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Managing Lymphedema Induced by Lymphatic Filariasis: Implementing and Improving Care at the Individual and Programmatic Levels
Charles D. Mackenzie
Charles D. Mackenzie
Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD), Task Force for Global Health, Atlanta, Georgia;
The END Fund, New York, New York;
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The END Fund, New York, New York;
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D Ramaiah Kapa
D Ramaiah Kapa
Consultant Lymphatic Filariasis Epidemiologist, Pondicherry, India;
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Suma Krishnasastry
Suma Krishnasastry
Filariasis Research Unit, WHO Collaborating Center for LF MMDP, Government T. D. Medical College Hospital, Kerala University of Health Sciences, Alappuzha, India;
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Jan Douglass
Jan Douglass
Division of Tropical Health and Medicine, James Cook University, Townsville, Australia;
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Achim Hoerauf
Achim Hoerauf
Institute for Medical Microbiology, Immunology and Parasitology, University Hospital of Bonn, Bonn, Germany;
German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Germany
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German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Germany
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Eric A. Ottesen
Eric A. Ottesen
Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD), Task Force for Global Health, Atlanta, Georgia;
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Providing and improving the care of patients suffering from lymphedema remains an essential goal for the clinical management of populations affected by lymphatic filariasis. Although the Essential Package of Care (EPC) recommended by the WHO leads to important positive benefits for many of these lymphedema patients, it is important to continue to address the challenges that remain both in quantifying these effects and in ensuring optimal care. This report, based on the authors’ scientific and field experience, focuses on the impact and significance of lymphedema, its clinical presentation, current treatment approaches, and the importance of lymphedema care to the Global Program to Eliminate Lymphatic Filariasis. It emphasizes specific practical issues related to managing lymphedema, such as the importance of beginning treatment in the condition’s early stages and the development of effective approaches to assess patients’ progress toward improving both their clinical status and their overall quality of life. Priorities for research are also examined, particularly the need for tools to identify patients and to assess disease burden in endemic communities, the creation of EPC accessibility to as many patients as possible (i.e., targeting 100% “geographic coverage” of care), and the empowerment of patients to ensure the sustainability, and ultimately the provision of care from sectors of the national public health systems of endemic countries.
Author Notes
Financial support: This work received financial support from the United States Agency for International Development (USAID) through its Neglected Tropical Diseases Program through their support of the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD) grant. The COR-NTD is funded at The Task Force primarily by the Bill & Melinda Gates Foundation and USAID. C. D. Mackenzie is also supported by the END Fund through the Reaching the Last Mile Fund, a consortium is led by His Highness Sheikh Mohamed bin Zayed Al Nahyan, President of the UAE and Ruler of Abu Dhabi, with additional support from the
Authors’ contributions: Concept: C. D. Mackenzie and E. A. Ottesen; Writing: all authors; Reviewing: all authors.
Current contact information: Charles Mackenzie, E-mail: tropmed@mac.com. D Ramaiah Kapa, E-mail: ramaiahk@yahoo.com. Suma Krishnasastry, E-mail: sumatk@gmail.com. Jan Douglass, E-mail: jan.douglass@jcu.edu.au. Achim Hoerauf, E-mail: hoerauf@uni-bonn.de. Eric Ottesen, E-mail: eottesen@taskforce.org.
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