It is possible: availability of lymphedema case management in each health facility in Togo. Program description, evaluation, and lessons learned

Abstract

Lymphatic filariasis (LF) is a vector-borne parasitic disease that can clinically manifest as disabling lymphedema. Although the LF elimination program aims to reduce disability and to interrupt transmission, there has been a scarcity of disease morbidity management programs, particularly on a national scale. This report describes the implementation of the first nationwide LF lymphedema management program. The program, which was initiated in Togo in 2007, focuses on patient behavioral change. Its goal is two-fold: to achieve a sustainable program on a national-scale, and to serve as a model for other countries. The program has five major components: 1) train at least one health staff in lymphedema care in each health facility in Togo; 2) inform people with a swollen leg that care is available at their dispensary; 3) train patients on self-care; 4) provide a support system to motivate patients to continue self-care by training community health workers or family members and providing in home follow-up; and 5) integrate lymphedema management into the curriculum for medical staff. The program achieved the inclusion of lymphedema management in the routine healthcare package. The evaluation after three years estimated that 79% of persons with a swollen leg in Togo were enrolled in the program. The adherence rate to the proposed World Health Organization treatment of washing, exercise, and leg elevation was more than 70% after three years of the program, resulting in a stabilization of the lymphedema stage and a slight decrease in reported acute attacks among program participants. Health staff and patients consider the program successful in reaching and educating the patients. After the external funding ended, the morbidity management program is maintained through routine Ministry of Health activities.

Figure 1.

Scaling up of the Togo Morbidity Program: geographic area and persons trained.

Figure 2.

Health education materials: poster for the general public. A, Poster used by community health workers. B, Togo Morbidity Program.

Figure 3.

Lymphedema patient booklet, Togo Morbidity Program.

Figure 4.

Patients enrolled in program, June 2007–March 2009, Togo Morbidity Program. LF = lymphatic filariasis.

Figure 5.

Percentage of program costs, Togo Morbidity Program.