Morbidity management and disability prevention (MMDP)

An estimated 40 million people worldwide suffer from clinically significant manifestations of the lymphatic filariasis (LF), predominately lymphedema, elephantiasis and hydrocele. These conditions can lead to impairments, reduced economic productivity, and discrimination.

In 1997, the World Health Assembly adopted Resolution WHA 50.29, which called on Member States to initiate steps towards elimination of lymphatic filariasis as a public health problem. In response to this call, WHO launched the Global Programme to Eliminate Lymphatic Filariasis in 2000. The recommended elimination strategy has two components: (i) to stop the spread of infection (interrupting transmission); and (ii) to alleviate the suffering of affected populations (controlling morbidity).

Stopping the spread of infection through preventive chemotherapy will prevent new cases of disease. However, to achieve the aims of the second component as outlined in the 2011 morbidity management and disability prevention (MMDP) position statement, a minimum package of care for every person with lymphedema, elephantiasis or hydrocele must be available in all areas of known patients where LF is endemic.

This recommended minimum package of care includes:

1. MDA or individual treatment to destroy any remaining adult parasites and microfilaria
2. Surgery for hydrocoele (in W. bancrofti endemic areas)
3. Treatment for episodes of adenolymphangitis (ADL)
4. Management of lymphoedema to prevent both progression of disease and episodes of ADL.

To ensure full geographic coverage of morbidity-management and disability prevention services, programmes must first understand the number and geographic distribution of patients. With this knowledge, programs can ensure facilities are providing services in all areas with known patients and work to ensure the quality of those services.

Countries claiming to have eliminated LF as a public health problem should clearly document the following information concerning care for LF patients:

• the number of patients (lymphedema and hydrocele) estimated by the implementation unit;
• the number of facilities designated to provide recommended care serving implementation units with known cases;
• an assessment of the readiness and quality of services provided in designated facilities
  

In order to assist programs in implementing MMDP services, a toolkit is being developed by WHO and incorporates relevant resources developed by WHO and partner institutions. The objectives of the toolkit are to:

• provide tools and templates for implementation of key activities necessary for strengthening the health system delivery of the recommended minimum package of care for LF patients
• make information and tools accessible for use by national LF programmes and health professionals around the world
• identify gaps in existing resources and provide new resources as needed to fill such gaps
  

This toolkit components focus on the following areas:

1. Planning, including patient estimation

2. Capacity Building to Deliver MMDP Services

3. Documentation of MMDP services

Joint reporting form

• JRF v.4 – generic version
• JRF v.4 – for Loa endemic countries