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The wider societal benefits of surgical interventions for lymphatic filariasis morbidity management and disability prevention

['Sarah Martindale', 'Centre For Neglected Tropical Diseases', 'Department Of Tropical Disease Biology', 'Liverpool School Of Tropical Medicine', 'Liverpool', 'United Kingdom', 'John Chiphwanya', 'Ministry Of Health', 'Lilongwe', 'Dorothy Emmie Matipula']

Date: 2021-09

Citation: Martindale S, Chiphwanya J, Matipula DE, Ndhlovu P, Betts H, Kelly-Hope LA (2021) The wider societal benefits of surgical interventions for lymphatic filariasis morbidity management and disability prevention. PLoS Negl Trop Dis 15(9): e0009701. https://doi.org/10.1371/journal.pntd.0009701 Editor: Peter U. Fischer, Washington University School of Medicine, UNITED STATES Published: September 16, 2021 Copyright: © 2021 Martindale et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This research was funded by grant support from the Foreign, Commonwealth and Development Office (FCDO) to the Centre for Neglected Tropical Diseases at the Liverpool School of Tropical Medicine. The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist.

Introduction Lymphatic filariasis (LF) is targeted for global elimination as a public health problem by interrupting transmission with mass drug administration and providing an essential package of care to people affected by the debilitating lymphedema and hydrocoele conditions [1]. In recent years, many LF endemic countries have scaled up their morbidity management and disability prevention (MMDP) programmes with a new focus on universal health coverage, primary healthcare strengthening, and integrated management of skin neglected tropical diseases (NTDs), with the aim of fully integrating quality services for LF MMDP into national health systems to ensure sustainability [2]. The positive impact of MMDP interventions for patients has been documented [3–6]; however, no research has been conducted on the wider societal benefits, including the impact on the people who care for patients, i.e., caregivers. Ton and colleagues [7] calculated that the burden of depressive illness in LF patient caregivers was 229,537 disability-adjusted life years (DALYs). Other studies have documented a negative socioeconomic impact on the caregivers of people affected by filarial and nonfilarial leg lymphedema and those who experience painful secondary bacterial infections, acute adenolymphangitis [8–10]. Hydrocoele is the most common LF clinical manifestation, which affects approximately 19 million men worldwide and can be cured by surgery [11]. In Malawi, recent large-scale patient mapping and modelling estimate that at least 14,000 men have hydrocoele across the country. In 2015, surgical campaigns were initiated to address the burden, together with a study to highlight the significant positive impact of surgery on men in highly endemic areas [4]. We advocate that the positive impact of this surgical intervention can extend beyond the patient to include their caregivers, who are likely to be family members (predominately female) and have their own time, work, and quality of life affected.

Conclusions These preliminary data on caregivers highlight the wider burden of filariasis morbidity on families and endemic communities if left untreated. Like the struggles that patients face before interventions, caregivers have their daily living activities, own time, and ability to work negatively affected by providing additional assistance on a range of tasks in and around the home. Further, there was a negative psychosocial impact, with caregivers’ friendships and intimate relationships thwarted, and many felt neglected, shamed, and concerned for the future [7,14]. Importantly, these preliminary data highlight the significant positive change that a surgical intervention can have on many aspects of caregivers’ lives, especially female family members. This has additional wide-ranging societal and economic benefits. It helps to address gender inequalities, which have been highlighted with lymphedema [10], and are vital to making progress towards the Sustainable Development Goal 5, in recognising and valuing unpaid care and domestic work [15]. It also suggests that the high benefit–cost ratio of 24.5 of surgery recently calculated for hydrocoele patients by Sawers and colleagues [16] could potentially be doubled if caregivers’ postsurgery economic productivity was included in the calculations. This highlights the value of this intervention, and a clear message of “buy 1 surgery and get 2 people back to work” may convince international donors and ministries of health to continue to invest. For example, in Malawi, this would mean that at least 28,000 people would benefit from 14,000 surgeries. Therefore, we advocate that the continued support and scale-up of LF MMDP activities will have comprehensive physical, social, psychological, and economic benefits to patients, their families, and the endemic communities in which they live. This will further help national elimination programmes address the requirements of universal healthcare as part of WHO NTD Road Map, help families and communities get out of the poverty cycle, and ensure that no one is left behind [1].

Supporting information S1 Table. Summary of the frequency, percentage, and mean of domain scores of the 40 caregivers pre- and postsurgery. https://doi.org/10.1371/journal.pntd.0009701.s001 (DOCX)

Acknowledgments We thank the hydrocoele patient caregivers who agreed to participate in this study and acknowledge the health surveillance assistants for their help in locating and recruiting participants.

[END]

[1] Url: https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0009701

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