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Title: Investigation of lymphatic filariasis distribution, morbidity management and disability prevention in Bangladesh
Author: Hafiz, Israt
ISNI:       0000 0004 7658 7442
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2018
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Lymphatic filariasis (LF), a mosquito-borne parasitic disease, is a major cause of disability in Bangladesh with an estimated 70 million people at risk of infection and tens of thousands suffering from the main clinical conditions. LF is targeted for elimination as part of the Global Programme to Eliminate LF (GPELF), which aims to interrupt transmission through mass drug administration (MDA) and providing patient care to those affected through morbidity management and disability prevention (MMD). Since 2001, the National LF Elimination Programme in Bangladesh has successfully scaled up MDA and of interrupted transmission. More recently the LF Programme has focussed on MMDP strategies, however there were significant gaps in knowledge, little understood about the distribution of disease and local communities and health workers. In this context, this research project aimed to address the current status of LF disability and its management including i) to examine the historical distribution of clinical cases in an endemic district, ii) determine the number and prevalence of LF after MDA activities, iii) to determine the knowledge, attitude, practices (KAP) of community members and patients and iv) to assess the workload, experience and perspectives of community health workers (CHWs) for morbidity control in a highly endemic district. The descriptive and statistical analysis of historical data in Nilphamari district found that cases of lymphoedema were widespread and cases of hydrocoele were more clustered in one area of the district. Women were more affected by lymphoedema and men by hydrocoele, and older people were more affected by clinical condition and people with more advanced disease suffered from more acute attacks. A cluster survey conducted in Nilphamari district after MDA activities in 2012, including 1242 people found low prevalence of clinical cases LF with very few cases especially in people less than 30 years old and the leg being the most affected body part. Women were more affected by lymphoedema and men by hydrocoele. A KAP study conducted in the same district demonstrated that community members and people affected by LF were aware of the National LF Programme and some measures to care for themselves. However, despite good awareness campaign by National LF Programme it was revealed that there is practice of some inappropriate and unhygienic measures like cutting by fish bones/knife and Jharfoak (A local term meaning traditional healing based on people's belief). A KAP study conducted on CHW revealed that knowledge about MDA and morbidity control was impressive before any large scale MMDP activities. However, the CHWs expressed that they have too much workload, inadequate training and lack of incentives for good practice related to morbidity control. These results will help the National Programme better understand the distribution of clinical disease and what practices to put in place. Bangladesh is progressing well towards the elimination of LF. At this stage national programme will need to demonstrate that services are integrated into health systems for long term sustainable support for patients - as their condition are chronic and many individuals will remain affected for many more decades. This study result will provide guidance on where to focus targeted activities on morbidity control and how best to utilize the CHW to integrate.
Supervisor: Kelly-Hope, Louise Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral