Advancing in the treatment of podoconiosis and lymphatic filariasis (LF) in Ethiopia.

In Ethiopia, podoconiosis is endemic in 345 districts, with 34.9 million people at risk, while LF is endemic in 112 districts with more than 5.6 million people at risk for the disease. Podoconiosis is an inflammatory disease caused by prolonged contact with irritating soil minerals, while LF is a parasitic infection transmitted by mosquitoes. The project seeks to improve the quality of life of patients with podoconiosis and LF and improve their access to medical care in four endemic districts of Ethiopia.

CONTEXT

Podoconiosis and lymphatic filariasis (LF) are the main causes of tropical lymphedema in Ethiopia. Podoconiosis is an inflammatory disease caused by prolonged contact with irritating soil minerals, while LF is a parasitic infection transmitted by mosquitoes. However, both diseases require a similar provision of medical care, but until recently, the Ethiopian health system did not integrate the morbidity treatment aspect into regular health care services.

In Ethiopia, podoconiosis is endemic in 345 districts, with 34.9 million people at risk, while LF is endemic in 112 districts with more than 5.6 million people at risk for the disease. Fifty-three of these districts are co-endemic for podoconiosis and LF.

The stigmatization of people with podoconiosis and LF and their families is evident; The patient and his children are excluded from school, local gatherings, churches, and mosques. The project aligns with the Global Program to Eliminate Lymphatic Filariasis, which aims to eliminate lymphatic filariasis as a public health problem by 2020, as well as with the second edition of Ethiopia's National Plan for Neglected Tropical Diseases "for 2016- 2020 that focuses on lymphatic filariasis and podoconiosis for elimination in 2020 and 2030 respectively.

The Federal Ministry of Health (FMOH) has adopted an integrated approach to care delivery, because it was not feasible to differentiate between the two diseases in primary health care centers and due to the similarity in health care services for both. diseases. Podoconiosis and LF are the main causes of lymphedema in tropical areas. Podoconiosis causes lymphedema of the lower limb and sharp pain. The early stages of the disease are reversible, but the later stages need lifelong treatment.

The main prevention methods are the use of footwear, regular foot hygiene, while people already affected receive treatment for their morbidity related to lymphedema. Treatment includes daily foot hygiene with soap, water, and antiseptics, emollients to restore skin function, leg elevation, exercise, use of socks and shoes, and, if necessary, compression bandages and surgical removal of nodules.

Since 2009, the International Orthodox Christian Charitty (IOCC) has implemented lymphedema management and disease prevention activities in various areas of Ethiopia. Based on the lessons learned through the implementation of the program, the IOCC can participate efficiently and effectively in the prevention and treatment of podoconiosis and LF in the proposed area - North and South Wollo Zones - in collaboration with the local and regional governments.

PROJECT

General objective of the project:

Improve the quality of life of patients with podoconiosis and LF and improve their access to medical care in four podoconiosis endemic districts with isolated cases of LF in the Amhara regional state of Ethiopia.

Specific objectives of the project:

1. Increase access to treatment services for podoconiosis and LF by developing the capacity of health personnel; and

2. Prevent and reduce the disability of affected people through community treatment.

Summary of the main components and activities:

1.Provide training to 56 mid-level health workers in four podoconiosis endemic districts with isolated cases of LF in the North and South Wollo areas on the management of morbidity from podoconiosis and LF:

IOCC will hold two training events for mid-level health workers. Lymphedema morbidity management sessions will focus on disease causation, prevention, treatment, differential diagnosis, and referrals. The training will allow them to recognize the disease, offer an accurate diagnosis, and prescribe appropriate treatment for patients. The training will be aimed at mid-level health workers and university and college graduates who work at district health centers and who provide treatment to patients from remote communities. This training will be carried out by IOCC trainers in collaboration with the Regional Health Office.

2. Train 200 community leaders as entry points to endemic communities and catalysts for behavior change.

IOCC will develop and carry out a variety of behavior change and education strategies to address the causes and effects of stigma and further increase awareness in the community. People with podoconiosis and LF face isolation and rejection from the community. Community and religious leaders and leaders of women's groups will act as entry points to endemic communities.

Trained community leaders supported by patient-led groups and information and communication materials produced in the local language will be used to raise awareness with a focus on the cause and prevention of disease and the relatively simple methods of treatment and care.

Two hundred community leaders will be trained. Each training event will last half a day and will include 50 community leaders from each district. A total of 80 members of women's-led groups will be included in the training from the four districts.

3. Organize 200 awareness-raising events in communities about the care, treatment, prevention, stigma and discrimination associated with podoconiosis and LF, and about the general economic and social impact of these diseases.

Community empowerment and mobilization are critical to the prevention and control of neglected tropical diseases (NTDs). At the district and community level, the focus will be on educating people about different disease prevention measures and raising awareness about the availability of treatment in health clinics.

Podoconiosis and LF can affect both men and women, regardless of age. The nature of the diseases and associated stigma often means that podoconiosis and LF patients are the most difficult to reach and most vulnerable groups. An important aspect of communication campaigns is to make messages accessible and meaningful to the entire community.

4. 800 people will receive lymphedema treatment and self-care information to maintain health.The quality of life for lymphedema patients will improve by increasing their access to treatment, which will reduce leg and foot swelling, improve skin condition, and reduce the frequency of "acute episodes" of fever, pain, and additional swelling.

The first steps of podoconiosis and LF treatment are done with simple, portable, and inexpensive treatments that include foot hygiene and care, including washing the feet in clean water, drying them properly, using an emollient cream, bandaging the inflamed area , elevation and movement to improve the lymphatic. circulation, and the use of socks and shoes. A small number of patients require surgery, i.e. surgical removal of foot nodules and hydrocele surgery for podoconiosis and LF, respectively. Patients will be trained to use safe and effective self-care techniques by mid-level health workers at selected health centers

5. Establish patient-led patient groups to spearhead ongoing community-based prevention and treatment efforts crucial to eliminate these diseases

Consultation with beneficiaries has demonstrated the importance of "expert patients" who can act as advocates of self-treatment and provide care in communities. This project will establish 28 patient-led groups, one per "kebele" group (Ethiopia's smallest administrative unit, similar to a neighborhood). "Patient leaders" will be selected from patients treated with podoconiosis or LF based on their level of literacy and ability to teach and coordinate to other patients, as well as their adherence to treatment procedures.

BENEFICIARY POPULATION

Number of direct beneficiaries: 10,568 of them, number of women: 4,564, and number of children (<15 years): 3,520

Number of indirect beneficiaries: 42,272 of them, number of women: 21,136, and number of children (<15 years): 18,600

Description of the direct beneficiaries: people who suffer from the disease and receive treatment and education about self-care in health centers; people participating in awareness-raising events on the prevention and treatment of lymphatic filariasis and podoconiosis; Health professionals receive training on morbidity management, disability prevention; Health professionals, health extension workers, and the health development brigade are reached through orientation and cascade training, similar to a train-the-trainer model; and community leaders receive training on the prevention and treatment of lymphatic filariasis and podoconiosis.

Description of indirect beneficiaries: the family of the patient who benefits from the treatment of the patients since it allows them to seek livelihoods to support their family; the children of patients who can attend schools and other social institutions that are vital to their development; family members benefit from behavior change information received during community awareness events; and household members of local health workers benefit from the income provided through their employment.