https://orcid.org/0000-0002-4985-2912
Figures
Abstract
Background
Lymphatic filariasis (LF) is a significant neglected tropical disease in the Democratic Republic of the Congo (DRC). Although progress has been made toward interrupting transmission through mass drug administration, LF-related morbidities—particularly hydrocele, lymphoedema, and recurrent acute dermatolymphangioadenitis—continue to cause substantial disability, comorbid infections, and reduced quality of life. National evidence on the burden of LF morbidities and factors associated with access to morbidity management remains limited.
Methods
We conducted a national retrospective analysis of routinely collected programmatic data from the National Neglected Tropical Diseases Control Programme in the DRC between 2018 and 2024. Data included estimates and management of LF-related hydrocele and lymphoedema across endemic provinces. Descriptive analyses assessed morbidity burden, geographic distribution, and temporal trends. Care cascade analyses were performed to quantify attrition across key stages of morbidity management. Multivariable linear regression models at provincial level were used to identify programmatic and health-system factors associated with hydrocele surgery coverage and lymphoedema management coverage.
Results
A total of 8,471 hydrocele cases and 5,310 lymphoedema cases were identified nationwide. During the study period, 2,013 hydrocele surgeries (23.8%) were performed, while 877 lymphoedema patients (16.5%) received the essential package of care. Marked geographic disparities were observed, with several high-burden provinces exhibiting particularly low coverage. Care cascade analyses revealed substantial attrition between case identification and receipt of care for both conditions. In multivariable analyses, hydrocele surgery coverage was positively associated with external partner support and availability of trained surgical personnel, while higher caseloads, post–Transmission Assessment Survey (post-TAS) surveillance phase, and geographic inaccessibility were associated with lower coverage. Lymphoedema management coverage was strongly associated with community-based care activities, health worker training, and availability of basic hygiene supplies.
Conclusions
LF-related morbidities remain a substantial and unevenly addressed public health burden in the DRC, including in provinces that have achieved or are approaching interruption of transmission. Strengthening and scaling up morbidity management and disability prevention services—particularly for lymphoedema and hydrocele—are essential to improve patient quality of life and to meet World Health Organization requirements for elimination of lymphatic filariasis as a public health problem.
Author summary
Lymphatic filariasis is a disabling neglected tropical disease that can cause swelling of the legs (lymphoedema) and scrotal swelling in men (hydrocele). These conditions lead to pain, recurrent infections, social stigma, and reduced ability to work. In the Democratic Republic of the Congo, thousands of people continue to suffer from these complications even though medicines are distributed every year to stop transmission of the infection. In this study, we analysed national data collected between 2018 and 2024 by community drug distributors during door-to-door drug distribution campaigns. These community workers identified people with possible lymphoedema or hydrocele and referred them to health facilities for care. We found large differences between regions in both the number of cases and access to treatment. Many patients were identified but did not receive surgery for hydrocele or care for lymphoedema. Access to treatment was better in areas where health workers were trained, where hygiene supplies were available, and where external partners provided support. Our findings highlight the need to strengthen care services at the health zone level, improve early detection by community workers, and expand access to simple diagnostic methods such as transillumination for hydrocele. Improving these services is essential to reduce suffering and achieve elimination of lymphatic filariasis as a public health problem.
Citation: Makenga Bof JC, Muteba D (2026) Geographical disparities and programmatic determinants of hydrocele surgery and lymphoedema management coverage for lymphatic filariasis in the Democratic Republic of the Congo, 2018–2024: A national analysis of routine programme data. PLoS Negl Trop Dis 20(6): e0014406. https://doi.org/10.1371/journal.pntd.0014406
Editor: Krystyna Cwiklinski, University of Liverpool, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
Received: January 13, 2026; Accepted: May 22, 2026; Published: June 2, 2026
Copyright: © 2026 Makenga Bof, Muteba. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant aggregated data underlying the findings are fully available within the manuscript and its Supporting Information files (S1 Table and S2 Table).
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Lymphatic filariasis (LF) is a debilitating neglected tropical disease (NTD), affecting impoverished populations in tropical and subtropical regions worldwide [1]. The disease is caused by mosquito-borne filarial parasites and is characterised by chronic clinical manifestations, including surgically treatable hydrocele, irreversible lymphoedema, and recurrent acute dermatolymphangioadenitis (ADLA) [2]. These conditions not only cause physical disability but also lead to profound social stigma, psychological distress, reduced productivity, and long-term socioeconomic hardship for affected individuals and their households [3].
To address the global burden of LF, the World Health Organization (WHO) established the Global Programme to Eliminate Lymphatic Filariasis (GPELF), built on two complementary pillars: interruption of transmission through mass drug administration (MDA), and morbidity management and disability prevention (MMDP) for individuals already affected by chronic manifestations [4]. While substantial progress has been made toward reducing transmission, the MMDP component has often received comparatively less investment and remains insufficiently implemented in many high-burden settings [5]. Ensuring availability of hydrocele surgery, hygiene-based lymphoedema care, management of ADLA episodes, and psychosocial support is essential for improving quality of life and achieving WHO validation of elimination as a public health problem [6,7].
Despite WHO recommendations that all endemic countries provide an essential package of care for LF-related morbidity management, access in practice remains limited, unevenly distributed, and dependent on external partner support and local health system capacity [8]. Barriers include shortages of trained personnel, weak referral pathways, geographic inaccessibility, and limited availability of supplies required for lymphoedema self-care. Community-based detection systems led by community drug distributors (CDDs), who identify suspected cases during door-to-door MDA campaigns, are unevenly implemented. Moreover, although hydrocele can be reliably confirmed through transillumination, its use remains inconsistent in many endemic districts.
The Democratic Republic of the Congo (DRC) bears one of the highest LF burdens in sub-Saharan Africa [9]. Despite significant expansion of MDA, and despite several health zones approaching or achieving transmission interruption, LF-related morbidities remain widespread across the country [10]. National estimates indicate tens of thousands of individuals living with hydrocele or lymphoedema, many of whom have never received appropriate care [11]. In the DRC, co-endemicity with other filarial infections, combined with vast geographic distances, insecurity, poor road networks, and limited surgical capacity, complicates morbidity attribution and poses major operational challenges for the delivery of MMDP services [12].
Yet, nationally representative evidence on morbidity burden, geographic disparities in care coverage, and programmatic determinants influencing access to services remains scarce. Available data are fragmented, based on small-scale assessments, or limited to isolated hydrocele surgery campaigns [13]. Comprehensive analyses integrating burden estimates, care cascade evaluation, and identification of determinants of coverage are urgently needed to inform national strategic planning and support WHO verification of LF elimination [14].
In this study, we present the first national retrospective analysis of LF morbidity management in the DRC between 2018 and 2024 using routinely collected programme data. Our objectives were to: (i) describe the national burden and geographic distribution of hydrocele and lymphoedema; (ii) assess coverage and attrition along the morbidity management care cascade; and (iii) identify programmatic and health system factors associated with access to hydrocele surgery and lymphoedema care at provincial level. By addressing these gaps, this study provides actionable evidence for strengthening morbidity management and disability prevention services across endemic health zones in the DRC and similar high-burden settings.
Methods
Ethical considerations
This study used anonymised, aggregated programme data collected as part of national LF surveillance and morbidity management. No identifiable personal data were accessed.
The protocol was reviewed and approved by the Ethics Committee of the School of Public Health, University of Kinshasa (Approval No. ESP/CE/938/2025), in accordance with national regulations and international standards [15].
In line with World Health Organization guidance, formal individual informed consent was not required for this secondary analysis of routine public health programme data [15].
As this study involved secondary analysis of anonymised and aggregated routine programme data, no individual written or verbal informed consent was required.
Study design and setting
We conducted a national retrospective programmatic analysis of lymphatic filariasis (LF) morbidity management in the Democratic Republic of the Congo (DRC) covering the period from January 2018 to December 2024. The study analysed routinely collected data from the National Neglected Tropical Diseases Control Programme (NTD-CP), which implements World Health Organization (WHO)–recommended strategies for LF elimination, including morbidity management and disability prevention (MMDP) [16].
The primary operational unit for planning, implementation, and reporting was the health zone, supervised by provincial NTD coordinations responsible for oversight, supervision, and validation of morbidity data [16]. The analysis included all 26 provinces (provincial coordinations) and 264 health zones with reported LF morbidity data during the study period. These units represent the national operational coverage of the LF morbidity management programme in the Democratic Republic of the Congo.
Data sources
Data were extracted from multiple routine programmatic sources maintained by the National Neglected Tropical Diseases Control Programme (NTD-CP), including morbidity registers, annual provincial reports, hydrocele surgery campaign reports, and monitoring and evaluation databases.
Morbidity data were primarily generated through household-level case detection conducted by trained community drug distributors (CDDs) during door-to-door mass drug administration campaigns, in accordance with national programme guidelines and WHO recommendations [17,18]. Prior to field deployment, CDDs received programme-specific training on the identification of suspected hydrocele and lymphoedema cases, including recognition of chronic lower-limb swelling and scrotal swelling suggestive of filarial hydrocele, based on standard case definitions. Suspected cases were subsequently validated through supervisory review at health zone level. This community-based surveillance approach relies on door-to-door registries rather than health-facility reporting, thereby providing a broader and potentially more exhaustive representation of the morbidity burden at population level, while acknowledging the possibility of under-detection compared with formal clinical examination.
The aggregated dataset used in this analysis included:
- identified hydrocele and lymphoedema cases
- eligibility and receipt of morbidity management
- geographic distribution across health zones and provinces
- availability of trained personnel for morbidity management
- documentation of external partner support
Together, these complementary sources provided comprehensive national coverage of lymphatic filariasis morbidity and service delivery activities for the period 2018–2024.
A detailed summary of annual morbidity management activities by province and year is provided in S2 Table.
Study population and case definitions
The study population comprised all individuals identified by the national programme as having LF-related hydrocele or lymphoedema during the study period.
Hydrocele cases were defined as males presenting with scrotal swelling consistent with LF and eligible for surgery after clinical assessment. Eligibility for hydrocele surgery was determined through clinical examination, including transillumination where appropriate, confirmation of filarial hydrocele, assessment of operability, and exclusion of contraindications for surgery [19].
Lymphoedema cases were defined as individuals presenting with chronic swelling predominantly affecting the lower limbs (legs), consistent with lymphatic filariasis-related lymphoedema, irrespective of disease stage, and eligible for the essential package of care [20].
Morbidity management interventions
Hydrocele management consisted of surgical treatment performed during routine hospital services or organised surgery campaigns, following WHO-recommended surgical techniques [21].
Lymphoedema management followed the WHO essential package of care, including hygiene-based self-care, wound care, treatment of acute dermatolymphangioadenitis (ADLA), education, and community follow-up [22].
Access to these services varied according to health zone capacity, trained personnel, partner support, and geographical accessibility.
Outcome measures
Primary outcomes included:
- Hydrocele surgery coverage: proportion of identified hydrocele cases receiving surgery.
- Lymphoedema management coverage: proportion of identified lymphoedema cases receiving the essential package of care.
Secondary outcomes included care cascade attrition, defined as losses between case identification, evaluation, and treatment [23].
Explanatory variables
Explanatory variables were selected based on WHO guidance and evidence from LF elimination programmes, including:
- external partner support
- availability of trained surgical personnel
- number of trained health workers
- availability of lymphoedema care supplies
- total caseload
- geographic accessibility
- provincial Transmission Assessment Survey (TAS) status [24,25]
These variables represent programmatic and health-system determinants of MMDP coverage.
Statistical analysis
Descriptive analyses summarised morbidity burden, geographic distribution, and coverage of morbidity management. Care cascade analyses quantified attrition at successive stages of care.
Multivariable linear regression models were fitted at the provincial level to assess associations between explanatory variables and hydrocele surgery coverage and lymphoedema management coverage. The provincial-level analytical dataset used for the regression models is provided in S1 Table. Regression coefficients were expressed as absolute percentage-point changes. Statistical significance was set at p < 0.05. Analyses were conducted using Stata version 17.0 (StataCorp, College Station, TX, USA) [26].
Results
Burden and distribution of lymphatic filariasis–related morbidities
Between 2018 and 2024, a total of 13,781 lymphatic filariasis (LF) morbidity cases were identified nationwide in the Democratic Republic of the Congo, including 8,471 hydrocele cases (61.5%) and 5,310 lymphoedema cases (38.5%) (Table 1). Data were available from all 26 provinces and 264 health zones included in the national LF morbidity management reporting system.
Hydrocele cases were reported in 264 health zones, while lymphoedema cases were reported in 252 health zones, confirming broad but heterogeneous geographic distribution.
Among all identified hydrocele cases, 2,013 patients (23.8% of all identified cases and 29.6% of clinically eligible cases) underwent surgery. Among identified lymphoedema cases, 877 patients (16.5%) received the essential package of care.
Although lymphoedema can affect both sexes, the routine programme data showed that reported cases occurred in both men and women, with a higher proportion among men (63.9%) than women (36.1%). This may reflect gender-related differences in community reporting, health-seeking behaviour, and possible under-detection of male cases during household-based case identification.
Overall morbidity burden and the distribution of hydrocele and lymphoedema by province and health zone are summarised in Table 1.
Year-by-year provincial summaries of morbidity management activities are presented in S2 Table.
Provincial coverage of morbidity management
The analysis included all 26 provincial coordinations and 264 reporting health zones. Population denominators and reported case rates per 100,000 population covered are presented in Table 2. Coverage of morbidity management varied markedly across provinces (Table 2). Hydrocele surgery coverage ranged from 0% to 69.1%, with higher coverage in provinces receiving sustained partner support and demonstrating stronger surgical capacity. Several high-burden provinces, including Kasaï Central and Ituri, reported very low or no surgical coverage.
Lymphoedema management coverage was consistently lower than hydrocele surgery coverage, with several provinces reporting no documented lymphoedema care activities. Geographic disparities are illustrated in Fig 1.
Choropleth map showing the proportion of identified hydrocele cases that received surgical treatment across provinces between 2018 and 2024. Coverage was classified using programmatically relevant thresholds: 0– < 10%, 10– < 25%, 25– < 50%, 50– < 75%, and ≥75%. Provinces with no documented surgeries appear in the lowest category. The map highlights substantial geographic disparities in access to hydrocele surgery services, with several high-burden provinces reporting limited or absent coverage. All data were derived from routine programmatic reports compiled by community drug distributors and provincial NTD programme teams. Base map shapefile source: Natural Earth, public domain, compatible with CC BY 4.0. Grey provinces indicate non-endemic provinces or provinces with no reported morbidity data during the study period.
Reported case rates among the covered population ranged from 6.7 to 82.6 hydrocele cases per 100,000 and from 10.4 to 166.8 lymphoedema cases per 100,000, indicating marked geographic heterogeneity in morbidity burden across provinces.
Care cascade of morbidity management
The care cascade analysis revealed substantial attrition between case identification, eligibility for care, and receipt of services (Table 3 and Fig 2).
The figure illustrates the care cascade for lymphatic filariasis–related morbidities, showing the number and proportion of hydrocele and lymphoedema cases at successive stages of care. For hydrocele, the cascade distinguishes cases identified, cases clinically eligible for surgery, cases receiving surgical treatment, eligible cases still awaiting surgery, and cases deemed not eligible for surgery. Patients not eligible for hydrocele surgery are presented separately and are not included among those awaiting care. For lymphoedema, the cascade includes cases identified, cases receiving the essential package of care, and cases remaining without documented morbidity management by the end of the study period. Percentages are calculated using the total number of identified cases for each morbidity category as the denominator.
For hydrocele, 6,800 cases (80.2%) were clinically assessed and deemed eligible for surgery. Among these, 2,013 patients (29.6%) underwent surgical treatment, while 4,787 eligible patients remained awaiting surgery by the end of the study period. A further 1,671 identified hydrocele cases were deemed not eligible for surgery and were therefore analysed separately from those awaiting care. The higher proportion of hydrocele cases reported as awaiting care in Table 1 (76.2%) includes all patients who had not received surgery by the end of the study period, including those deemed not eligible for surgery, whereas the 56.5% reported in Table 3 refers specifically to clinically eligible patients still awaiting surgical management.
For lymphoedema, all 5,310 identified cases were considered eligible for care, of whom 877 (16.5%) received the essential package of care and 4,433 (83.5%) remained without documented morbidity management by the end of the study period.
Factors associated with hydrocele surgery coverage
Multivariable regression analysis identified external partner support, number of trained surgeons, and availability of operating room nurses as strong predictors of higher surgical coverage (Table 4). Conversely, high caseloads, post-TAS surveillance phase, and geographic inaccessibility were associated with significantly reduced coverage. These relationships are illustrated in Fig 3. The full provincial-level dataset used for these analyses is presented in S1 Table.
Scatter plot showing the association between the number of identified hydrocele cases and hydrocele surgery coverage at the provincial level. Each point represents a province. The solid line represents the fitted linear regression, indicating an inverse relationship between morbidity burden and treatment coverage. Provinces with larger hydrocele caseloads tended to have lower surgical coverage, reflecting capacity constraints and geographic access challenges. Data are from aggregated routine programme sources.
Factors associated with lymphoedema morbidity management coverage
Community-based lymphoedema care activities, health-worker training in the essential package of care, and availability of washing kits were significantly associated with higher coverage (Table 4). In contrast, higher caseloads, post-TAS phase, and hard-to-reach settings were associated with lower coverage.
Summary of key findings
LF-related morbidities remain widespread and largely unmet in the DRC. Only one quarter of hydrocele cases and one sixth of lymphoedema cases accessed morbidity management. Significant geographic disparities persist, and attrition along the care cascade is substantial, particularly for lymphoedema. Programmatic capacity, partner support, trained personnel, and community-based delivery mechanisms were key determinants of coverage.
Discussion
This national retrospective analysis provides the most comprehensive evaluation to date of the burden, coverage, and determinants of lymphatic filariasis (LF) morbidity management in the Democratic Republic of the Congo (DRC). Despite substantial progress toward interrupting LF transmission through large-scale mass drug administration (MDA), our findings clearly show that LF-related morbidities persist widely and remain largely unmanaged. Fewer than one-quarter of identified hydrocele cases and less than one-fifth of lymphoedema cases received appropriate care during the study period, underscoring critical weaknesses in the implementation of the morbidity management and disability prevention (MMDP) pillar of the elimination strategy.
Persistent morbidity burden and programmatic gaps
The large number of hydrocele and lymphoedema cases identified between 2018 and 2024 confirms that morbidity persists long after transmission has declined, consistent with evidence from several endemic countries where morbidity remains substantial despite successful MDA programmes [27,28]. These findings highlight that interruption of transmission alone is insufficient to achieve WHO validation of LF elimination and that long-term investment in MMDP services remains essential.
Marked geographic disparities in morbidity burden and coverage further indicate profound inequities in access to care. Provinces with the highest burden were often those with the lowest coverage, reflecting a mismatch between needs and service availability. This inverse relationship between burden and coverage has been documented in other high-burden settings [29] and is exacerbated in the DRC by vast geographic distances, limited road networks, health workforce shortages, and logistical constraints.
Differential coverage of hydrocele and lymphoedema management
Hydrocele surgery coverage was higher than lymphoedema management coverage across provinces, although still insufficient overall. This reflects the episodic nature of hydrocele surgical campaigns often partner-supported and periodically intensified when resources permit [30] compared to the continuous and community-based nature of lymphoedema care, which requires sustained availability of hygiene supplies, regular follow-up, and ongoing health worker engagement [31].
The particularly low coverage of lymphoedema management is concerning given the chronic, progressive nature of the condition and its strong association with recurrent acute dermatolymphangioadenitis (ADLA), disability, and stigma. Evidence from multiple countries shows that low-cost hygiene-based interventions can significantly reduce acute episodes and improve quality of life when consistently implemented [32,33]. Scaling up these interventions must therefore be prioritised within the DRC’s national LF strategy.
Determinants of morbidity management coverage
Multivariable analyses identified clear determinants of access to morbidity management services. External partner support was strongly associated with hydrocele surgery coverage, highlighting the extent to which LF morbidity services rely on donor-funded activities. While external support has facilitated critical gains, its episodic nature raises concerns regarding long-term sustainability [34].
Across conditions, the presence of trained personnel and consistent availability of essential supplies emerged as central determinants of improved coverage. These findings align with evidence from other LF-endemic countries, where integration of MMDP services into primary healthcare systems has strengthened continuity, sustainability, and equity [35].
Conversely, provinces in the post–Transmission Assessment Survey (post-TAS) phase exhibited significantly lower morbidity management coverage. This suggests that, when transmission metrics improve, programmatic attention to MMDP often declines—a paradox identified in other countries [36]. This decline poses a direct risk to achieving WHO validation of LF elimination, which requires clear evidence of access to morbidity management services across all endemic areas.
Strengths and limitations
This study has several important strengths. It draws on nationally representative programmatic data collected over seven years, enabling a comprehensive assessment of morbidity burden and service coverage across all endemic provinces. The combination of descriptive burden analysis, care cascade evaluation, and multivariable regression offers a robust understanding of both programmatic performance and system-level determinants of access to care. Hydrocele eligibility was confirmed using transillumination, improving diagnostic specificity and reducing misclassification. The use of community-based registries collected by community drug distributors during door-to-door MDA also provides a more accurate reflection of morbidity burden compared with facility-based reporting systems.
However, several limitations should be acknowledged. Data were aggregated and derived from routine programme reports, which may be subject to under-reporting and variability in data quality across provinces. Analyses conducted at the provincial level reduce geographic granularity and may mask substantial intra-provincial differences in access to morbidity management, raising the potential for ecological bias. Moreover, the absence of patient-level clinical information prevents assessment of disease severity, treatment outcomes, or the long-term impact of morbidity management. Although provincial-level analyses were necessary for comparability, morbidity management activities are implemented at the health zone level, meaning that sub-provincial heterogeneity may not be fully captured.
In addition, morbidity cases identified through CDD-based surveillance may underestimate the true burden compared with formal clinical examination, as previously reported in LF morbidity mapping studies [37,38].
Implications for policy and practice
Despite these limitations, our findings have immediate and actionable implications for LF elimination efforts in the DRC and similar high-burden settings. Strengthening MMDP services, particularly lymphoedema management, must be prioritised alongside ongoing transmission monitoring. Key actions should include:
- integrating morbidity management into routine primary healthcare
- scaling up training of frontline health workers
- ensuring continuous availability of hygiene and wound-care supplies
- strengthening community-based detection and follow-up
- expanding access to hydrocele surgery, including through routine services
- securing predictable domestic and partner financing mechanisms
The findings also underscore the need for sustained support in post-TAS provinces to prevent programmatic decline at the very moment when community-based morbidity care becomes most essential.
Particular attention should be given to strengthening the pre-service and in-service training of physicians, nurses, and community health workers involved in LF morbidity management. Sustained capacity building, regular supportive supervision, and integration of the essential package of care into routine primary healthcare services are critical to improve continuity, quality, and equity of access, particularly in hard-to-reach and post-TAS settings.
Conclusions
This national retrospective analysis demonstrates that lymphatic filariasis–related morbidities remain a substantial, persistent, and unevenly addressed public health challenge in the Democratic Republic of the Congo. Despite measurable progress in interrupting transmission, access to morbidity management services for both hydrocele and lymphoedema remains critically low, characterized by pronounced geographic disparities and significant attrition at every stage of the care cascade.
Strengthening and institutionalizing morbidity management and disability prevention within routine health services is essential to bridge these gaps. Priority actions include expanding community-based lymphoedema care, ensuring continuous availability of essential hygiene and wound-care supplies, scaling up access to safe hydrocele surgery, and investing in sustained training and supportive supervision of frontline health workers. Equally important is the establishment of stable financing mechanisms and reliable supply chains to reduce dependence on external partners and improve long-term sustainability.
Addressing these persistent weaknesses is vital for improving patient quality of life and reducing the burden of preventable disability. Critically, these improvements are also required for the Democratic Republic of the Congo to meet World Health Organization criteria for validation of lymphatic filariasis elimination as a public health problem. Without significant and sustained investment in morbidity management, progress toward elimination risks stalling despite advances in transmission control.
Supporting information
S1 Table. Provincial-level dataset used for regression analyses.
This file contains the aggregated provincial dataset used to construct the multivariable regression models for hydrocele surgery coverage and lymphoedema morbidity management coverage. Variables include hydrocele and lymphoedema caseloads, number of surgeries performed, care coverage, partner support, trained personnel, accessibility indicators, and post–Transmission Assessment Survey status.
https://doi.org/10.1371/journal.pntd.0014406.s001
(DOCX)
S2 Table. Summary of lymphatic filariasis morbidity management activities by year (2018–2024).
This file presents the annual national totals of identified hydrocele and lymphoedema cases, eligibility assessments, hydrocele surgeries performed, and lymphoedema care delivered across all endemic provinces. It summarises temporal trends in morbidity management activities over the seven-year period.
https://doi.org/10.1371/journal.pntd.0014406.s002
(DOCX)
Acknowledgments
The authors express their sincere gratitude to the Ministry of Public Health, Hygiene and Prevention of the Democratic Republic of the Congo, the National Neglected Tropical Diseases Control Programme, and the provincial health authorities for their support in implementing morbidity management and disability prevention activities. We also acknowledge the invaluable contributions of health workers and community drug distributors involved in case identification and patient follow-up. We thank all technical and financial partners who supported morbidity management interventions during the study period.
References
- 1.
World Health Organization. Lymphatic filariasis. Geneva: World Health Organization; 2023.
- 2. Taylor MJ, Hoerauf A, Bockarie M. Lymphatic filariasis and onchocerciasis. Lancet. 2010;376(9747):1175–85. pmid:20739055
- 3. Stanton MC, Yamauchi M, Mkwanda SZ, et al. Measuring the physical and economic impact of lymphatic filariasis in endemic communities. PLoS Negl Trop Dis. 2013;7(9):e2520.
- 4. World Health Organization. Global programme to eliminate lymphatic filariasis: progress report. Wkly Epidemiol Rec. 2019;94:457–72.
- 5. Molyneux DH, Dean L, Adekeye O. Neglected tropical diseases and the Sustainable Development Goals: An opportunity for morbidity management. Trans R Soc Trop Med Hyg. 2018;112(8):357–61.
- 6. Addiss DG, Brady MA. Morbidity management in lymphatic filariasis: A neglected component of disease elimination. PLoS Negl Trop Dis. 2007;1(2):e44.
- 7.
World Health Organization. Managing morbidity and preventing disability in lymphatic filariasis: guidelines. Geneva: World Health Organization; 2013.
- 8. Stocks ME, Freeman MC, Addiss DG. The effect of lymphatic filariasis on quality of life: A systematic review. PLoS Negl Trop Dis. 2011;5(10):e1161.
- 9.
World Health Organization. Ending the neglect to attain the Sustainable Development Goals: a roadmap for neglected tropical diseases 2021–2030. Geneva: World Health Organization; 2020.
- 10. Rebollo MP, Bockarie MJ. Can lymphatic filariasis be eliminated in Africa?. Trends Parasitol. 2013;29(6):277–85.
- 11.
World Health Organization. Validation of elimination of lymphatic filariasis as a public health problem. Geneva: World Health Organization; 2017.
- 12. Ramaiah KD, Ottesen EA. Progress and impact of 13 years of the Global Programme to Eliminate Lymphatic Filariasis. PLoS Negl Trop Dis. 2014;8(11):e3319.
- 13. Brady MA, Hooper PJ, Ottesen EA. Projected benefits from integrating neglected tropical disease programmes in sub-Saharan Africa. PLoS Negl Trop Dis. 2006;1(1):e28.
- 14. Turner HC, Bettis AA, Dunn JC. Economic considerations for morbidity management in lymphatic filariasis elimination programmes. PLoS Negl Trop Dis. 2016;10(2):e0004479.
- 15.
World Health Organization. Ethical considerations in public health surveillance. Geneva: World Health Organization; 2017.
- 16.
World Health Organization. Monitoring and epidemiological assessment of mass drug administration in the Global Programme to Eliminate Lymphatic Filariasis. Geneva: World Health Organization; 2011.
- 17.
World Health Organization. Preventive chemotherapy in human helminthiasis. Geneva: World Health Organization. 2006.
- 18.
World Health Organization. Guidelines for reporting neglected tropical disease programme data. Geneva: World Health Organization; 2017.
- 19. Capuano GP, Capuano C. Surgical treatment of filarial hydrocele: Techniques and outcomes. Trop Med Int Health. 2012;17(9):1133–9.
- 20. Dreyer G, Noroes J, Addiss D. The silent burden of chronic filarial disease. Trans R Soc Trop Med Hyg. 2000;94(2):121–4.
- 21.
World Health Organization. Surgical approaches for hydrocele management in lymphatic filariasis. Geneva: World Health Organization; 2015.
- 22. Addiss DG, Louis-Charles J, Roberts J. Feasibility and effectiveness of basic lymphoedema management in lymphatic filariasis. PLoS Negl Trop Dis. 2010;4(11):e728.
- 23. Subramanian S, Krishnamoorthy K. Morbidity management and disability prevention for lymphatic filariasis: progress and challenges. PLoS Negl Trop Dis. 2012;6(4):e1587.
- 24. Rebollo MP, Mohammed KA, Thomas B. Operational challenges for lymphatic filariasis elimination programmes. Parasit Vectors. 2016;9:614.
- 25. Mwingira UJ, Chikawe M, Mandara WL. Integrating morbidity management into lymphatic filariasis elimination programmes: Experiences from endemic countries. PLoS Negl Trop Dis. 2017;11(8):e0005918.
- 26.
StataCorp. Stata Statistical Software: Release 17. College Station (TX): StataCorp LLC. 2021.
- 27. Kelly-Hope LA, Molyneux DH, Bockarie MJ. Can lymphatic filariasis be eliminated by 2020?. Trends Parasitol. 2013;29(1):11–7.
- 28. Kastner RJ, Stone CM, Steinmann P. Morbidity management after transmission interruption in lymphatic filariasis. PLoS Negl Trop Dis. 2015;9(7):e0003890.
- 29. Gyapong JO, Gyapong M, Weiss MG, Tanner M. The burden of lymphatic filariasis in endemic communities. Trop Med Int Health. 2000;5(2):120–7.
- 30. Stanton MC, Mkwanda SZ, Debrah AY. Developing a framework for integrated morbidity management in lymphatic filariasis. PLoS Negl Trop Dis. 2017;11(4):e0005480.
- 31. Takougang I, Meli J, Lamlenn SB. Lymphoedema management in resource-limited settings. Trop Med Int Health. 2010;15(4):463–72.
- 32. Addiss DG, Dreyer G, Eberhard ML. Lymphatic filariasis: Neglected tropical disease of global importance. Clin Microbiol Rev. 2014;27(3):609–39.
- 33. Stocks ME, Freeman MC, Addiss DG. Recurrent acute attacks and lymphoedema management. PLoS Negl Trop Dis. 2015;9(1):e0003750.
- 34. Fitzpatrick C, Asiedu K, Jannin J. Where the road ends: Morbidity management for NTDs. PLoS Negl Trop Dis. 2014;8(6):e2921.
- 35. Mitjà O, Marks M, Bertran L, et al. Integrated control of neglected tropical diseases. PLoS Negl Trop Dis. 2017;11(1):e0005288.
- 36.
World Health Organization. Guidelines for validation of elimination of lymphatic filariasis as a public health problem. Geneva: World Health Organization; 2017.
- 37. Mathieu E, Amann J, Eigege A, Richards F, Sodahlon Y. Collecting baseline information for national morbidity alleviation programs: Different methods to estimate lymphatic filariasis morbidity prevalence. Am J Trop Med Hyg. 2008;78(1):153–8. pmid:18187799
- 38. Smith EL, Mkwanda SZ, Martindale S, Kelly-Hope LA, Stanton MC. Lymphatic filariasis morbidity mapping: A comprehensive examination of lymphoedema burden in Chikwawa district, Malawi. Trans R Soc Trop Med Hyg. 2014;108(12):751–8. pmid:25282001