title: Lymphatic filariasis morbidity mapping: a comprehensive examination of lymphoedema burden in Chikwawa district, Malawi.
abstract: BACKGROUND
  Managing lymphatic filariasis (LF) morbidity and reducing disability is one of the two primary goals of the Global Programme to Eliminate Lymphatic Filariasis. However, in order to achieve this, the geographical distribution of LF morbidity needs to be better estimated.
  
  
  METHODS
  All cases of lymphoedema within a single health centre catchment area (pop. 42 000) in the southern region of Malawi were examined. Maps of lymphoedema burden were produced and trends in patient demographics, severity of lymphoedema (Dreyer staging) and health-seeking behaviour were explored. The number of lymphoedema cases was compared with records maintained by the Ministry of Health, Malawi.
  
  
  RESULTS
  A total of 69 lymphoedema cases were identified (32 per 10 000 population), of which 48 (70%) were female and 21 (30%) male. The majority of cases (51/69) had Dreyer stage 2-3, and almost all (65/69) had experienced acute attacks as a result of their lymphoedema. This burden was much greater than that estimated by Ministry of Health (33 cases).
  
  
  CONCLUSIONS
  Current case detection methods underestimate the burden of lymphoedema in Malawi. There is a continued need to develop new LF morbidity identification and surveillance approaches to ensure that future morbidity management strategies are effectively targeted.
authors.affiliation: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.
authors.forename: Emma L
authors.initials: EL
authors.lastname: Smith
authors.affiliation: National Lymphatic Filariasis Elimination Programme, Ministry of Health, Lilongwe, Malawi.
authors.forename: Square Z
authors.initials: SZ
authors.lastname: Mkwanda
authors.affiliation: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Martindale
authors.affiliation: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Kelly-Hope
authors.affiliation: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK michelle.stanton@lstmed.ac.uk.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Stanton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D060740:Disease Eradication / Q000379:methods*; D019468:Disease Management; D004605:Elephantiasis, Filarial / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D062305:Geographic Mapping; D006801:Humans; D008209:Lymphedema / Q000453:epidemiology; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058069:Neglected Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D011159:Population Surveillance; D055815:Young Adult
keywords: Dreyer staging; Hydrocoele; Lymphatic filariasis; Lymphoedema; Malawi; Morbidity