02669nas a2200301   4500000000100000008004100001653000900042653001400051653003900065653002500104653001500129100001400144700001600158700001400174700001400188700001300202700001300215700001700228700001400245700001500259700001500274245015000289856005700439300001000496490000700506520184000513022001402353       2013                            d10aTogo10aSelf care10aNeglected tropical diseases (NTDs)10aLymphatic filariasis10aEvaluation1 aMathieu E1 aDorkenoo AM1 aDatagni M1 aCantey PT1 aMorgah K1 aHarvey K1 aZiperstein J1 aDrexler N1 aChapleau G1 aSodahlon Y00aIt is possible: availability of lymphedema case management in each health facility in Togo. Program description, evaluation, and lessons learned.  uhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748474/  a16-220 v893 a<p>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.</p>
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