Both lymphatic filariasis (LF) and Podoconiosis are priority NTDs in Ethiopia and they occur in the same target age groups. Furthermore, there is an overlap in the areas of the country endemic for each disease. It is therefore more cost-effective to direct a single MMDP campaign as it reduces the duplication of efforts and resources.
Identification of Cases
In 2015, CNTD supported the first ever integrated morbidity mapping of lymphoedema and hydrocele cases in 20 LF and podoconiosis co-endemic districts in Amhara and SNNP regions of Ethiopia. This was conducted in collaboration with the National Podoconiosis Action Network (NaPAN) and supported by the Federal Ministry of Health. A total of 612 Health Extension Workers and 40 supervisors were trained and participated in the mapping exercise which identified the following number of cases:
- Leg lymphoedema: 24,908
- Hydrocele: 751
- Both (leg lymphoedema & hydrocele): 387
- Breast lymphoedema: 77
Integrated Morbidity Management
To begin to provide support to the cases identified, CNTD has provided financial support to implement a package of MMDP care in three districts with the highest burden of cases as identified during the mapping. This includes the training of 123 nurses and 541 community health workers on the morbidity management of lymphoedema caused by both LF and podoconiosis. Furthermore, 5,407 lymphoedema patients will have access to MMDP supplies to care for their lymphoedema and 200 hydrocele patients will have access to hydrocele surgery. This is being delivered through selected health facilities in each of the three districts, using the community network of health workers for patient referral to ensure all patients have equitable access.
Initially supported by CNTD, the method of identifying patients is now being scaled up to a further 14 co-endemic districts (supported by RTI) and a further 50 podoconiosis endemic districts (supported by the WHO). The integrated package of MMDP care as described above, will be the first of its kind and lessons learnt from its implementation will be vital in guiding the future scale-up of MMDP care by partners and the Federal Ministry of Health.