Elephantiasis community health case group work

1. KENYATTA UNIVERSITY
SCHOOL OF HEALTH SCIENCES
DEPARTMENT OF COMMUNITY HEALTH.
HCH102: SOCIAL WOK AND COMMUNITY
DEVELOPMENT
GROUP 17 MEMBERS:
1.Audi Stephanie P29/3375/2015
2.Lando Evis P29S/16344/2015
3.Stephen Wagiita P29S/16334/2015
4.Ambrose Mitati P29S/16340/2015
5.Zena Omar P29S/16301/2015
6.Boaz Onsare P29S/1067/2014
7. Victor Otii P29/3399/2015
8.Winnie Gaku P29S/16306/2015
9.Evelyn Komora P29/5665/2015
10. Deka Nur Sabrie P29S/16273/2015
TASK:Fighting against the increasing cases of elephantiasis.

2. INTRODUCTION
What is Elephantiasis?
This is a disease that affects body lymphatics. It is caused by Wucheroria boncrofti is a microfilirae
which are round worms. The name is derived from gross enlargement of the limbs or genitals to
elephantoid size. The long threadlike worms block lymphatic channels thus lymph channels thus lymph
fluid collects in tissues (lymphedema)The worms are carried by mosquitoes and those parasites are
introduced into the blood when one is bitten by a vector mosquito
Prevalence
The worms and vector mosquitoes are mostly found in tropical and subtropical regions. In Kenya the
disease is most prevalent in the CoastalRegion. Also it manifests mostly in adult due to the time the
worms take to replicate well enough to seriously block the lymphatics and more so in adult males above
50 years.
Risk Factors that have led to increasing casesofthe Disease.
Communicable aspect of the disease due to the Parasite being vector-borne.
Climatic Conditions ;warm, hot and humid
Poor drainage that creates breeding ground for mosquitoes.
Unkempt environment that similarly creates breeding ground for the mosquitoes.
Poor ventilation of houses; the worms pre-exist due to dust and dirt. Mosquitoes can therefore breed
easily.

3. Deductions
Statistics revealthat the worst hit areas in the Coastal region are the rural and pre-urban areas. Other than
climatic conditions, cases of poverty as well as cultural concepts have influenced the increasing spread of
the disease. A
Lack of social awareness and ignorance has also caused many more people to suffer in silence due to little
understanding of the disease.
Constant and early blood screening play a role in preventing the spread of the disease but unfortunately
lack of adequate health facilities and expertise has also fuelled the increase in spread.
The taboo that surrounds the disease has also led to its increase in spread .It is associated with witchcraft
or punishment due to immorality as perceived with the symptom of (swelling of the genitals)
Treatment is also relatively costly for the people affected. In most cases amputation of limbs and
mutilation of the affected body parts is involved. This reality is not well perceived by the patients as they
opt to live with the disease rather than incurring the cost to get treated.
As a social worker the aim in tackling the spread of the disease is propelled by the dehumanising aspect
of the disease as well as its huge impact on the socio-economic status of the community affected and the
individuals. It will also involve clearing webs of myths and misconception that surround the disease and
empowering the people to reduce risk factors despite the disadvantageous and inevitable climatic aspect
that favours the disease.
WORK PLAN.
Understanding the community’s aspect of the disease and acknowledging it effect on the total life of the
community.
Meeting relevant authorities to have their say on the disease and also bring them to an awareness of the
facts and info obtained about the disease.
Begin groundwork:
Set out on awareness scheme for the community which will heavily involve members of the community
for better communication.
Make relevant contacts with financial bodies to obtain funds to add to the community contribution
towards tackling the problem.

4. Handwork by members of the community.
Assessment and recommendation.
SOCIAL WORK PLAN BREAKDOWN:
UNDERSTANDINGCOMMUNITYCONCEPTOF THE DISEASE.
As mentioned earlier the disease is most prevalent in the coastalregion. It manifests mostly in
adults, in male more so. Connotations of witchcraft and immorality are attached to the disease.
People also ignore the consequences of not going for treatment due to financial in capabilities.
MEETING OF THE AUTHORITIES.
Involving authorities is a way of having a change of attitude towards dealing with a problem as a social
worker. I inquire from the leaders what they understand about the disease and what has been done so far
to deal with it. And who are those leaders? The area administration: chief, sub chief, and village elders,
clergy, women and youth group leaders, co-ordinations of other social workers, teachers and school
heads, all health officers and village herbalists or healer.
During this session, there is also the deliberate effort, by the social worker to put up facts of the disease so
that together with the leadership, efforts are pulled to start working towards dealing with it.
BEGINNINGGROUND WORK.
This part very much depends on consents of the area leadership. Culture integrity is very much upheld
and it aims at involving the whole community in dealing with elephantiasis.
As a social worker I mostly act as a facilitator of the process.
It also opens room for external intervention that includes administration of drugs and treatment of the
same.
It is based on creating an awareness of the disease, getting rid of stigma and empowering people to
combat it at an individual level.
The awareness program is first preceded by a short training of the people chosen by the leaders to
disseminate the information. This training is basically an open workshop to streamline information that
would be passed around. It is also an opportunity to demonstrate some practical procedures that will be
involved in addressing the disease.

5. The main aim of this part is teaching and practicing ways of preventing and controlling spread of the
disease. The prevention includes:
Sleeping under mosquito nets.
Slashing bushes
Draining stagnant water
Closing up open quarries
Proper disposal of garbage
Going for early screening of blood to detect infection.
Control measures includes:
Using insecticides to kill mosquitos
Using drugs to kill the worms in the body
Organization and coordination of the public talks as well as hand work is a proposal and activity of the
community leadership. As the social worker, my work is mostly facilitatory.
External intervention comes in handy mostly on financial and expertees matters.
CASE STUDIES:
Elephantiasis thrives amid funding gap.
Stigma has allowed a distinguishing microscopic worm to thrive in Kenya’s coastal region, but with
adequate funding, the spread of lymphatic filariasis (LF), also know as Elephantiasis, could easily be
stopped in the East African country with the help of just a couple of pills per year.
Spread of mosquitos, elephantiasis can cause severe swelling of the limbs, breasts, and scrotum as well as
thickening and hardening of the skin.
Some three mollion people living in the Kenya’s coastal province are “at risk”, a category that includes
those who may already have contracted the disease, whose symptoms can take decades to manifest
themselves.

6. “In the larger Kilifi District alone, 460,000 cases have been reported over the years,”Safari Ngowa,
programme manager for MAP international, an international NGO that has helped elephantiasis patients
in Kenya since 2008,
“A lot of these people perhaps do not know that they can get help at public hospitals,” Ngowa
said. “MAP international mostly conducts operations for those with swellings in their genitals
and provides palliative care for those with swollen limbs.”
Shanaz Sharif, director of public health and sanitation in Kenya’s ministry of Health, said: “reluctance to
come forward and seek treatment also complicates (compiling) figures for the disease. Some of the
sufferers have lived with the condition so long they just don’t come forward.”
He said Kenya was committed to eradicating the disease but budgetary constraints had affected
the mass administration of two drugs which, when taken annually for four or five years, halt the
transmission of the infecting parasite. The World Health Organization(WHO) Global Programme
to eliminate LF is leading this effort.
Mass drug administration:
“There was a delay in conducting the mass drug administration (MDA) in 2009 but we did it early this
year in the affected districts,” Sharif said.
MDA in Kenya was launched in Kilifi district in 2002 and then scaled up to include malindi and Kwale
districts in 2003.
An highly endemic area along River Sabaki in Malindi district has been used for operational research by
the Kenya medical Research institute (KEMRI) since 20002. Four rounds of MDA given to the
communities in this area have led prevalence rates to drop from 21 percent in 2002 to under one percent
in 2009,according to KEMRI scientist Sammy Njenga.
Scaling up(MDA) was supposed to happen every year but we have not been able to do this, or deliver
drugs every year,because of financial constraints,” he told Irin, explaining that the issue was not so much
the cost of the drugs themselves, but that of their delivery and correct administration in remote areas.
Njenga described LF(Lymphatic filariasis) as a “hidden disease” that in the past had not been taken as
seriously by health officials as malaria, HIV and tuberculosis.
On a more positive note, he said studies had shown that, while interrupting MDA in other countries had
allowed prevalence to rise, this did not appear to be the case in Kenya.

7. According to WHO, there are other reasons why less than a third of those at risk of LF in Africa benefit
from MDA.
Loa loa.
“In over 10 LF-endemic countries in central Africa, Loa loa, another parasitic disease is also present.
Because people with loa loa infections are at risk of severe adverse reactions when given ivermectin,
traditional MDA for LF can not be implemented in these areas,” Kazuyu Ichimori, who works with the
programme to eliminate LF at WHO’s department of control of neglected tropical
Diseases, told IRIN in an emailed response to questions. “This is one of the biggest challenges to scaling
up the geographical coverage of MDA and research is ongoing to better map the specific areas of overlap
and to determine alternative strategies to interrupt transmission,” she added.
“The other major challenges are the 13 countries which have not begun MDA that are in conflict or post-
conflict stages as well as logistical problems in implementing MDA(and achieving high coverage) in
urban areas,”she wrote.
A WHO strategic plan to eliminate the disease as a public health problem by 2020 discusses “potential of
enhanced drug regimens and vector control as a complement or alternative to the traditional MDA
approach,” she added.
According to WHO figures, LF affects more than 120 million people worldwide, one third of whom live
in Africa. At least 40 million people around the world are seriously incapacitated and disfigured by the
disease. It is endemic in 81 countries.
In 2009, WHO said the MDA programme targeted 496 million people and treated 385 million-a 77
percent coverage rate.
Kilifi County ranks low on health spending as disease ravages region (standard digital news
Thursday, November 14th
2013).
Pokeshe Kadenge has been concealing some weight aroiund his private parts using a leso for the past 18
years. The private nature of his condition has made it difficult to seek medical attention in public
hospitals. But he had no choice after his legs begun swelling.
Kadenge 75, is a resident of Mbararani village in Kilifi County. He suffers from a condition that is most
endemic at the Kenyan coast: Elephantiasis.

8. Elephantiasis affects thousands of people in Kilifi yet it can be prevented. The disease has no cure and
access to treatment is hampered by stigma and poor health infrastructure. The most visible part of the
disease is the swollen legs, but there are cases like that of kadenge, where people suffer from swelling of
the legs and private parts. Because of his condition, kadenge does not wear trousers. They can be
uncomfortable, so he prefers the coastal style of tying a leso around his waist.
“This is my 18th
year with the disease. I cannot go on a long trip. I can not walk for long distances. In the
last three months, I haven’t left my compound,” kadenge reveals. His condition has worsened in the last
two years after both his legs begun swelling.
“My wife fends for my children. She brings me food here on the mat. Sometimes I shiverand drink a lot
of water and lose my appetite for food.” He adds.
Kadenge directed us to the homes of two other people with the same condition. In the neighboring village,
we meet Christine Sani 23, who dropped out of school more than a decade ago after she got the disease.
Sani has to lift an extra 10kg of weight as se walks around. She rejected attempts to have her legs
amputated. She would rather keep them in that form than walk around on crutches, She reasons.
In the next village named Forodhoyo, lives Dhahabu Kenga,47. She stopped attending clinics when
doctors were no longer available to attend to her. “Every time I went to the clinic in Kilifi, I was told the
senior doctor who would attend to me was unavailable. So after three months of no treatment. I stopped
going.” Kenga tells us.
There are more cases, which we find without much effort in Kilifi County’s Ganze constituency. But
these three best illustrate the pain of thousands of residents wo are silently suffering from elephantiasis in
Kilifi County, which is one of the six most neglected tropical diseases in Kenya. Ironically, the Kilifi
County governmentis yet to prioritise elephantiasis on its budget.
There is an issue with Elephantiasis mostly in Kwale. I must say it is being handled like any other disease
in terms of curative and management measures,” Kilifi County’s executive member for health swabah
Omar told the standard. Her office has commissioned a study that is being conducted by Kenya medical
research institute to inform action.This is despite the existence of numerous studies done by both
government and international agencies on the disease.
An ambitious five year strategic plan for the control of neglected tropical diseases was released by the
ministry of health. It maps out where the disease is most prevalent, while giving recommendations on
what should be done to meet the international goal of eradicating elephantiasis by 2020.

9. The strategic plan was commissioned by the then public health minister, Beth Mugo, and was to be
implemented between 2011 and 2015.That has not happened.
Locally, Kilifi County has not budgeted a single cent towards fighting elephantiasis in its over sh. 300
million health development budget for 2013/2014. Kilifi will invest sh.255 per person to develop health
services. This is six times less than what Lamu County has set aside to spend on each resident.

10. References
Recommendations of the International Task Force for Disease Eradication. MMWR Recomm
Rep. 1993, 42: 1-38.
Ismail MM, Jayakody RL, Weil GJ, Nirmalan N, Jayasinghe KS, Abeyewickrema W, Rezvi
Sheriff MH, Rajaratnam HN, Amarasekera N, de Silva DC, Michalski ML, Dissanaike AS:
Efficacy of single dose combinations of albendazole, ivermectin and diethylcarbamazine for the
treatment of bancroftian filariasis. Trans R Soc Trop Med Hyg. 1998, 92: 94-97.View
ArticlePubMed
Weil GJ, Lammie PJ, Weiss N: The ICT Filariasis Test: A Rapid-format Antigen Test for
Diagnosis of Bancroftian Filariasis. Parasitol Today. 1997, 13: 401-404.View ArticlePubMed
Amaral F, Dreyer G, Figueredo-Silva J, Noroes J, Cavalcanti A, Samico SC, Santos A, Coutinho
A: Live adult worms detected by ultrasonography in human Bancroftian filariasis. Am J Trop
Med Hyg. 1994, 50: 753-757.PubMed
Mand S, Marfo-Debrekyei Y, Dittrich M, Fischer K, Adjei O, Hoerauf A: Animated
documentation of the filaria dance sign (FDS) in bancroftian filariasis. Filaria J. 2003, 2: 3-
PubMed CentralView ArticlePubMed
Dreyer G, Addiss D, Dreyer P, Norões J: Basic Lymphoedema Management. Treatment and
prevention of problems associated with lymphatic filariasis. 2002, New Hampshire, Hollis, 112-1
Molyneux DH, Neira M, Liese B, Heymann D: Lymphatic filariasis: setting the scene for
elimination. Trans R Soc Trop Med Hyg. 2000, 94: 589-591.View ArticlePubMed
Ottesen EA, Duke BO, Karam M, Behbehani K: Strategies and tools for the control/elimination
of lymphatic filariasis. Bull World Health Organ. 1997, 75: 491-503.PubMed CentralPubMed
Molyneux DH, Zagaria N: Lymphatic filariasis elimination: progress in global programme
development. Ann Trop Med Parasitol. 2002, 96 Suppl 2: S15-40.View ArticlePubMed