1. Trends in Morbidity for Lymphatic Filariasis in the Most Affected Area of Bangladesh Midori Morioka 1, Hossain Moazzem 2, Kazuhiko Moji 3, Yukiko Wagatsuma 1 1 University of Tsukuba, Department of Clinical Trial and Clinical Epidemiology, 2 Institute of Allergy and C ｌ inical Immunology of Bangladesh, 3 Research Institute for Humanity and Nature 1-2 / September / 2012, 3th NTD Conference

2. 1 Epidemiology: * Infection: 120 million people in 72 countries (WHO,2010) * Low human development index of 94% of those countries (Cristine Bonfim et al, 2009) * Second biggest factor related to impairment (WHO, 1995) Situation in Bangladesh: * Endemic area: 34 of 64 districts * Risk of infection: 70 million people * Infection: 20 million people (MOHFW Bangladesh, 2010) Background Figure1) Map of endemic areas in Bangladesh

3. 2 Symptom of LF: 1. Asymptomatic microfilariaemia 2. Acute manifestation Acute episodic Adenolymphangitis (ADL) a) Acute filarial lymphangitis (AFL) b) Acute dermatolymphangioadenitis (ADLA) 3. Chronic manifestation Lymphedema, Elephantiasis, Hydrocele 4. Occult Filariasis etc Background

4. 3 Acute manifestation: Background

5. 4 Chronic manifestation: Background

6. 5 Eliminate LF by 2020 as started in the WHO initiative Prevention Treatment To interrupt transmission of infection by Mass Drug administration (MDA) To alleviate and prevent both the suffering and disability by morbidity control (MC) Elimination of LF by 2015 in Bangladesh

7. Study area: 6 Methods Nilphamari Jaldhaka selected from 6 upazilas Paurashava and Kanthali union selected from 12 unites Paurashava: Ward2,3,6 Kanthali: Ward2,4 5 wards randomly selected Figure2) Map of Jaldhaka upazila

8. Study sample: * Patients who had filarial acute or/and chronic manifestations * Patients aged less than 10 years - only registered, not interviewed chronic manifestation a) lymphedema with lower limb b) lymphedema with upper limb c) hydrocele d) lymphedema with breast e) lymphedema with sex organ f) other filarial symptoms 7 Methods

9. 8 Date collection: * Screened all households in 5 ward by 8 trained research assistants * Structure interview: socio-demographic information, medical and treatment history a) acute – ADL within previous and previous 12 months b) chronic – Dreyer staging system * Checked the validation by supervisor Data analysis: * Basic characteristics to show the distribution of lymphatic filariasis

10. 9 Results Flow chart of sampling: 4,584 households 728 residents listed 540 residents interviewed as patients 536 patients analyzed 149 residents not directly observed 8 residents refused to join 31 residents aged less than 10 years 4 patients excluded because of misclassification

11. 10 Results Graph1. Disease Distribution n= 557 because 21 patients suffer from lymphatic filariasis with 2 parts. Child patients aged less than 10 years are not included.

12. 11 Results Table1. Sex distribution 9 male patients suffer from lymphatic filariasis with 2 parts. 12 female patients suffer from lymphatic filariasis with 2 parts. Child patients aged less than 10 years are not included.

13. 12 Results Graph2. Age distribution 21 patients suffer from lymphatic filariasis with 2 parts. Child patients aged less than 10 years are not included.

14. 13 Results Table2. Disease distribution of child case aged 10-14 years length of illness mean (±SD): 5.2 (±3.4) years 31 child patients aged less than 10 years, that means to born after MDA, were also registered.

15. 14 Results Graph3. Distribution of length of illness 21 patients suffer from lymphatic filariasis with 2 parts. The longest period is adopted for the patients affetced with both of right and left part. One is excluded because of only pain after hydrocele operation. Child patients aged less than 10 years are not included. after MDAbefore MDA

16. Earlier age is adopted for the patients affected with both of right and left part. One is excluded because of only pain after hydrocele operation. 15 Results Graph4. Age of onset (clinical manifestation) - before and after MDA lymphedema with lower limbhydrocele 0-9 years: increased after MDA because of 31 child cases Mean age (±SD) 30.7 years (±12.7) 24.6years (±13.7) 37.0years (±13.5) 29.7years (±16.5)

17. 16 Discussion and Conclusion * Disease magnitude (number of patients) hydrocele > lymphedema with limb sampling bias: working- aged male with hydrocele * Child case with hydrocele, family history * New case (chronic manifestation) despite of MDA, but not increasing * Age on onset getting higher after MDA, but increasing child case aged less than 10 years?? recall bias: before MDA * Further clinical assessment and statistical analysis especially focused on child hydrocele after MDA

18. Thank you for listening Acknowledgement Dr. Moazzem and IACIB, Prof Moji, Prof Wagatsuma, Field research assistants and Patients