftian filariasis was detected in 438 and 512 Myanmar immigrants residing in Bangkok and Ranong Provinces, respectively, along with 81 Thai citizens living in Bangkok. The immunochromatograpy card test was positive in 5 Myanmar immigrants living in Bangkok and 1 living in Ranong for a prevalence of 0.63%. Antifilarial IgG4 antibodies were found in 21 Myanmar immigrants living in Bangkok and 14 living in Ranong for a prevalence of 3.68%. None of the samples from Thai citizens were positive with either test. These prevalence rates are lower than those observed between 2001 and 2005. The Thai mass drug administration program to eliminate lymphatic filariasis among Myanmar immigrants appears to be a successful public health strategy.

Touchdown-touchup nested PCR for low-copy gene detection of benzimidazole-susceptible Wuchereria bancrofti with a Wolbachia endosymbiont imported by migrant carriers.

A novel, sensitive and specific touchdown-touchup nested PCR (TNPCR) technique based on two useful molecular markers, a Wuchereria bancrofti ß-tubulin gene involved in benzimidazole susceptibility and a Wolbachia ftsZ gene involved in cell division, was developed to simultaneously detect the parasite W. bancrofti (W1) with its Wolbachia endosymbiont (W2) from both microfilaremic and post-treatment samples of at-risk migrant carriers infected with geographical W. bancrofti isolates. The detection and characterization of authentically low-copy gene-derived amplicons revealed no false positive identifications in amicrofilaremia with or without antigenemia. The W1-TNPCR was 100-fold more sensitive than the W2-TNPCR regardless of the microfilarial DNA isolation method and compared well with the thick blood film and membrane filtration techniques. These locus-specific TNPCRs could also detect Wolbachia-carrying W. bancrofti genotype in addition to a link to benzimidazole sensitivity among those with unknown infection origins that exhibited microfilaremia responsiveness against treatment with diethylcarbamazine plus albendazole. These TNPCR methods can augment the results of microscopic detection of the parasite because these methods enhance DNA isolation and PCR amplification capabilities.

DNA-based diagnosis of lymphatic filariasis.

Lymphatic filariasis (LF) is still a major public health problem. The disease is ranked by the World Health Organization (WHO) as the second leading cause of permanent and long-term disability, and has been targeted for elimination by 2020. Effective diagnosis LF is required for treatment of infected individuals, for epidemiological assessment and for monitoring of the control program. Conventional diagnosis of LF depends on detection of microfilariae (Mf) in blood specimens, which has low sensitivity and specificity. Detection of specific circulating filarial antigens is regarded by WHO as the 'gold standard' for diagnosis of LF. However, the limitations of the antigen tests are cost and inconsistent availability. Although anti-filarial IgG4 antibody levels are associated with active LF infections, however, cross-reactivity with other filarial parasites is common. Not as sensitive as antigen tests, DNA-based techniques have been developed to diagnose and differentiate filarial parasites in humans, animal reservoir hosts, and mosquito vectors. These include DNA hybridization, polymerase chain reaction (PCR) amplification using specific primers (eg Ssp I repeat, pWb12 repeat, pWb-35 repeat, and LDR repeat for Wuchereria bancrofti and Hha I repeat, glutathione peroxidase gene, mitochondrial DNA for Brugia malayi), and universal primers, multiplex-PCR, PCR-restriction fragment length polymorphism (PCR-RFLP), PCR-enzyme linked immunosorbent assay (PCR-ELISA), as well as quantitative PCR. Furthermore, because bancroftian filariasis is endemic on the Thai-Myanmar border, the potential now exists for a re-emergence of bancroftian filariasis in Thailand, and random amplified polymorphic DNA (RAPD) analysis has proved effective to differentiate Thai and Myanmar strains of W. bancrofti.

Health-related stigma among women with lymphatic filariasis from the Dominican Republic and Ghana.

People fearful of being stigmatized by a health-related condition often do not embrace prevention behaviors or seek medical help. They may adhere poorly to treatment regimes for disease and abruptly terminate much needed treatment. Globally, 120 million--many poor women--suffer consequences of lymphatic filariasis that include stigmatizing lymphedema or elephantiasis of the leg. We investigated how women with lymphedema from two different cultures experience stigma and its consequences. Our qualitative data were collected from 56 Dominican women and 48 Ghanaian women with lymphedema. A lymphedema-related stigma framework was developed from constructs derived from the literature and emergent themes from the data. Women described a spectrum of enacted, perceived, and internalized stigma experiences, such as being criticized and isolated by the community, health providers, and even by friends and relatives; they were often denied access to education and meaningful work roles. Some antecedents, consequences, coping strategies, and outcomes of these experiences varied across cultures, with Dominican women faring somewhat better than Ghanaians. Poverty, poor access to health care resources, limited education, and diminished social support challenged the coping strategies of many women and exacerbated negative consequences of lymphedema-related stigma.

Immunoglobulin allotypes among the Bicolanos of Sorsogon province, Luzon, Philippines: implications of phenotypes for filariasis.

Immunoglobulin (Ig) allotypes are polymorphic genetic systems that show distinct racial arrays, thus making them powerful tools for studies of genetic admixture and biological relationships. In the province of Sorsogon, southern Luzon, Philippines, allotyping was completed on 252 persons residing in two neighboring villages. The people demonstrated 14 GM and 3 KM phenotypes. The frequency of homozygous KM3, KM1 and heterozygous KM1,3 was identical in these villages; however, half of the GM phenotypes present in one village were significantly less frequent in the other village. The frequency of KM and GM haplotypes was different from those reported in Filipino aboriginal groups, but similar to a population on Samar Island, the only other Filipino group for which Ig allotype data exist. Variability in the prevalence of parasitic disease such as lymphatic filariasis may in part reflect differences in genetic susceptibility, resulting from allotypic heterogeneity between villages.

Community perception regarding chronic filarial swellings: a case study of the Duruma of coastal Kenya.

The aim of this study, carried out between August 1991 and August 1992, was to understand community perception regarding chronic filarial swellings in Lutsangani village, Kwale district, Kenya. Interviews were conducted with 65 patients and informal discussions held with family and community members. The results indicate that bodily change is the concern of most patients who felt that their physical appearance influenced community reactions towards them. These reactions varied from sympathy to neglect. The community attributed elephantiasis to causes other than mosquitoes and these included witchcraft, sexual intercourse and consumption of burnt food. The patients noted the inability of any form of health care to alleviate their suffering. Medical anthropology and general medical knowledge have been used to interpret results.

Lymphatic filariasis and the women of India.

Lymphatic filariasis is a disease of the poor and underprivileged and has received little attention in the past. In particular, there has been a lack of gender sensitive research on women and lymphatic filariasis. Women suffer from lymphatic filariasis to a great extent but embarrassment, shame, cultural constraints and social taboos are some of the reasons that refrain them from reporting problems and seeking help. Women are thus silently bearing the brunt of this disease. This study has tried to obtain basic information on women and lymphatic filariasis with a gender approach. To understand the consequence of lymphatic filariasis on women in India, a holistic framework was used for this study, which encompasses all issues in women's lives such as their perspective on the disease, their role as social and economic entities and their relationships with others; in addition to their reproductive role. A qualitative approach using the technique of informal interview was used for this research. Eighty-eight women and 39 children were interviewed, during home visits and at clinics, primary health care centers and schools in both urban and rural areas in India. The study has obtained the much needed information on the knowledge of lymphatic filariasis among women in India, the impact of the disease on the women which include the social and economic aspects, clinic attendance and the barriers to health care for women with the disease, and women's awareness regarding control programs for lymphatic filariasis. The study also found how women cope with the disabilities or other manifestations of the disease. This paper discusses lymphatic filariasis using a gender sensitive approach. It reviews the literature, describes the study, analyzes the results and suggests feasible disease control programs for women with a multisectoral approach.

Clinical filarial disease in two ethnic endemic communities of Orissa, India.

To evaluate the possible role of ethnicity in susceptibility to filarial infection, a comparative study of the prevalence of filarial infection was initiated in an endemic village inhabited by two ethnic populations of mainlanders and tribals. An age and sex matched sampled population of 591 mainlanders and 106 tribals was studied by detailed clinical and parasitological (60 mm3 blood) examinations. Sera collected from both population groups (26 each) matched for clinical stage of infection were analysed for humoral immune responses such as antifilarial IgG, circulating filarial antigen and immune complex level. The overall prevalences of clinical disease and infection in both mainlanders (34.18 and 14.4%) and tribals (25.47 and 17.9%) were comparable. However, both annual average adenolymphangitic attack rate (1.77 year-1) and the prevalence of chronic filarial disease (22.6%) amongst tribals were significantly lower. No true elephantiasis was observed in tribals. No significant difference was observed in their humoral immune response, although the antifilarial antibody of IgG class in all stages of filarial infection was lower in tribals than in mainlanders. The results did not reveal any difference in susceptibility to filarial infection in the ethnic groups. The paucity of progressive lesions observed in tribals possibly reflects a difference in the anatomy of lymphatics or genetic or immunoregulatory mechanisms, that needs further study.