Managing morbidity and preventing disability in the Global Programme to Eliminate Lymphatic Filariasis -- WHO position statement

Overview

In 1997, the World Health Assembly resolved to eliminate lymphatic filariasis as a public-health problem. In 2000, the World Health Organization (WHO) established the Global Programme to Eliminate Lymphatic Filariasis to assist Member States in achieving this goal by 2020. The global programme includes two main components:

• interrupting transmission of the parasite that causes lymphatic filariasis by using mass drug administration to deliver annual treatment to all people living in endemic areas who are at risk of the disease; and

• managing morbidity and preventing disability among people who have already been affected by the disease.

Infection may damage the lymphatic system, and put people at risk of secondary infections and complications. An estimated 40 million people worldwide have clinically significant manifestations of the disease, predominantly lymphoedema, elephantiasis and urogenital disorders (especially hydrocele in men). These clinical manifestations account for a burden of 5.9 million disability-adjusted life years,1and lead to social stigmatization and a concomitant loss in productivity. 

National elimination programmes should focus on managing morbidity and preventing disability in order to achieve the objectives of the global programme, which include providing care to those already affected by lymphatic filariasis even after transmission has been interrupted. Patients who experience various clinical and social consequences of the disease have a right to health care, and national programmes must make this right a reality.

Activities to manage morbidity and prevent disability will not only meet the needs of those with disease but will also enhance compliance with mass drug administration, and thereby contribute to efforts to interrupt transmission of the parasite and prevent new infections.

The global programme has been integrated into efforts to prevent and treat a number of related, neglected tropical diseases. Collaboration has already been established and shared activities developed with other programmes working to control neglected tropical diseases and vector-borne diseases; these programmes deliver preventive chemotherapy and integrated vector management aimed at interrupting transmission. In order to manage morbidity and prevent disabilities, integration efforts should also consider combining approaches that involve other disease-specific programmes, such as those targeting the chronic clinical manifestations of Buruli ulcer, leprosy, infection with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), and diabetes.