Smith Emma L, Mkwanda Square Z, Martindale Sarah, Kelly-Hope Louise A, Stanton Michelle C
Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.
National Lymphatic Filariasis Elimination Programme, Ministry of Health, Lilongwe, Malawi.
Trans R Soc Trop Med Hyg. 2014 Dec;108(12):751-8. doi: 10.1093/trstmh/tru150. Epub 2014 Oct 4.
Managing lymphatic filariasis (LF) morbidity and reducing disability is one of the two primary goals of the Global Programme to Eliminate Lymphatic Filariasis. However, in order to achieve this, the geographical distribution of LF morbidity needs to be better estimated.
All cases of lymphoedema within a single health centre catchment area (pop. 42 000) in the southern region of Malawi were examined. Maps of lymphoedema burden were produced and trends in patient demographics, severity of lymphoedema (Dreyer staging) and health-seeking behaviour were explored. The number of lymphoedema cases was compared with records maintained by the Ministry of Health, Malawi.
A total of 69 lymphoedema cases were identified (32 per 10 000 population), of which 48 (70%) were female and 21 (30%) male. The majority of cases (51/69) had Dreyer stage 2-3, and almost all (65/69) had experienced acute attacks as a result of their lymphoedema. This burden was much greater than that estimated by Ministry of Health (33 cases).
Current case detection methods underestimate the burden of lymphoedema in Malawi. There is a continued need to develop new LF morbidity identification and surveillance approaches to ensure that future morbidity management strategies are effectively targeted.
控制淋巴丝虫病（LF）的发病率并减少残疾是全球消除淋巴丝虫病规划的两个主要目标之一。然而，为实现这一目标，需要更好地估计淋巴丝虫病发病率的地理分布情况。
对马拉维南部一个单一卫生中心服务区域（人口42000）内的所有淋巴水肿病例进行了检查。绘制了淋巴水肿负担地图，并探讨了患者人口统计学特征、淋巴水肿严重程度（德雷尔分期）和就医行为的趋势。将淋巴水肿病例数与马拉维卫生部保存的记录进行了比较。
共识别出69例淋巴水肿病例（每10000人口中有32例），其中48例（70%）为女性，21例（30%）为男性。大多数病例（51/69）处于德雷尔2 - 3期，几乎所有病例（65/69）都因淋巴水肿经历过急性发作。这一负担远高于卫生部估计的病例数（33例）。
目前的病例检测方法低估了马拉维淋巴水肿的负担。持续需要开发新的淋巴丝虫病发病率识别和监测方法，以确保未来的发病率管理策略能够有效靶向。
