03556nas a2200313   4500000000100000008004100001653003000042653001600072653001400088653002300102100001200125700001000137700001500147700002500162700001300187700001700200700001800217700001200235700001200247700001600259700001300275700001700288245015100305856009900456300001300555490000700568520265300575022001403228       2019                            d10aLymphatic filariasis (LF)10aLymphoedema10aHydrocele10aClinical risk maps1 aKarim M1 aHaq R1 aMableson H1 aSultan Mahmood A S M1 aRahman M1 aChowdhury SM1 aRahman FA K M1 aHafiz I1 aBetts H1 aMackenzie C1 aTaylor M1 aKelly-Hope L00aDeveloping the first national database and map of lymphatic filariasis clinical cases in Bangladesh: Another step closer to the elimination goals.  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0007542&type=printable  ae00075420 v133 a<p><strong>BACKGROUND: </strong>The Bangladesh Lymphatic Filariasis (LF) Elimination Programme has made significant progress in interrupting transmission through mass drug administration (MDA) and has now focussed its efforts on scaling up managing morbidity and preventing disability (MMDP) activities to deliver the minimum package of care to people affected by LF clinical conditions. This paper highlights the Bangladesh LF Programme's success in conducting a large-scale cross-sectional survey to determine the number of people affected by lymphoedema and hydrocoele, which enabled clinical risk maps to be developed for targeted interventions across the 34 endemic districts (19 high endemic; 15 low endemic).</p>

<p><strong>METHODOLOGY/PRINCIPAL FINDINGS: </strong>In the 19 high endemic districts, 8,145 community clinic staff were trained to identify and report patients in their catchment area. In the 15 low endemic districts, a team of 10 trained field assistants conducted active case finding with cases reported via a SMS mHealth tool. Disease burden and prevalence maps were developed, with morbidity hotspots identified at sub-district level based on a combination of the highest prevalence rates per 100,000 and case-density rates per square kilometre (km2). The relationship between morbidity and baseline microfilaria (mf) prevalence was also examined. In total 43,678 cases were identified in the 19 high endemic districts; 30,616 limb lymphoedema (70.1%; female 55.3%), 12,824 hydrocoele (29.4%), and 238 breast/female genital swelling (0.5%). Rangpur Division reported the highest cases numbers and prevalence of lymphoedema (26,781 cases, 195 per 100,000) and hydrocoele (11661 cases, 169.6 per 100,000), with lymphoedema predominately affecting females (n = 21,652). Rangpur and Lalmonirhat Districts reported the highest case numbers (n = 11,199), and prevalence (569 per 100,000) respectively, with five overlapping lymphoedema and hydrocoele sub-district hotspots. In the 15 low endemic districts, 732 cases were identified; 661 lymphoedema (90.2%; female 39.6%), 56 hydrocoele (7.8%), and 15 both conditions (2.0%). Spearman's correlation analysis found morbidity and mf prevalence significantly positively correlated (r = 0.904; p&lt;0.01).</p>

<p><strong>CONCLUSIONS/SIGNIFICANCE: </strong>The Bangladesh LF Programme has developed one of the largest, most comprehensive country databases on LF clinical conditions in the world. It provides an essential database for health workers to identify local morbidity hotspots, deliver the minimum package of care, and address the dossier elimination requirements.</p>
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