8 FRIDAY, SEPTEMBER 16, 2016
FRIDAY, SEPTEMBER 16, 2016 7
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Daily Monitor
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MINISTRY OF HEALTH
PRESS STATEMENT
Uganda on course to eliminate Elephantiasis: 7.8 million people in 33 districts protected from the disease
Uganda is on course to eliminate elephantiasis by
2020. With more than 10 years of programme
implementation, the disease is nearing elimination.
To date, 33 districts with a population of 7.8 million
are free of parasites that cause Elephantiasis. The
Programme to Eliminate elephantiasis, also known
as Lymphatic Filariasis (LF), was launched in
Uganda in 2002, starting in the then districts of
Katakwi and Lira. The programme later expanded
to cover a total of 55 districts where parasites that
cause elephantiasis and hydroceles were found to
be rampant.
What is Lymphatic Filariasis or Elephantiasis?
Lymphatic
Filariasis,
commonly
called
elephantiasis, is a disease caused by tiny thread
like worms found in infected individuals. It is
transmitted from an infected individual to another
person by Anopheles mosquitoes, the same
mosquitoes that transmit malaria in Uganda. The
disease manifests as swollen legs, arms or both,
causing elephantiasis in men and women. In men,
the common chronic sign in Uganda is the swelling
of the scrotal sacs, commonly known as
hydroceles, which is due to accumulation of fluids.
Infection with this disease occurs early in life but
the signs appear after many years of repeated
infections.
In all affected communities, the majority of
infected individuals shows no obvious signs of the
disease but are capable of infecting mosquitoes
and perpetuating the disease because the
parasites are in their blood. That is why the
elimination
programme
treats
all
eligible
individuals in a community, whether infected or
not. It is important to note that both elephantiasis
and hydroceles are debilitating conditions that
cause great pain, ill health, stigma, divorce and
poor productivity. The disease generally causes
suffering and results in poor quality of life of the
victims as well as the communities that have to
support them. In some communities in Obalanga
Subcounty, Amuria District, residents, mostly men
but also women, who were affected by
elephantiasis and / or hydroceles, in 1995 formed
an association Obalanga Hydrocele Association to
fight the disease and advocate for their rights as
disabled people. This Association members later
sought to be exempted from paying taxes because
they were disabled. The Association is now an
NGO working on health and assisting victims of LF.
However, there is another type of elephantiasis in
Uganda called podoconiosis, which is not caused
by parasites, nor is it transmitted by mosquitoes /
insects. This type of elephantiasis affects people
who are exposed to types of soils which are rich in
some minerals, mainly Aluminium and Silica. It is
rampant in rural farming communities in highland
areas, where most residents walk bare-footed. The
tiny mineral particles in the soil penetrate the soles
of the feet, enter vessels that remove waste fluids
and cause irritation and swelling of these vessels.
The vessels eventually fail to perform their function
of draining the body’s waste fluids, leading to
accumulation of these fluids and swelling of the
feet, legs (elephantiasis) and in some cases
causing small hydroceles as well. Podoconiosis is
common in mountainous and hilly areas including,
some parts of Kabale, Kamwenge, Kibaale, Kisoro,
Mubende, Sironko, Kapchorwa, Manafwa, Kween
and Nakapiripirit districts among others.
Photo showing a scrotum affected by
elephantiasis due to LF
Elephantiasis caused by parasites is now known to
occur in 55 out of the 116 districts in Uganda with
16 million people estimated to be at risk or
exposed at baseline. The Vector Control Division
of the Ministry of Health conducted surveys in all
the districts of Uganda. These surveys provided
information on the distribution, magnitude,
manifestations and transmission of the disease.
The most affected areas were found to be in
Lango, Acholi, West Nile, Teso, Busoga,
Bundibugyo and Karamoja sub regions. In some
communities in Amuria, Alebtong, Dokolo, Lira,
Kaberamaido and Katakwi Districts, up to 30% of
adult males had hydroceles. In these districts, LF
manifestations are well known and have local
names. For example for hydroceles (Longo-Luo,
Akuwe-Ateso,
Eribinda
–
Kasese,
Empanama-Luganda and Lusoga; while for
elephantiasis (Enjovu-Luganda, Bokotolo-Lusoga,
Ebatira-Ateso, Apim-Luo; Esyambiringiti-Kasese,
obujojo-Rutoro), to mention a few.
The Programme to Eliminate Lymphatic Filariasis
(PELF), was launched in 2002. Its major goal is to
eliminate LF as a public health problem in Uganda
by 2020 by interrupting LF transmission and
alleviating the effects of elephantiasis and
hydroceles.
According to World Health Organization (WHO)
guidelines, only districts with LF parasite
prevalence of 1% and above qualify for LF
elimination interventions. The main elimination
strategy is mass treatment or Mass Drug
Administration of all the eligible individuals using a
combination of two drugs, namely albendazole
(ALB) and Ivermectin (IVM), given once every year
for at least five consecutive years. The medicines
are given to all individuals aged 5 years and above.
Children aged 1-4 years are given Albendazole
alone.
The medicines are distributed by teachers in
schools and members of the Village Health Teams
(Community
Medicine
Distributors)
in
all
communities in affected districts. These medicines
are donated for as long as needed by two
companies, Albendazole by GlaxoSmithKline (UK),
and Ivermectin by Merck & Co. Inc. (USA)
respectively, through their respective donation
programs and coordinated by WHO. The rationale
for mass treatment is to clear parasites from all
infected individuals so that transmission of the
disease by mosquitoes is no longer possible.
Uganda is one of the affected (endemic) countries
in the world that has made a commitment to
eliminate elephantiasis in collaboration with
partners by the year 2020.
Some of the key achievements include:
a) Country-wide mapping completed in 2010.
b) Launching the elimination programme in 2002
and scaling-up throughout the country.
c) 33 out of 55 affected districts have interrupted
transmission of the disease and have stopped
mass treatment (yellow colour in map).
d) A total of about 7.8 million people have been
freed from the risk of contracting elephantiasis
and hydroceles caused by parasites.
e) 8 more districts (blue colour) have recently
been surveyed and the infection levels are very
low, meaning they can stop annual treatments.
Final approval to stop mass treatment is
awaited.
f) The 14 remaining districts (red color) are
expected to be re-surveyed in 2017/18
Photo showing elephantiasis and hydrocele victims in Amuria District
Plans to accelerate LF elimination:
• Re-survey the 14 remaining districts (in red) in 2017/2018
• Focus on morbidity management and disability prevention through rapid assessment / mapping cases,
scaling up hydrocele surgeries and training communities in management of elephantiasis cases
Map 1: LF situation at the beginning (baseline)
Map 2: Current LF situation in the country –
August 2016
Acknowledgements
This success story has been through the
efforts of the Ministry of Health’s Programme
to Eliminate Lymphatic Filariasis (PELF).
The Programme has received tremendous
support from several partners as follows:
ENVISION/RTI/USAID, which provided funds
for completing mapping, capacity
strengthening, technical support, mass
treatments and impact surveys; WHO which
provided some of the funds for mapping,
developing the elimination plan, initiating
treatments in 2002, advocacy, technical
guidance and coordinated drug donations
and deliveries to Uganda; the integrated NTD
implementing partners including
Envision/RTI, Sightsavers, The Carter Center,
Schistosomiasis Control Initiative, which have
played a key role in planning and technical
support supervision of PELF; Merck & Co.
(USA), which donates Ivermectin through
Mectizan Donation Program (MDP);
GlaxoSmithKline (UK) for donating
Albendazole used in the Programme; The
Centre for Health and Development formerly
Danish Bilharziasis Laboratory-Denmark
provided funds for capacity strengthening of
VCD/MoH, research on LF, baseline
investigations and mapping LF in schools
throughout the country; the support and
cooperation of District Local Governments
and staff; the District NTD Focal Persons /
Vector Control Officers, Teachers, Community
Medicine Distributors/VHTs; Supervisors at
various levels, local NGOs, affected
communities that allowed these
achievements to be made.
For more information contact:
The Director General Health Services,
Ministry of Health,
P.O. Box 7272 Kampala,
Telephone: +256-414-340874,
+256 414 231584
Fax:
+256-414-414 340877,
+256 414 231 584
E-mail: [email protected]
Website:www.health.go.ug
KEY
Districts with the disease
Districts without the disease
KEY
Districts continuing with mass treatment
Districts just surveyed,
will stop treatment 2016
Districts stopped treatment in 2015
Districts without the disease
Or visit a Health Office, Unit nearest to
you and your Community Health Worker