It is Possible: Availability of Lymphedema Case Management in each Health Facility in Togo. Program Description, Evaluation, and Lessons Learned

Els Mathieu Centers for Disease Control and Prevention, Atlanta, Georgia; Ministry of Health, Lomé, Togo; Emory University, Atlanta, Georgia; Mectizan Donation Program, Decatur, Georgia

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Ameyo M. Dorkenoo Centers for Disease Control and Prevention, Atlanta, Georgia; Ministry of Health, Lomé, Togo; Emory University, Atlanta, Georgia; Mectizan Donation Program, Decatur, Georgia

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Michael Datagni Centers for Disease Control and Prevention, Atlanta, Georgia; Ministry of Health, Lomé, Togo; Emory University, Atlanta, Georgia; Mectizan Donation Program, Decatur, Georgia

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Paul T. Cantey Centers for Disease Control and Prevention, Atlanta, Georgia; Ministry of Health, Lomé, Togo; Emory University, Atlanta, Georgia; Mectizan Donation Program, Decatur, Georgia

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Kodjo Morgah Centers for Disease Control and Prevention, Atlanta, Georgia; Ministry of Health, Lomé, Togo; Emory University, Atlanta, Georgia; Mectizan Donation Program, Decatur, Georgia

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Kira Harvey Centers for Disease Control and Prevention, Atlanta, Georgia; Ministry of Health, Lomé, Togo; Emory University, Atlanta, Georgia; Mectizan Donation Program, Decatur, Georgia

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Joshua Ziperstein Centers for Disease Control and Prevention, Atlanta, Georgia; Ministry of Health, Lomé, Togo; Emory University, Atlanta, Georgia; Mectizan Donation Program, Decatur, Georgia

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Naomi Drexler Centers for Disease Control and Prevention, Atlanta, Georgia; Ministry of Health, Lomé, Togo; Emory University, Atlanta, Georgia; Mectizan Donation Program, Decatur, Georgia

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Gina Chapleau Centers for Disease Control and Prevention, Atlanta, Georgia; Ministry of Health, Lomé, Togo; Emory University, Atlanta, Georgia; Mectizan Donation Program, Decatur, Georgia

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Yao Sodahlon Centers for Disease Control and Prevention, Atlanta, Georgia; Ministry of Health, Lomé, Togo; Emory University, Atlanta, Georgia; Mectizan Donation Program, Decatur, Georgia

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Lymphatic filariasis (LF) is a vector-borne parasitic disease that can clinically manifest as disabling lymphedema. Although the LF elimination program aims to reduce disability and to interrupt transmission, there has been a scarcity of disease morbidity management programs, particularly on a national scale. This report describes the implementation of the first nationwide LF lymphedema management program. The program, which was initiated in Togo in 2007, focuses on patient behavioral change. Its goal is two-fold: to achieve a sustainable program on a national-scale, and to serve as a model for other countries. The program has five major components: 1) train at least one health staff in lymphedema care in each health facility in Togo; 2) inform people with a swollen leg that care is available at their dispensary; 3) train patients on self-care; 4) provide a support system to motivate patients to continue self-care by training community health workers or family members and providing in home follow-up; and 5) integrate lymphedema management into the curriculum for medical staff. The program achieved the inclusion of lymphedema management in the routine healthcare package. The evaluation after three years estimated that 79% of persons with a swollen leg in Togo were enrolled in the program. The adherence rate to the proposed World Health Organization treatment of washing, exercise, and leg elevation was more than 70% after three years of the program, resulting in a stabilization of the lymphedema stage and a slight decrease in reported acute attacks among program participants. Health staff and patients consider the program successful in reaching and educating the patients. After the external funding ended, the morbidity management program is maintained through routine Ministry of Health activities.

Author Notes

* Address correspondence to Els Mathieu, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341. E-mail: emm7@cdc.gov

Financial support: This study was supported by the U. S. Agency for International Development and IMA World Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Authors' addresses: Els Mathieu, Paul T. Cantey, Kira Harvey, and Naomi Drexler, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: emm7@cdc.gov, pcantey@cdc.gov, kaharvey@cdc.gov, and isj3@cdc.gov. Ameyo M. Dorkenoo, Michael Datagni, and Kodjo Morgah, Ministry of Health, Lomé, Togo, E-mails: monicadork@yahoo.fr, michael.datagni@yahoo.fr, and morgah@yahoo.fr. Joshua Ziperstein and Gina Chapleau, Centers for Disease Control and Prevention, Atlanta, GA, and Emory University, Atlanta, GA, E-mails: joshzip@gmail.com and gina.chapleau@emory.edu. Yao Sodahlon, Mectizan Donation Program, Decatur, GA, E-mail: ysodahlon@taskforce.org.

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