Two PQMD members -- GlaxoSmithKline and Merck -- lead efforts to rid Tanzania of lymphatic filariasis

 

Just over 39 million people live in Tanzania, a Republic located on the eastern coast of Africa with an average life expectancy of 51 years. More than 80% of the population is rural.The country is made up of 26 regions. One of these is Morogoro, which is home to roughly 1.7 million people. 

 

The economy in Tanzania is largely agriculturally based, which accounts for half the country’s GDP. Tourism is the country’s second largest sector of income from visitors to its world famous national parks. Despite the country’s commitment to poverty reduction, Tanzania is one of the poorest countries in the world. Per capita income in 2006 was roughly US$350. Tanzania has a very high unemployment rate of 76%.

 

Tanzania is a country at risk for Lymphatic Filariasis (LF), known as Elephantiasis, which is one of the world’s most disabling diseases. LF is a parasitic infection spread by mosquitoes that affects over 1 billion people in 83 countries around the world.

 

When a mosquito bites someone who is infected with LF it ingests microscopic worms which circulate in its bloodstream. These worms develop into insect larvae which are transmitted into the next person bitten. Once infected the adult worms live for many years producing millions of larvae which lodge themselves in a person’s lymphatic system. This can result in the swelling of limbs (Lymphoedema) or the enlargement of male genitals (Hydrocele). When the lymphatic system is compromised the person is unable to fend off common skin infections and a vicious cycle of feverish attacks occurs.

 

Most of those infected do not realize they have the disease for years. LF is not life threatening, but those with physical symptoms are usually infected during their most productive years. The disability and incapacitating acute attacks leave them unable to work and leads to a life of poverty. They are also often stigmatized by the community.

 

With the exception of 2 districts, LF is endemic throughout Tanzania. 37 million people are considered at risk of infection.  The prevalence and severity of the clinical disease is amongst the highest in the world.  On the island of Mafia, for example, more than 40% of males suffer from hydrocele, lymphoedema, or elephantiasis. Over 4 million Tanzanians live with clinical manifestations of the disease.

 

GlaxoSmithKline (GSK) is one of the founding partners of the Global Alliance to Eliminate Lymphatic Filariasis – a public private partnership with the sole aim to free the world of this disfiguring and disabling disease forever. As part of their commitment GSK donates Albendazole, an anti-parasitic drug that stops transmission of the disease when given in combination with either Mectizan®, donated by Merck & Co., Inc, or Diethylcarbamazine (DEC ) .   In 1998, Merck & Co, Inc. expanded its ongoing Mectizan® Donation Program for control of River Blindness to include mass treatment for the elimination of LF in countries where River Blindness and LF co-exist. This unique cooperation between GSK and Merck is a groundbreaking and effective industry partnership to advance a common public health goal.

 

In Tanzania Albendazole is given with Mectizan. To date GSK has donated over 900 million treatments to 46 countries. They have pledged to continue their Albendazole donations for as long as needed to eliminate the disease worldwide. To date GSK and Merck have shipped over 40 million treatments of Albendazole and Mectizan, respectively, to Tanzania and Zanzibar.

 

GSK and Merck also contribute cash grants to the partnership. These go towards coalition-building, monitoring and evaluation, training, education and communication initiatives.

 

In order to be successful in elimination the program reaches out to even the most rural areas to make sure the medications are actually taken, and that the population is educated on the disease and motivated to prevent it. For those who are already infected and display LF symptoms there are programs in place to teach simple skin hygiene for lymphoedema and provide surgery for male hydrocele. By alleviating symptoms sufferers can begin to resume a normal life, including returning to work.

 

In Tanzania thousands of community health volunteers selected by the villages distribute tablets to the community. These community health volunteers travel by foot and by bicycle to visit people at their home using a door-to-door strategy.  The volunteers are trusted members of the community trained and supervised by health staff to educate people about the disease and distribute the medicines. Volunteers can be identified by colorful badges, tee shirts and caps with sunflower emblems to symbolize hope.

 

The program has shown results around the world. To date Egypt, several Pacific Island countries, Sri Lanka, Zanzibar and Togo have completed the minimum five annual mass drug administrations. They are now undergoing post-program surveillance and treating residual pockets of infection. Meanwhile other countries are joining the program or expanding their existing activity to new areas. It is estimated that 25 million babies have been born in areas undergoing treatment – all of whom have now been saved from the risk of contracting this debilitating disease.

 

In Tanzania LF patients going through the mass drug administration program have reported that they are getting better. Their say their legs are less swollen, with a reduction in the frequency and duration of their acute attacks. This surprising additional benefit is currently being researched to record and understand it further.  In Tanzania since the start of the program, 8000 hydrocelectomies have been performed. In 2003, the Ministry of Health declared that these would be provided for free.

 

 

 

Sultan says that his legs are much smaller when he wakes up in the morning, but by the afternoon he feels they have grown larger and heavier. Although his legs prevent him from leading a normal life, it is the acute attacks that cause him most discomfort. Sultan, like most LF patients, suffers these attacks regularly – once or even twice a month – with each attack lasting anything up to seven days. These feverish attacks make him feel very poorly and make working difficult.

 

His condition, together with a lack of secondary education, means that he finds it almost impossible to find regular employment. He is therefore self employed and carries water for money, when he can. The reactions to his condition from his local community are difficult to understand and explain. People have different reactions; some are sad for him, others are revolted by his condition.

 

He has used traditional medicine but it had no effect. The lymphatic filariasis elimination programme has now come to his town, Morogoro, in Tanzania and he is taking part in the mass drug administration. He is also being taught how to care for his legs, which will help him manage and hopefully reduce the disabling effects caused by his condition.