BACKGROUND

The Philippines has the highest number of new leprosy cases in the Western Pacific Region, with 1,000 to 2,000+ cases detected annually over the past decade. Out of 46 filariasis-endemic provinces in the country, 43 have eliminated lymphatic filariasis. However, many grade 2 disabilities acquired from these neglected tropical diseases (NTDs) remain undetected due to inadequate monitoring during and after treatment. This was further exacerbated by the detrimental impact of COVID-19 on healthcare access. The pandemic prompted initial adoption of teletraining, making a feasibility study necessary.

This study aimed to determine the feasibility of using telehealth and distance learning to train healthcare workers and patients in the integrated rehabilitation and prevention of impairments and disabilities from leprosy, lymphatic filariasis, mycetoma, diabetes, pressure ulcers, and other chronic wounds.

Selected rural health units, patients with disabilities, and their caregivers in a leprosy- and lymphatic filariasis-endemic region were recruited. Municipal health officers and leprosy coordinators helped in the conceptualization, planning, implementation, and evaluation of the teletraining program to ensure its acceptability and utilization. Asynchronous and synchronous methods were used. The main reference was the "Ten Steps" guide. Training materials were shared via Google Drive and flash drives sent to each study site. One-day didactics and skills trainings were conducted through live-interactive sessions using online platforms (Zoom or Google Meet). Topics focused on nerve function assessment (for leprosy and diabetes), problems of mobility, lymphedema, wound care, and self-care. Participants practiced and demonstrated their skills on local patients, with mentoring through Messenger chats. Knowledge and performance assessments were conducted.

The study was conducted from 2021 to 2022 and the actual training implemented within four months of 2022. Two municipalities of Sultan Kudarat province, Mindanao Island group with one rural health unit (RHU) each had participated. All participants (N=16; eight RHU personnel and eight village health workers) attended the synchronous skills training, 12 (75%) submitted return demo videos, and 13 (81.25%) had practicum patients. All participants rated the training as successfully attaining objectives and activities. All were generally satisfied with the teletraining because of improved knowledge and skills gained and were willing to continue it. Efficiency, speed, quality of training, and trainers had high ratings. Teletraining was considered effective in improving the wound care of their patients. Patients were also satisfied with the home care. However, the unreliable internet service in the study sites created difficulties during synchronous sessions and negatively affected appropriateness of teletraining. Finding patients for practicum was challenging. Some supplies were not available in local drugstores and had to be shipped from Manila, raising costs. Overall, the rating of the teletraining was good.

Teletraining of health workers from distant health units on integrated disability prevention and care is feasible in terms of implementation, acceptability, and practicality if stable internet connectivity is available. Larger studies are recommended.

The epidemiological surveys and inquest of retrospective data were conducted from 2002 to 2003 in Thua Thien – Hue, results showed that there were 4 patients with chronic complications of lymphatic filariasis in Hue city, Huong Tram district and Nam Dong district. Then the surveys were carried out in 7 communes with 2003 blood firms were taken and examined for microfilariae from November 2002 to April 2003. No positive slide has been found so far
Elephantiasis, Filarial ; Epidemiologic Studies ; Disease

An epidemiological survey for lymphatic filariasis was conducted in Nov.2001 in 4 communes of GiaLai and KonTum provinces. Blood was taken at night for detecting filarium,and mosquitoes were caugh for surveying entomologically.No microfilarium was detected in blood but a high rate of Culex quinquefasciatus,Culex vishnui, Culex puscocephalia was found. Dissection performed on 681 invidual mosquitoes did not show micofilarium
Elephantiasis, Filarial ; epidemiology ; diagnosis ; blood ; mosquitoes ;

In this survey, night blood firms were taken from 2,389 people in 2 communes of Lam Dong province: Tien Hoang (Cat Tien district) and Da Don ( Lam Ha district); and 2 communes of Dak Lak province: Eatrang (M’drak district) and Krongana (Buon Don district). No microlymphrea has been found. An entomological survey was also conducted in 4 same communes, showed that Culex quinquefasciantus and Culex vishnui occupied a high proportions among the collected mosquitoes. LF wasn’t found in the dissection of 461 mosquitoes
Elephantiasis, Filarial ; Epidemiologic Studies ; Disease ; epidemiology

In mid-1987 a baseline microfilarial prevalence survey was conducted among five villages in the Mt Bosavi region of the Southern Highlands Province of Papua New Guinea. Through use of the Nucleopore filtration technique, it was determined that 48% of villagers had detectable microfilaraemia. The highest prevalence was documented in Fogomaiyu, where the microfilaraemia rate was 92%. On the basis of this initial survey and the expressed interest of the community, the Division of Health in the Southern Highlands Province undertook an integrated community-based pilot control program. The project used two principal control methods: (a) drug treatment with low-dose diethylcarbamazine citrate (DEC) distributed to the community weekly and (b) vector control with permethrin-impregnated bednets. Results six months after the intervention indicate that the program was successful in reducing microfilaraemia at Fogomaiyu village from 92% to 6%. The reduction is principally related to the effects of DEC, although the bednets, by limiting vector-person contact, are expected to reduce the incidence of both filariasis and malaria.
Adolescent ; Altitude ; Bedding and Linens ; Community Participation ; Elephantiasis, Filarial - epidemiology

INTRODUCTION: Lymphedema develops due to the abnormality of the transport capacity of the lymphatic system. Clinically lymphedema is not only a cosmetic deformity, but also a disabling and distressing condition. CLASSIFICATION: Primary lymphedema is an inborn defect caused by such condition as absence or underdevelopment of the lymphatic system. It occurs in approximately 1 in 10,000 persons less than 20 years of age, with females being affected more frequently than males. Secondary lymphedema is an acquired condition resulting from loss or obstruction of the previously normal lymphatic system due to infection, tumor, filariasis and other miscellaneous conditions. CLINICAL FEATURES: Clinical symptoms and signs depend on the duration and the severity of the lymphedema. In the early stage of disease, the edema is soft and pits easily with pressure (pitting edema) and may decrease or disappear with elevation of the limbs. In the advanced stage, the skin texture turns woody as the surrounding tissue becomes indurated and fibrotic. DIAGNOSIS: Lymphangiography was introduced in the early 19th century. But there are several drawbacks to this procedure, including the complexity of the procedure, irradiation by contrast agent that may result in lymphangitis and potentially worsen the lymphedema. Lymphoscintigraphy is easier to perform than lymphangiography and is not reported to cause lymphangitis. Lymphoscintigraphy is gradually replacing lymphangiography. TREATMENT: The mainstay of the treatment is complex decongestive physical therapy including leg elevation, elastic or rigid compression, manual lymph drainage, and intermittent pneumatic compression. When the function of the limb is significantly impaired, surgical reduction is considered. The surgery is not curative, but it can make the disorder more manageable by complex decongestive physical therapy.
Classification ; Congenital Abnormalities ; Diagnosis ; Drainage ; Edema ; Extremities ; Female ; Filariasis ; Humans ; Leg ; Lymphangitis ; Lymphatic System ; Lymphedema* ; Lymphography ; Lymphoscintigraphy ; Male ; Skin

Adult ; Chyle ; Female ; Filariasis ; complications ; Humans ; Laparoscopy ; Lymphatic System ; surgery ; Male ; Middle Aged ; Retroperitoneal Space ; Urine ; Urologic Surgical Procedures ; methods

Elephantiasis nostras verrucosa (ENV) is a rare clinical condition associated with chronic non-filarial lymphedema caused by bacterial or non-infectious lymphatic obstruction. A variety of etiologies, including infection, tumor obstruction, trauma, radiation, chronic venous stasis, congestive heart failure, and obesity, can lead to chronic lymphatic obstruction and edema. Mossy papules, plaques, and cobblestone-like nodules are clinically impressive features of ENV, but biopsy reveals only moderately abnormal findings such as pseudoepitheliomatous hyperplasia, dilated lymphatic spaces, fibrous tissue hyperplasia, and chronic inflammation. We present a case of ENV in a 67-year-old man with a 10-year history of multiple nodules and verrucous plaques on both feet. Microbiology ruled out a filarial infection. Nodule biopsy revealed pseudoepitheliomatous hyperplasia, marked dermal fibrosis, and a chronic inflammatory infiltrate. No evidence of carcinoma was identified. Both venous stasis and recurrent cellulitis could contribute to the dermal fibrotic changes of the lesions. However, before the recurrent cellulitis, he did not have any nodular lesions on his feet despite a 10-year history of venous disease. Therefore, this case suggests that venous stasis alone cannot produce the fibrotic nodular lesions of ENV
Aged ; Biopsy ; Cellulitis ; Edema ; Elephantiasis ; Fibrosis ; Foot ; Heart Failure ; Humans ; Hyperplasia ; Inflammation ; Non-Filarial Lymphedema ; Obesity

OBJECTIVE: Elimination eforts for lymphatic flariasis are underway in the Philippines using mass drug administration (MDA) of diethylcarbamazine and albendazole as one of the main strategies. This cost analysis was done to determine the MDA implementation cost and provide useful information to the control programme on how to best utilize limited resources.

METHODS: This cost analysis study was conducted in the province of Sorsogon, Philippines in 2004. The study was done from a program perspective. Cost data for 2003 was obtained retrospectively via key informant interviews and records review using a standardized guide from a multi-country cost analysis study of flariasis elimination programs. Cost fgures were classifed as either economic or fnancial costs and expressed in real terms using 2002 as base year. Sensitivity analysis was likewise performed.

RESULTS: The total economic cost and cost per person treated with MDA were estimated at US$223,549.55 (Php12,116,385.48) and US$0.40, respectively. The fnancial costs were less than half of the economic costs. The main cost driver was drug distribution. The highest economic and fnancial costs were incurred at the national (54.5%) and municipal (74.4%) levels, respectively. High variation in costs of MDA activities was observed.

CONCLUSION: This cost analysis provides reasonable estimates which may be used to assist government and other stakeholders in program planning and resource generation for flariasis elimination programs in endemic areas.

Indonesia and South Korea have become inseparable in various respects since the 2 countries established diplomatic relation in 1973. Indonesia is a tropical region that stretches across the equator, comprised of 5 main islands (Java, Kalimantan, Sumatra, Sulawesi, and Papua) and 4 archipelagoes (Riau, Bangka Belitung, Nusa Tenggara, and Maluku). As most population of Eastern Indonesia (Sulawesi, Papua and Nusa Tenggara & Maluku) live in poor areas, it is expected that there will be many parasites. Nevertheless, little is known about the status of parasites in Indonesia. This study examines the prevalences of malaria and lymphatic filaria, which are prevalent in Indonesia, as well as those of soil-transmitted-helminths (STH). As a result, the Plasmodium falciparum and P. vivax case loads are almost equal. The current prevalence of P. vivax is uniformly low (<5%) in all age groups and annual parasite incidence (API) showed decreasing tendency as 0.84 per 1,000 population in 2016. However, more than 65 million people still live in malaria epidemic regions. Lymphatic filariasis remains an important public health problem and 236 cities were classified as endemic areas in 514 cities/districts in 2017. It is difficult to ascertain the current prevalence rate of STH in Indonesia, although West Sumba and Southwest Sumba in East Nusa Tenggara reported prevalence rate of more than 20%. The study also considers the (sero) prevalences of other parasites identified in Indonesia. This report should be useful not only to parasitologists but also to travelers and people with business in Indonesia.
Commerce ; Diplomacy ; Elephantiasis, Filarial ; Humans ; Incidence ; Indonesia ; Islands ; Korea ; Malaria ; Parasites ; Plasmodium falciparum ; Prevalence ; Public Health