PREVALENCE, CLINICAL MANIFESTATION AND ASSESSMENT OF KNOWLEDGE, PERCEPTION AND PRACTICES OF LYMPHATIC FILARIASIS IN PAIKORO LOCAL GOVERNMENT, NIGER STATE

ABSTRACT

There are ongoing current efforts of mass drug administration for the interruption of lymphatic filariasis (LF) in Nigeria but the disease is still one of the major disabling filarial diseases of public health significance. Unupdated possible data on the transmission of LF informed this study  to  elucidate  the  prevalence  of   Wuchereria  bancrofti  infection  in  Paikoro  Local Government, Niger State. Immunochromatographic card test (ICT) for detecting circulating filarial antigen (CFA) using whole blood and overt clinical manifestations (Lymphoedema and hydrocoele) were used as diagnostic tools. The demographic characteristics as well as knowledge and perception of participants were determined using structured questionnaire, out of the 1015 randomly selected subjects aged >5years an overall prevalence of 24.33% was established, there was  a  trend  of  higher  prevalence  in  males  (13.11%)  than  females  (11.22%).  Wuchereria bancrofti prevalence varies significantly (p<0.05) among the age group examined while the highest prevalence was recorded among age group of  16-25 (8.6%)  the lowest prevalence was recorded among age group of 56—65years . Participants were aware of the symptoms such as itching, pain, and chill and majority of the respondents acknowledged that the disease is transmitted through mosquito bite and controlled by sleeping under mosquito net.   37.7% of participants were informed by past experience with Lymphatic filariasis, Community health workers,  Mass  media  and  Hospitals.  On  the  other  hand,  the  infection  varied  significantly (p<0.05) with respect to marital status and occupational characteristics of the participants in the communities. The results indicated that W. bancrofti infection is widely spread in Paikoro Local Government  and  it  is  a  major  health  issue,  this  calls  for  urgent  need  for  mass  drug administration, mass sensitization, sustained intervention program towards the people in the study area.

CHAPTER ONE

1.0. INTRODUCTION

1.1. Background to the Study

Lymphatic filariasis (LF) is a parasitic neglected tropical disease (NTD) targeted for global elimination by the year 2020 as part of the Global Programme to Eliminate Lymphatic Filariasis (GPELF) (WHO, 2017), although the disease is has not yet been eliminated due to unupdated data. Lymphatic filariasis is caused by three parasitic worms: Wuchereria bancrofti, Brugia malayi, and B. timori, with W. bancrofti causing over 90% of the infections which are vectored by Culex, Anopheles, and Aedes mosquitoes.

One of the GPELF’s main strategies is to interrupt transmission through mass drug administration (MDA) using three combinations of antihelminthic medicines: Albendazole plus Diethylcarbamazine (DEC); Albendazole plus ivermectin (onchocerciasis co-endemic areas), or the alternative strategy of albendazole twice yearly plus vector control (WHO, 2016). About 40 million people suffer from clinical manifestations of the disease which usually results into serious disfiguration and incapacitation of the body, where approximately 1.4 billion people are at risk of the infection (Amaechi, 2014)

Elkana  et  al.,  (2017)  posits  that  various  clinical  manifestations  of  lymphatic  filariasis ranges from: itching, elephantiasis, hydrocoele, and lymphoedema of breast at varying rates.  Lymphatic filariasis  has a major social and economic impact with an estimated annual loss of $1 billion and impairing economic activity up to 88%. Hydrocoele, lymphoedema and elephantiasis are the overt, chronic disabling consequences observed in patients with these damaging parasitic infections of the lymphatic vessels (WHO, 2016).

Lymphatic filariasis is the second leading cause of permanent and long-term disability in the world, inflicting serious public health and socio-economic problem in endemic communities and the disease is usually seen among the poorest of the poor, in the priorities of most of the countries where it is prevalent for many years having a very low public health rating. People living for a long time in tropical or sub-tropical areas where the disease is common are at the greatest risk for infection and about 30% of people at risk reside in the African region while 65% of those at risk reside in South-East Asia Region, with the remainder in other parts of the world (Terranella et al., 2006, Nilmini et al., 2018).

The visible manifestations of the disease are severe and disfiguring, it has been reported that one third of infected individuals present with overt clinical manifestations such as lymphoedema and elephantiasis of the limbs, or genitals, hydrocoele, chyluria,  or recurrent infections associated with damaged lymphatic-vessel lives in Africa (Sherchand et al., 2003). According to Person et al. (2006)acute attacks of adenolymphangitis (ADL) are characterized by fever, chills, local warmth and inflammation of the inguinal node. Patients are usually weak for 4-7 days while the attack lasts and the swelling later becomes permanent in the form of lymphoedema of lower extremities and at times there is dysfunction of the genital lymphatic that leads to hydrocoeles (WHO, 2010).

The main vectors of lymphatic filariasis in Nigeria are mosquitoes of the An. gambiae (principally  An.  gambiaes.s.  and  An.  arabiensis)  and  Anopheles  funestus  complexes (Lenhart et al., 2007; Sinka et al., 2010). Lymphatic filariasis is prevalent in all states and geopolitical  zones  of Nigeria before the success  of the two  states  and  a total  of 241 lymphoedema and 205 hydrocoele cases have been reported from mapping surveys conducted in Nigeria (Okorie et al., 2011). Programs to eliminate lymphatic filariasis are under way in more than 66 countries. These programs are at eradicating transmission of the filarial parasites and reducing the risk of infection amongst people living in or visiting these communities, targeted for elimination and the national programme is scaling up mass drug administration (MDA) across the country to interrupt transmission (Brant et al.,2018; CDC, 2018).

Lymphatic filariasis, a neglected tropical disease presently affects the poorest of the poor in most sub-Saharan African countries, Nigeria exclusive having a negative significant impact on the psychological, economic and social life of the affected populace. An understanding of  the  geographical  distribution  of  LF  in  Niger  State  is  required  to  meet  national elimination programs. This enables more effective targeting of control efforts on highly endemic areas.

1.2. Statement of the Research Problem

The socioeconomic impact of lymphatic filariasis in endemic areas is prevailing. It leads to loss of labour or work  caused by both acute episode of acute adenolymphangitis and chronic diseases thereby affecting dramatically the productivity of affected individuals, households and communities. These disease problems hamper the most important daily activities of the affected individuals and impose transient (in acute disease) or life-long (in chronic disease) limitations on their inputs (Ramaiah et al., 2000). The impact of lymphatic filariasis on marriage and sexual life is a serious problem in endemic areas. Women, more than men, depend on their physical presentation for their self-esteem (World Bank, 1993); and the destruction of the skin and beauty of the physical appearance of adolescent girls and women by lymphedema and elephantiasis seriously affect women, including hindering marriage prospects/opportunities.

Also stigmatization of men with hydrocoele is also observed in some of the endemic countries. Villagers in some parts of Nigeria expressed fear and insecurity towards people with filarial skin lesions and towards men with genital complications and elephantiasis of the extremities (Nwoke et al., 2000). Out of the 128 million people estimated to be globally infected by LF (McCarthy, 2000), 22 million of them (17.2%) are children below the age of 15years school aged children (Michael and Bundy, 1997)). LF is the second leading cause of permanent as well as long term disability (Ottesen et al., 1997). Upon the concerted control efforts by the government and international bodies yet, lymphatic filariasis is still a disease of public health concern in Nigeria, with an estimated 106 million cases, placing the country as one with the highest prevalence in Africa (Okorie et al., 2015)

1.3. Justification for the Study

Lymphatic filariasis, caused by Wuchereria bancrofti is widespread in Nigeria with most individuals at risk for LF in Africa and second largest globally behind India, with approximately 120 million of Nigeria’s estimated 174 million inhabitants in need of MDA (WHO, 2014). It is a serious public health problem as well as a major cause of acute and chronic morbidity in Nigeria (Nwoke et al., 2010).

It is estimated that there are about 1.2 billion people who are at risk of the disease in the 83 countries (20% of the world population); and over 128 million people are infected or diseased (McCarthy, 2000). About 76 million people in the world are estimated to be suffering from the hidden disease or subclinical renal, respiratory, lymphatic and genital complications associated with LF (Bockarie, 2002). Out of the 128 million people infected globally by LF, 91% of them are due to W. bancrofti while B. malayi and B. timori account for the other 9% burden (Addis, 1998).

In Africa, Nigeria has the heaviest LF burden with an estimated 120 million people at risk (Okorie et al., 2013). In 2013, the Nigerian National LF Elimination Programme planned to scale-up MDA based on recent national mapping results, and the use of micro-stratification overlap mapping (MOM) to delineate LF-loasis co-endemicity, Community-directed treatment with ivermectin (CDTI), and insecticide-treated net/long-lasting insecticidal mosquito net (ITN/LLIN) distributions to protect from the main Anopheles vectors (Okorie et al., 2013, 2011). Initial programme work demonstrated successful integration of ITNs with MDA in Central Nigeria (Eigege et al., 2013), links with the malaria program and co- implementation strategies (Federal Ministry of Health, 2013). However, in some LF-loiasis co-endemic areas more refined mapping and definition of risk factors were important where there was uncertainty about the risk of serious adverse events (SAEs) and if CDTI or alternative  intervention  strategies  should  be  used.  In  Nigeria,  the  CDTI  strategy  was adopted in 1997, and currently more than 45 million people are being treated in more than 36,000 communities during the annual MDA (FMOH, 2017). This research work was carried out in Paikoro Local Government in Niger State with the villages namely; Jazu, Jere, Jeresapai. For total elimination of the disease one must take into account the range of people’s knowledge and perceptions for the Global elimination program for lymphatic filariasis (GEPLF) to gain wide acceptance.

1.4. Aim and Objectives of the Study

The aim of this study is to investigate the clinical epidemiology of lymphatic filariasis (LF), knowledge and perceptions among some selected communities in Paikoro Local Government, Niger State.

The objectives of the study were to:

(i)        Determine Prevalence and detection of iGg antibody (chromatographic filarial antibody) of LF among communities of Paikoro Local Government, Niger State.

(ii)       Clinical signs and symptoms of Lymphatic Filariasis among communities of Paikoro Local Government, Niger State.

(iii)      Investigate  community’s  perception,  practices  and  knowledge  of  lymphatic filariasis (LF) among communities of Paikoro Local Government, Niger State.

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