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Ethiopia: Increasing access to MMDP services

Lymphatic filariasis (LF) and podoconiosis are endemic in Ethiopia and cause painful and disabling lymphoedema. A burden assessment conducted in 2015 found 26,123 cases of lymphoedema and hydrocele across 20 districts of Ethiopia. 

To increase access to quality morbidity management and disability prevention (MMDP) services for lymphoedema and hydrocele cases, integrated into the health system, a pilot study was conducted in three co-endemic districts of the Southern Nations, Nationalities, and Peoples’ Region (SNNPR) over a twelve-month period from September 2016. This included:

i)                    Training of health professionals at each health facility and cascade training of health extension workers (HEWs) and health development army (HDA) on MMDP and patient referrals;

ii)                   Patient mobilisation and recruitment to services (integrated into the health system);

iii)                 Provision of supplies and training on lymphoedema care; and referral of hydrocele patients to hospitals for surgery

iv)                 Patient prospective monitoring with key progress indicators such as severity of condition, wounds present and frequency of acute attacks.

RESULTS

A total of 483 health professionals (60.2% female), 163 HEWs and 2,330 HDA from 22 health facilities had been trained on MMDP and patient referrals, with 2,033 lymphoedema cases (68% female), and 82 men with hydroceles having accessed the MMDP service which has been integrated into the health system. Conditions ranged from mild (n=655, 32.2%), moderate (n=1,062, 52.2%) to severe (n=317, 15.6%). Two thirds of lymphoedema patients (n=1,344, 66.1%) had experienced an acute attack in the month prior to their enrolment, and 333 (16.4%) had visible wounds on the affected limb. Further results, as the project commences, will highlight physical improvements in patients using key progress indicators.

CONCLUSION

So far, the results show promise for an MMDP system integrated into the existing health structure, which may be scaled-up across Ethiopia. This will be a significant contribution to patient care and will help to ensure all lymphoedema and hydrocele patients have access to quality care.

 The photograph shows a nurse (left) in Chebe Health Centre and his patient, Mr Dingato (right). This is Mr Dingato’s third visit to the health centre for follow-up treatment for his lymphoedema following enrolment into the MMDP service integrated into the health system. He said: ‘My feet no longer smell and I can now wear shoes thanks to the help I’ve received as previously my legs were too swollen to wear shoes. In the past I never came to the health centre as I didn’t think I could be helped but now I am really being helped.’