Supreme worth of clinical epidemiology in Africa:bancroftian Filariasis as just one case in point.
Clinical epidemiology is going to be the Discipline par excellence of the next century, if not the millennium. Coming as it does from one who has spent decades in clinical medicine and therapeutics, this is a bold statement. Clinical epidemiology answers the questions what? Where? How? When? Who? Why? And Which? In matters of health and disease. It is because these questions have come to be answered effectively with respect to bancroftian Filariasis that it has been included in the world's six "potentially eradicable" diseases. In his impressive Review Article on page (), Dr. Gyapong takes us through answers to these epidemiology questions [1]. Filariasis occurs in 38 African countries where the mere presence of a hydrocele affords "a rapid diagnostic index" for infection [2], while the so-called "filarial dance sign" is known to be present in intrascrotal lymphatics of microfilaraemic patients [3]. That the social and economic consequences of filarial morbidity are enormous on community preventive measures. People must be told that the mosquito, not juju or other "supernatural factors: [1] is the culprit. I am old enough to remember the "Town council Man" in colonial Gold Coast. He would visit every house assigned to him, enforcing environmental sanitation and destroying pools of water and mosquito breeding places. If but one cocoanut shell was found in the compound with water in it,whether or not it contained a mosquito larva, the head of the household was given summons to go to court and pay a fine. Came independence and the community also became independent of the "Town Council Man" with the result that there are infinitely more mosquitoes now in independent Ghana than there were in the colonial Gold Coast. "The WHO", it is widely held, "will do it for us". Today, a vaccine is awaited for most things while the insects flourish. Deal with mosquito, and both malaria and Filariasis will be dealt a death blow. Fortunately, ivermectin will reduce the parasitic reservoir from which transmission occurs, and diagnosis of subclinical cases no longer has to rely on blood sampling at night or on Diethyl Carbamazine provocation tests [4], but is reliably achieved using finger prick to detect Og4C3 circulating antigens day or night [5,6]. Mosquito nets reduce nocturnal bites and hence incidence of both malaria and Filariasis. Doctors should keep long-term records and ascertain whether insecticide impregnanted nets lead to pesticide resistance or not. Spraying should never be abandoned as it had often been on the rumour that "it does no good, and produces insecticide resistance". These preventive measures are best supervised through decentralised programmes [1,7] and are most effectively conducted in the mother tongue of the community at the grassroots [8]. Local businessmen and market women should be encouraged to assist chiefs and community leaders in giving monthly prizes in environmental sanitation while public health experts chart the effect of such sanitation on morbidity of Filariasis and mortality from malaria. We should go back to the "Sanitary Branch" institutions of the colonial days[9] when clinical epidemiology did much to protect the health of the community. Central government should fund trips to Japan, Taiwan, Solomon Islands, South Korea and some parts of China [1] for African health workers to learn first hand how those communities managed to eradicate lymphatic Filariasis. Even with the current AIDS problem, I remain convinced that clinical epidemiology is the answer [10]. Vaccines have achieved much this century, but to "wait for WHO to give us vaccines" while we neglect ourselves and our environment is wholly irresponsible.
Kanotey-Ahulu
F I
FI
Ghana Institute of Clinical Genetics and Consultant Physician , Korle BU Teaching Hospital now at Cromwell Hospital, London, SW OUT, England.