Tackling NTDs: Elephantiasis not caused by ‘village people’Exclusive 

At the 73rd meeting of the World Health Assembly (WHA) in November 2020, a roadmap was established to tackle the 20 Neglected Tropical Diseases (NTDs) and other groups of diseases that affected millions of people around the world.
Elephantiasis

According to WHA, the decision-making body of the World Health organisation (WHO), the roadmap is aimed at improving the coordination and collaboration between health partners, integrate and mainstream approaches, and promote greater ownership of tackling NTDs by governments and communities.

The 2021-2030 roadmap titled ‘Ending the neglect to attain the Sustainable Development Goals: a roadmap for neglected tropical diseases 2021-2030’ replaces the first of its kind which was published in 2012.

The new roadmap also sets global targets and milestones to prevent, control, eliminate, and eradicate the NTDs and other disease groups.

Some of the features of the new 2021-2030 roadmap targets in alignment with the Sustainable Development Goals (SDGs) are; a 90 per cent reduction in the number of people requiring treatment for neglected tropical diseases, elimination of at least one NTD in 100 countries, a 75 per cent reduction in the disability-adjusted life years related to NTDs and the eradication of two diseases – dracunculiasis, commonly known as guinea-worm disease; and yaws, a chronic skin disease that primarily affects children under 15 years of age.

Nevertheless, in Nigeria, some of the NTDs, for example, the elephantiasis also known as Lymphatic Filariasis (LF) is widely being attributed to some spiritual forces against individuals.

However, outlining contributions made by partners and government responsibility in tackling the NTDs, Daniel Emmanuel, a deputy director and programme manager for the national LF elimination program at the federal ministry of health in an interview with Lafiya360 addresses myths and misconceptions as well as a management of the diseases.

What is Lymphatic Filariasis?

Lymphatic Filariasis, also known as elephantiasis, is a parasitic infection caused by mosquitoes. This is a disease condition whereby  areas around the arms and legs and even the genitals for example the scrotum swells up more than its normal size, resembling the skin of an elephant.

Mosquitoes, the Anopheles species culex; the anopheles transmit malaria especially in the rural areas. it also transmits lymphatic filariasis from an infected person to a non-infected person and the female mosquitoes are responsible for this – carrying of the infection from an infected person to a non-person.

They do this during blood meal – when they are taking blood from humans – they will pick the baby ones called microfilariae, which is the effective stage of lymphatic filariasis. That is when they pick it from a non-infected person.

Normally, if you’re infected with this parasite, it has a long term effect before manifesting as elephantiasis and hydrocele (swollen scrotum) in men.

So those are the consequences of this infection and as you know, this parasite that causes LF is the common one peculiar to us here in Nigeria and Africa is called wuchereria bancrofti.

It is the species that is responsible for the LF – a parasitic infection.

So mosquito is the vector and the species of mosquito are normally the anopheles and culex. And as you know anopheles mosquitoes are responsible for malaria.

Should people be worried about LF, is it life-threatening?

Well, the point here is that as you can see, the issue of stigma is there, there is also the issue of non-productivity, for instance, those with big legs (elephantiasis) find it very difficult to engage in their normal activities; if they were farming, they cannot go to the farm because of the massiveness of the swelling.

Also, it comes with crisis and secondary infections if it is not well managed or taken care of. So for those kinds of people, they cannot do anything, they become a burden to society and the economy. Aside from that, psychologically, they are down, especially those that are married, you find out that they end up having a crisis in marriage – either the other spouse leaves them, mostly because they cannot continue to live with them due to the offensive smell of the affected part.

However, apart from all of these, if it is well managed, the person can be re-integrated into the society while for those with massive swelling, continuous washing with normal water and soap over years can reduce the massiveness and also the smelling and the crisis that comes along with the infection. So that is succour for them, but the most important thing is for them to have this knowledge through health care providers.

Also, for those with hydrocele, the enlarged scrotum in men, surgery can be used to correct it, and we have doctors who have been doing it in various states. Being infected with the disease is not the end of the world. And for those living in areas that are at risk, continuous use of medicine annually – that is the ivermectin and albendazole donated when taken annually, can help them not to come down with these chronic stages.

The areas that are at risk of these diseases are called endemic Local Government Areas (LGAs) and if the people living in these areas can do it (take the drugs) for at least over five years – we call it five years treatment, they can break the cycle of this disease and also eliminate the disease in these areas that they are endemic.

What are the symptoms of LF?

First of all, we have already identified all the LGs – they are 583 in Nigeria – that are at risk of this disease. What this means is that anybody who lives in any of these LGs is at risk. So what we do is mass drug administration. And when we give you 1, 2, 3 to 5 sometimes even at one, the mosquitoes in the area cannot pick the microfilariae (the baby ones when they are taking their blood meals). So the likelihood of transferring it would not be there. This can only happen when the people living in the identified Local Government Areas (LGAs) take these donated medicines.

For those who have had the infection already or are suspected to have it, it can be identified through microscopy by taking their blood films and looking under the microscope for the microfilariae. In this case, the blood sample is taken within 10 pm and 3 am because the microfilariae are nocturnal; that is when they come out in the blood system.

We can also use the assessment test kits. However, the assessment test kits, are not within our purview, they cannot get it, we usually order it for assessment and it is donated free through WHO.

How long should one in this identified LGAs take the drugs

It is taken annually for individuals who are five years and above. And from our record, if you take the medicine consistently for over five years, you can break the transmission cycle of the disease in that particular LGA.

Can Nigeria meet up with the global target on NTDs?

I am very optimistic that we can meet the 2030 target. What we need is for everyone to be part of the stakeholders’ committee by making sure that people take these medicines. And also, the government at every level should be able to put effort into making sure that the medicines reach the affected LGs and the supporting partners. It is a collective effort and if we do it we can break the cycle and eliminate the NTDs before 2030.

What is expected of the government to meet the global target on NTDs?

It is ownership. The government should ensure that ownership for instance is set if they are aware that this disease is there which we have a duty to let them know, which they already know and also know the implication of people living in the affected LGAs not taking these medicines.

We have seen instances that where communities work with their LGAs to collect these medicines and distribute them among residents because they have taken ownership, they want to break the cycle. The government need to know that it is their responsibility to ensure that people take the medicine and break the cycle of transmission.

In fact, if the government take ownership they would be no need to bother donors on this matter. A lot of LGAs have started breaking the transmission cycle but it is very slow and there is a need to quicken the process.

There is always a religious or spiritual attachment LF in Nigeria, what is your advice to religious and traditional leaders?

There is no spirituality to this and I think the onerous is on us to educate the people in every community; traditional and even the religious leaders on this. This is because the information you have liberates you from misconceptions.

For advocacy messages in the endemic areas, every person especially the traditional and religious leaders, the youth wings, everybody must be involved as strong stakeholders.

If everyone is involved in this process, which means they have taken ownership and that means everybody would participate and be knowledgeable about the disease and the process of breaking the cycle. This also means that the likelihood of people coming down with the disease will be very slim.

For those already infected, what you need to know is that this thing was caused by mosquitoes and unfortunately, you have not been taking treatment and the thing has come to manifest. You need to know that it was not caused by “your village people” or any spiritual forces as widely speculated.

People should also know that while the swollen leg might not totally reside, there is the possibility of an infected person continuing with their normal life if they adhere to all the management processes.

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