MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, Faculty of Medicine, Norfolk Place, London, W2 1PG, UK.
Department of Statistics, University of Oxford, Oxford, UK.
BMC Infect Dis. 2019 Apr 23;19(1):332. doi: 10.1186/s12879-019-3959-6.
Lymphatic filariasis (LF) is a mosquito-borne parasitic disease and a major cause of disability worldwide. To effectively plan morbidity management programmes, it is important to estimate disease burden and evaluate the needs of patients. This study aimed to estimate patient numbers and characterise the physical, social and economic impact of LF in in rural Nigeria.
This is a matched cross-sectional study which identified lymphedema and hydrocele patients with the help of district health officers and community-directed distributors of mass drug administration programmes. A total of 52 cases were identified and matched to 52 apparently disease-free controls, selected from the same communities and matched by age and sex. Questionnaires and narrative interviews were used to characterise the physical, social and economic impact of lymphedema and hydrocele.
Forty-eight cases with various stages of lower limb lymphedema, and 4 with hydrocele were identified. 40% of all cases reported feeling stigma and were 36 times (95% CI: 5.18-1564.69) more likely to avoid forms of social participation. Although most cases engaged in some form of income-generating activity, these were low paid employment, and on average cases spent significantly less time than controls working. The economic effects of lower income were exacerbated by increased healthcare spending, as cases were 86 times (95% CI: 17.48-874.90) more likely to spend over US $125 on their last healthcare payment.
This study highlights the importance of patient-search as a means of estimating the burden of LF morbidity in rural settings. Findings from this work also confirm that LF causes considerable psychosocial and economic suffering, all of which adversely affect the mental health of patients. It is therefore important to incorporate mental health care as a major component of morbidity management programmes.
淋巴丝虫病（LF）是一种由蚊子传播的寄生虫病，也是全球残疾的主要原因。为了有效地规划发病率管理计划，估计疾病负担和评估患者的需求非常重要。本研究旨在估计患者数量，并描述在尼日利亚农村地区 LF 的身体、社会和经济影响。
这是一项匹配的横断面研究，通过地区卫生官员和社区定向药物分发方案的分发人员确定淋巴水肿和鞘膜积液患者。共确定了 52 例病例，并与来自同一社区且年龄和性别相匹配的 52 名明显无病对照相匹配。使用问卷和叙述性访谈来描述淋巴水肿和鞘膜积液的身体、社会和经济影响。
共发现 48 例下肢不同阶段的淋巴水肿病例和 4 例鞘膜积液病例。40%的病例报告感到耻辱，回避社会参与的可能性是对照组的 36 倍（95%CI：5.18-1564.69）。尽管大多数病例从事某种形式的创收活动，但这些活动都是低薪就业，平均而言，病例工作时间比对照组明显减少。由于医疗保健支出增加，低收入的经济影响更加严重，因为病例支付最后一次医疗保健费用的可能性是对照组的 86 倍（95%CI：17.48-874.90）。
本研究强调了患者搜索作为估计农村地区 LF 发病率负担的一种手段的重要性。这项工作的结果还证实，LF 会导致相当大的心理社会和经济痛苦，所有这些都会对患者的心理健康产生不利影响。因此，将心理健康护理纳入发病率管理计划的主要组成部分非常重要。
