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Keywords:

  • economic impact;
  • Guyana;
  • lymphatic filariasis;
  • psychosocial burden;
  • questionnaire

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

Objective

To assess the socioeconomic impact of lymphatic filariasis (LF) in Guyana.

Methods

Observational, cross-sectional study of 50 persons with chronic LF attending the Filariasis Clinic who were selected as the cases; and 50 persons with chronic skin conditions but no chronic LF, attending the Skin Clinic who were selected as the controls. The two groups were assessed using semi-structured interviews.

Results

Socioeconomic impact was statistically significant, especially with respect to ‘having to change jobs’ and experiencing major emotional and financial changes (P < 0.05). Fifty-six per cent of cases reported a major change since their diagnosis, whereas only 32% of controls did. Cases were less likely to be able to dress themselves and walk inside and outside the house than controls; they were three times more likely to spend money on transportation than controls (OR, 3.04 95% CI 1.11, 8.44).

Conclusion

Patients with chronic LF face a considerable burden, which should be addressed as part of the Elimination Programme. One way in which this can be done is to provide free transportation for patients with chronic LF to and from Filariasis Clinics.

Objectif

Evaluer l'impact socio-économique de la filariose lymphatique (FL) en Guyane.

Méthodes

Etude transversale d'observation. 50 personnes souffrant de FL chronique visitant la Clinique de Filariose ont été choisies comme les cas et 50 personnes atteintes d'affections chroniques de la peau, mais pas de FL chronique, visitant la Clinique Dermatologique ont été choisies comme témoins. Les deux groupes ont été évalués à l'aide d'interviews semi structurées.

Résultats

L'impact socio-économique était statistiquement significatif, en particulier en ce qui concerne «avoir à changer d'emploi» et le fait de vivre d'importants changements émotionnels et financiers (P < 0,05). 56% des cas ont rapporté un changement majeur depuis leur diagnostic, contre seulement 32% des témoins. Les cas étaient moins susceptibles d’être en mesure de s'habiller et de marcher à l'intérieur et à l'extérieur de la maison que les témoins; ils étaient trois fois plus susceptibles de dépenser de l'argent pour le transport que les témoins (OR: 3,04; IC95%: 1,11-8,44).

Conclusion

Les patients avec une FL chronique font face à une charge considérable, qui devrait être abordé dans le cadre du Programme d'Elimination. Une des façons de répondre à cela est d'assurer le transport gratuit pour les patients atteints de FL chronique vers et à partir des cliniques de filariose.

Objetivo

Evaluar el impacto socioeconómico de la filariasis linfática (FL) en Guyana.

Métodos

Estudio observacional y crosseccional en el que 50 personas con FL crónica y atendidas en una clínica para Filariasis fueron seleccionados como casos; y 50 personas con condiciones crónicas de piel pero no con FL crónica, atendidas en un clínica dermatológica fueron seleccionados como controles. Los dos grupos se evaluaron mediante entrevistas semiestructuradas.

Resultados

El impacto socioeconómico era estadísticamente significativo, especialmente con respecto al ‘tener que cambiar de trabajo’ y al experimentar cambios emocionales y financieros importantes (P < 0.05). Cincuenta y seis por ciento de los casos reportaron un cambio importante desde su diagnóstico, mientras que solo un 32% de los controles lo hicieron. Los casos tenían una menor probabilidad de ser capaces de vestirse por sí solos y de caminar dentro y fuera de la casa que los controles; y tenían tres veces más probabilidad de gastar el dinero en trasporte que los controles (OR, 3.04 IC 95% 1.11, 8.44).

Conclusión

Los pacientes con una FL crónica se enfrentaban a una carga considerable, algo que debería tenerse en cuenta dentro del Programa de Eliminación de la FL. Una opción es proveer transporte gratis a los pacientes con FL crónica, hasta y desde la clínica para Filariasis.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

Lymphatic Filariasis (LF) is a vector borne, parasitic filarial nematode disease that has been targeted for elimination (Morbidity & Mortality Weekly Report 1993). Wuchereria bancrofti, which accounts for 90% of all filariasis cases worldwide, affects approximately 107 million people (Ottesen et al. 1997). In 1995, WHO ranked LF as the second leading cause of disability worldwide after mental illness (WHO 1995). The Global Programme for the Elimination of Lymphatic Filariasis (GPELF), launched in 1998, aims to eliminate LF by 2020 (Zagaria & Savioli 2002).

In Guyana, the Ministry of Health (MoH), in collaboration with other Non-Governmental Organisations (NGOs) such as Pan American Health Organisation/WHO (PAHO/WHO), embarked on a programme to reduce the transmission of the disease and target morbidity in 1999 (UNDP 2000). The LF Elimination Programme in Guyana was initiated and a plan of action was developed, which included mapping of LF infection, assessing morbidity and developing a strategy of mass treatment.

The economic impact of LF can be related to the costs borne by infected and affected individuals and households, failure of production of individuals and communities in areas endemic for filariasis, and the costs sustained by the government (Haddix & Kestler 2000). Ottesen et al. (1997) envisage that further studies will show that the impact of LF is much greater than had been previously thought. For the chronic manifestations, such as hydrocele and lymphoedema, there may be a substantial decline in productivity, which may last a lifetime (Haddix & Kestler 2000). There is also the burden on the healthcare system in relation to the treatment and management of the acute and chronic effects of filariasis infection (Molyneux & Taylor 2001). At a national level, the cost may also be related to the resources, which have to be spent on any national filariasis elimination or control programme (Ramaiah et al. 1999). A study by Chu et al. (2010) found that worldwide, approximately 3 million newborns were protected during the first 8 years of the GPELF because they were born into areas where the disease was no longer being transmitted. This translated into more than US$ 2 billion net economic benefit (Chu et al. 2010). The financial and human resources which must be spent by the nation could be redirected.

The effects of chronic filarial infection can lead to psychosocial issues such as sexual dysfunction, social disgrace and reduced marital prospects (Ahorlu et al. 1999; Molyneux & Taylor 2001). Many persons are made to feel like outcasts within their own community (Coreil et al. 1998). Evans et al. (1993) indicated that although successful control programmes needed widespread acceptance by the communities, there is little information about the influence of socioeconomics on acceptance and compliance or whether other options would be more or less cost effective. Furthermore, other authors have emphasised the need for more studies on sociocultural issues for any campaign against LF to be effective and successful (Wynd et al. 2007). In Guyana, studies on socioeconomic burden are scarce, and it is therefore difficult to truly understand the problem and deal with it comprehensively.

This study presents the findings of an in-depth study of the socioeconomic impact of LF on persons with chronic LF.

Methodology

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

Subjects

Cases were persons attending the Filariasis Clinic at the Palms and at Lodge Health Centre with chronic clinical manifestations of LF such as lymphoedema, hydrocele or elephantiasis for at least 1 year, between the ages of 18 and 55 (the most productive years). Controls were persons attending the Skin Clinic at the Palms with no history of chronic, clinical manifestations of LF between the ages of 18 and 55 and who were diagnosed with a chronic skin condition, for at least 1 year. Some of the skin conditions included psoriasis and eczema.

Fifty cases and 50 controls were interviewed for the study. All of the cases attending Filariasis Clinics at the Palms (42) and Lodge Health Centre (8) were selected and interviewed. The controls attending the Skin Clinic at the Palms were randomly selected by systematic sampling from a sampling frame where every fifth patient was interviewed once they satisfied the inclusion criteria. Interviews took place between February and August 2006.

Study design

It was an observational, cross-sectional study where the data on exposure/independent and outcome/dependent variables were collected simultaneously. To investigate the impact, 50 controls were also interviewed. The dependent/outcome variable was socioeconomic impact and the independent/exposure variable was absence or presence of chronic LF.

To reduce selection bias, both groups were recruited from a ‘clinic setting’. Persons with chronic skin disease were recruited to reduce confounding bias. There were enough similarities between chronic skin diseases and LF to estimate the impact relatively well. Both diseases have low mortality but high morbidity, and both are associated with stigma. Both can negatively affect the (daily) quality of life over an extended period, but both are manageable once persons pay attention to hygiene and lifestyle.

Based on a sample size of 100, and an estimated prevalence rate of approximately 20% of antigenemia in adults, only an Odds Ratio of 3 or more would be considered significant. This study was limited by the unavailability of population data for the number of persons in Georgetown who have the chronic clinical manifestations of LF. The statistical calculation of sample size was therefore impossible. The 50 cases were people who came to the clinic (46) and those visited at home (4) within the time allocated for the completion of data collection.

Data collection

Data were collected using a face-to-face, semi-structured questionnaire. The questionnaire was pre-tested and modified to ensure clarity and relevance of the questions and to estimate the length of the actual interview. The interview lasted approximately 15–20 min. In Guyana, elephantiasis is termed ‘big foot’; hydrocele is ‘goadie’; and filariasis is ‘filaria’. These terms were reflected in the questionnaire.

Ethical considerations

Informed consent and right to privacy/confidentiality were some of the ethical issues that needed to be considered. Informed written consent was obtained from each patient, and the purpose of the study was explained. Patients were interviewed privately and were told that confidentiality would be maintained. The project proposal was reviewed by the St. George's University Institutional Review Board (IRB) in Grenada. The consent form was also approved by IRB. The MoH IRB in Guyana also reviewed the project and gave its approval.

Data analysis

Questionnaire responses were analysed using the Statistical Package for Social Sciences (spss) version 11.5 and epi info Version 3.5.1 software. The Chi-square test was used to determine significance between socioeconomic impact and presence or absence of chronic filariasis. The t-test was used to determine the level of significance between treatment and transportation costs and absence or presence of chronic filariasis. Differences were considered significant at P < 0.05.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

Sociodemographic profile

The sociodemographic characteristics of the study sample are shown in Table 1. Overall, females, those who were married, those who were Negro and those who had an income of 20 000–<50 000 G$ (100–250 US$) were in the majority. The table also shows that 62% of persons owned the house they lived in and that there was no significant difference in terms of home ownership between cases and controls (P > 0.05). The majority of the sample was employed (76%), and there was no significant difference between the two categories with respect to having a job. The majority of persons worked for 20 000–<50 000 G$ (100–250 US$). In general, few persons owned a bicycle (4%) and none of the respondents owned a car. However, the majority of persons owned TVs and radios, and the difference in ownership was statistically significant for ownership of TVs (P = 0.043) (odds ratio, 0.39 95% CI 0.14, 1.07).

Table 1. Sociodemographic characteristics of the respondents
CategoriesNo. (%) of respondents
Cases (n = 50)Controls (n = 50)P-value
  1. Exchange rate 200 G$ = 1 US$.

  2. a

    The variable has no significant impact (P > 0.05).

Gender
Male16 (32)17 (34) a
Female34 (68)33 (66) a
Marital status
Single24 (48)22 (44) a
Married22 (44)27 (54) a
Common-Law4 (8)1 (2) a
Race
Negro45 (90)24 (48)<0.001
Indian3 (6)16 (32) a
Chinese0 (0)1 (2) a
Portuguese0 (0)0 (0) a
Amerindian1 (2)3 (6) a
Mixed1 (2)6 (12) a
House ownership29 (58)33 (66) a
Employment36 (72)40 (80) a
Income
<20 000 G$ (100 US$)6 (12)6 (12) a
20 000–<50 000 G$ (100–250 US$)24 (48)29 (58) a
>50 000 G$ (>250 US$)4 (8)6 (12) a
Ownership of assets
Radio38 (76)40 (80) a
TV32 (64)41 (82)<0.05

Economic impact

More cases (44%) depended on relatives than controls (38%), but this was not statistically significant (P > 0.05). Furthermore, more controls were working than cases (Table 2) but again this difference was not statistically significant (P > 0.05). However, almost twice the number of cases (48%) had to change jobs as a result of their condition when compared with controls (26%), and this was found to be statistically significant (P = 0.023) (odds ratio, 2.63. 95% CI 1.05, 6.66). In informal discussion with the participants, five (5) cases reported that they had lost their job when their disease developed, whilst none of the controls reported any job loss.

Table 2. Factors measuring economic impact
CategoriesNo. (%) of respondents
Cases (n = 50)Controls (n = 50)P-value
  1. Exchange rate 200 G$ = 1 US$.

  2. a

    The variable has no significant impact (P > 0.05).

Financial upkeep
Working28 (56)31 (62) a
Relatives22 (44)19 (38) a
Condition caused a change in job
Yes24 (48)13 (26)<0.05
No26 (52)37 (74) a
Spending of money (significant economic variables)
Spent money on treatment in the previous week50 (100)48 (96) a
Average amount spent on5020.0 (G$)5410.4 (G$) a
Treatment25.1 (US$)27.1 (US$) 
Spent money on transportation in the previous week41 (82)30 (60)<0.05
Average amount spent on548.8 (G$)572.4 (G$) a
Transportation2.8 (US$)2.9 (US$) 

Participants spent money on transportation and treatment – the most significant economic variables – but none on help for household chores, help in the yard or someone to help buy groceries (Table 2). There was no significant difference in terms of those who spent money on treatment (P > 0.05) between cases and controls; however, the difference for those who spent money on transportation was significant (P = 0.015). Cases were three times more likely to spend money on transportation than controls (odds ratio, 3.04. 95% CI 1.11, 8.44). Further investigation revealed that the actual amount of money spent by cases and controls on treatment and transportation was not statistically different (Table 2) between cases and controls.

Psychosocial impact

Forty-four per cent of the participants reported that they had observed some major change when their disease was diagnosed (Table 3); however, only 4% of those ‘were made stronger’ emotionally, and they were all cases. The other 40% indicated that some of the changes included anxiety, cost of living, embarrassment and separation from spouses. In terms of major change, the difference between cases and controls was statistically significant (P = 0.016) (odds ratio, 2.70. 95% CI 1.11, 6.66). More cases reported anxiety, embarrassment and ‘people staring’ than did controls. At least four cases reported that they had difficulty purchasing shoes and another one indicated that she ‘can only wear pants’ because of her condition.

Table 3. Factors measuring psycho-social impact
Psychosocial variablesNo. (%) of respondents
Cases (n = 50)Controls (n = 50)P-value
  1. a

    The variable has no significant impact (P > 0.05).

Significant change since diagnosis made28 (56)16 (32)<0.05
Received counselling at the clinic32 (64)27 (54) a
Prevented from going out34 (68)40 (80) a
Prevented from visiting relatives39 (78)39 (78) a
Prevented from travelling38 (76)39 (78) a
Prevented from going to the supermarket37 (74)40 (80) a
Consider self as a burden to their family7 (14)1 (2)<0.05
When disease was diagnosed – kept it hidden26 (52)28 (56) a
Felt lonely when condition developed27 (54)19 (38) a
Felt as good as other people when condition developed43 (86)44 (88) a
Felt happy41 (82)42 (84) a
Felt disliked31 (62)24 (48) a
Would never have a relationship31 (62)24 (48) a
Felt hopeful about the future49 (98)42 (84)<0.05
Felt life was a failure31 (62)30 (60) a
Felt people were unfriendly29 (58)25 (50) a
Enjoyed life47 (94)46 (92) a

No significant difference was reported in the emotional counselling that the two groups received from staff working at the clinics (P > 0.05). Approximately 60% of persons overall were counselled, and all of the respondents reported that they were satisfied with the care they were getting from their respective clinics.

The majority of respondents were not prevented from going out, visiting relatives, travelling and going to the supermarket (Table 3), and the difference between the two groups was not statistically significant (P > 0.05). A greater percentage of persons did not feel that they were a burden to their families (84%), and there was a significant difference between the two groups (P = 0.03, Fisher's exact test – one tailed) with only one control (2%) and seven cases (14%) considering themselves as burdens. In contrast, although more than half of the persons interviewed (54%) tried to keep their condition hidden, there was no significant difference between the groups (P > 0.05).

Most participants displayed positive emotions except in the instance of feeling that people were unfriendly, feeling disliked and feeling that they would never have a relationship (Table 3). The differences in the emotions were not statistically significant aside from feeling hopeful about the future (P = 0.014, Fisher's exact test – one tailed), where controls were less likely to feel hopeful about the future. Most respondents enjoyed life (93%) with no significant difference between the two groups (P > 0.05).

When the question was asked about whether they enjoyed life, the majority responded positively and it is believed that they were honestly answering about how their life was in general (notwithstanding their condition). This seems to contradict the findings for those persons who indicated that they thought their life was a failure (Table 3). However for those persons, when asked why they felt their life was a failure, some responded that they did not achieve as much as they would have done had they not had LF.

Overall most persons indicated they were able to dress themselves, walk around and manoeuvre into and out of the bed on their own as it pertains to their daily life. However, the differences in the important aspects of daily life were found to be statistically significant for all the parameters (Table 4).

Table 4. Factors influencing quality of daily life
FactorsNo. (%) of respondents
Cases (= 50)Controls (n = 50)P-value
Ability to dress self40 (80)49 (98)0.004
Ability to get into and out of bed38 (76)49 (98)0.001
Ability to walk outside the house37 (74)48 (96)0.002
Ability to walk inside the house34 (68)48 (96)<0.001

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

This study showed that overall there was no significant difference between the two groups with respect to socioeconomic status; however, the socioeconomic impact was felt more by persons who had chronic LF. Generally, most persons did not consider themselves as burdens to their families; however, cases were much more likely to consider themselves as burdens. This can be compared with findings from Babu et al. (2002) where patients with chronic filariasis present as burdens to the family and community and findings from Gyapong et al. (1996) which showed that persons with advanced disease do consider themselves as economic liabilities to their families.

This study reveals that cases had to change jobs more often than controls and this was significant. One respondent reported that she was a hairdresser but when she developed chronic LF she had to settle for less lucrative employment as a part-time cleaner because she could no longer stand up for long periods. Another indicated that she was a cook but then she too had to settle for reduced hours. Several respondents pointed out that when they were diagnosed with chronic LF, they had to change jobs or they lost their jobs because of the loss of mobility and the rigours of their employment activities and the strain it put on them, thus exacerbating their condition.

The fact that cases also reported that they had lost their jobs, and the number of persons with chronic filariasis who had to change jobs reinforces the economic burden of the disease. Previous studies have shown that filariasis affected about 66% of patients from a rural area in India with respect to economic activity as a result of having to discontinue work, reducing working hours and changing jobs (Ramaiah et al. 1997).

There are several possible avenues of employment available to persons with chronic LF. These include working as cashiers, customer service or call centre agents, receptionists, website developers/software designers, clothing/furniture designers, and even counsellors or consultants for LF Elimination Programmes. NGOs such as the Institute for Private Enterprise Development (IPED) and PAHO could collaborate to provide training and advice in these areas.

This study also showed that both cases and controls spent money on treatment and transportation; however, cases were more likely to spend money on transportation. This is in contrast to a study by Babu et al. (2002), who found that patients with chronic LF spent most of their money on medicine. In Guyana, medication from the Palms is free and provided by the state, transportation is not. Some respondents indicated that medication, especially antibiotics, were not always available from the clinics, and therefore, they sometimes had to purchase drugs. Further, persons with elephantiasis may not be inclined to travel with the ‘public’ mini buses and would resort to the more expensive private ‘hire cars’ or taxis.

This shows that more patients with chronic filariasis should be provided with transportation to and from the clinic or health centres where they could be counselled and treated. This need not be done every day but can be done once a week; or every other week since the Palms is used as a Filariasis Clinic only once a week. Generally, most persons did not consider themselves as burdens to their families; however, cases were much more likely to consider themselves as burdens. This can be compared with findings from Babu et al. (2002) where patients with chronic filariasis present as burdens to the family and community and findings from Gyapong et al. (1996) which showed that persons with advanced disease do consider themselves as economic liabilities to their families. Both Government and NGOs should consider financial assistance for persons with chronic filariasis. Indeed, both cases and controls believe that financial help should be given to persons with chronic LF.

The psychosocial effects of filariasis are well documented in India (Kumari et al. 2005), in Thailand (Rauyajin et al. 1995), in Haiti (Coreil et al. 1998) and in the French Polynesian islands (Kessel 1957) where feelings of shame and inferiority, negligible marriage prospects, sexual inadequacy, a tendency to keep the disease hidden and stigma and discrimination by other members of society have been reported. This study confirms that patients with chronic filariasis suffer from feelings of anxiety, embarrassment and loneliness. This reflects the data obtained from a recent study carried out in Sri Lanka where 37% of lymphoedema patients attending filariasis clinics were negatively affected by their condition. 6% of the participants related that they had problems interacting with their families and 8.5% felt depressed; 12.6% felt lonely (Wijesinghe et al. 2007). Community-based interventions would be important in helping to communicate the information necessary to help LF patients deal with critical psychosocial issues (Wynd et al. 2007).

More of the cases felt hopeful about the future and this finding bodes well for the receptiveness of patients with LF to counselling. This study points to a necessity for the establishment of Support Groups where issues and problems can be discussed in an atmosphere of empathetic understanding. This can be done at the Clinic itself and facilitated by a counsellor and with no extra cost for transportation since that would have already been provided. Alternatively use of social networks and services such as Skype and Google+ may be considered as many Guyanese either have desk top computers, laptops (Government is presently rolling out its ‘One Laptop Per Family programme as part of Guyana's Poverty Reduction Strategy) or access to either through neighbourhood Internet cafes.

A media sensitisation campaign should be implemented about the services offered by the Palms for both filariasis management and treatment as well as skin conditions. This will be helped by the fact that the majority of persons own TVs or radios and emphasis should probably be on radio ‘infomercials’.

More females (68%) presented with chronic LF than males and this is similar to findings from a study in Orissa India (Babu et al. 2001). Although the researchers found that overall more men (15%) presented with chronic clinical manifestations than women (10%), further investigation revealed that elephantiasis affected women (4.5%) more than men (2.5%). The authors indicated that because hydrocele affects only men, this skewed the overall results. In this study, women were probably more motivated to attend the Filariasis Clinic because, unlike hydrocele, elephantiasis is not a condition that is easily hidden.

This study also found that Afro-Guyanese accounted for the majority of the cases and this is similar to findings from Chadee et al. (2003) and Nathan and Stroom (1990). Consideration of gender and race could, therefore, possibly influence the direction of an Elimination programme by refocusing the information available at health centres in areas which are predominantly Afro-Guyanese and ensuring that Afro-Guyanese women are adequately represented in any TV/radio ads or infomercials. Also a pilot exercise for the Support Groups mentioned earlier could be initially composed of a few Afro-Guyanese women (where their successes and pitfalls could be documented and studied), thereby paving the way for more successful Support Groups throughout Guyana.

Community-based interventions would be important in helping to communicate the information necessary to help LF patients deal with critical psychosocial issues (Wynd et al. 2007). The quality of daily life for persons without chronic filariasis was better in terms of mobility and therefore public health programmes would be necessary to specifically address this imbalance. The Clean-Apply antiseptic cream-Regular movement-Elevate (CARE) programme could be used as a platform for training persons who actually have chronic LF and whose mobility was improved to take care of other chronic LF sufferers. This would have a positive effect on the elimination programme and enhance its sustainability.

It is noteworthy that both groups expressed positive emotions overall and that cases were more hopeful about the future than controls. This may be a reflection of the coping mechanism of the cases, as well as the counselling and treatment provided by the clinics. But a more important area of intervention would be a study, which focuses on determining how having chronic LF has specifically affected their productivity and also determining appropriate employment activities specially tailored for persons with chronic filariasis. A number of possible activities have been listed. These could serve as an alternative to financial assistance (which would have to be provided by the Government or NGOs) and will allow patients with LF to make a worthwhile contribution to their own development, the community's development and the country as a whole.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

This study would not have been possible without the support of the Board of the Windward Islands Research & Education Foundation (WINDREF) of the St. George's University (SGU) in Grenada. The researcher expresses gratitude to Dr. Calum Macpherson (Dean, Graduate Studies Programme at SGU & Director of WINDREF) for his supervision and encouragement and also to the other hard-working and hospitable staff of WINDREF; namely Ms. Isha English and Mr. Trevor Noel. Thanks must also be conveyed to Dr. Shamdeo Persaud (Ministry of Health, Guyana; & Chair of MoH – IRB) and Dr. Theresa McCann (SGU – IRB) for providing invaluable advice with the research design and the ethical issues. I am grateful for the assistance provided by the staff of the Filariasis and Skin Clinics, especially Nurse Ayodele Watson and extend heartfelt thanks to the staff of the Faculty of Health Sciences, University of Guyana for their support. I especially appreciated the assistance of Dr. Curtis LaFleur who provided invaluable with the statistical analysis and the interpretation of the data. Many thanks to the respondents for their candid participation in the study.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methodology
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
  • Ahorlu CK, Dunyo SK, Koram KA, Nkrumah FK, Aagaard-Hansen J & Simoneson PE (1999) Lymphatic filariasis related perceptions and practices on the coast of Ghana: implications for preventions and control. Acta Tropica 73, 251261.
  • Babu BV, Acharya AS, Mallick G, Jangid PK, Nayak AN & Satayanarayana K (2001) Lymphatic filariasis in Khurda District of Orissa India: an epidemiological study. Southeast Asian Journal of Tropical Medicine and Public Health 32, 240243.
  • Babu BV, Nayak AN, Dhal K, Acharya AS, Jangid PK & Mallick G (2002) The economic loss due to treatment cost and work loss to individuals with chronic lymphatic filariasis in rural communities of Orissa India. Acta Tropica 82, 3138.
  • Chadee DD, Rawlins SC & Tiwari TS (2003) Short communication: Concomitant malaria and filariasis infections in Georgetown, Guyana. Tropical Medicine and International Health 8, 140143.
  • Chu BK, Hooper PJ, Bradley MH, McFarland DA & Ottesen EA (2010) The economic benefits resulting from the first 8 years of the Global Programme to eliminate Lymphatic Filariasis (2000–2007). PLoS Neglected Tropical Diseases 4, e708.
  • Coreil J, Mayard G, Louis-Charles J & Addiss DG (1998) Filarial elephantiasis among Haitian women: social context and behavioural factors in treatment. Tropical Medicine and International Health 3, 467473.
  • Evans DB, Gelband H & Vlassoff C (1993) Social and economic factors and the control of lymphatic filariasis: a review. Acta Tropica 53, 126.
  • Gyapong JO, Gyapong M, Evans DB, Aikins MK & Adjei S (1996) The economic burden of lymphatic filariasis in northern Ghana. Annals of Tropical Medicine and Parasitology 90, 3948.
  • Haddix AC & Kestler A (2000) Elimination of lymphatic filariasis as a public health problem. Lymphatic filariasis: economic aspects of the disease and programmes for its elimination. Transactions of the Royal Society of Tropical Medicine and Hygiene 94, 592593.
  • Kessel JF (1957) Disabling effects and control of filariasis. American Journal of Tropical Medicine and Hygiene 6, 402414.
  • Kumari AK, Harichandrakumar KT, Das LK & Krishnamoorthy K (2005) Physical and psychosocial burden due to lymphatic filariasis as perceived by patients and medical experts. Tropical Medicine and International Health 10, 567573.
  • Molyneux DH & Taylor MJ (2001) Current status and future prospects of the global lymphatic filariasis programme. Current Opinion in Infectious Diseases 14, 155159.
  • Morbidity and Mortality Weekly Report (1993) MMWR: Recommendation of the International Task Force for Disease Eradication. MMWR. Recommendations and Reports 42, 125.
  • Nathan M & Stroom V (1990) Prevalence of Wuchereria bancrofti in Georgetown Guyana. Bulletin of the Pan American Health Organisation 24, 301306.
  • Ottesen EA, Duke BO, Karam M & Behbehani K (1997) Strategies and tools for the control/elimination of lymphatic filariasis. Bulletin of WHO 75, 491503.
  • Ramaiah KD, Vijay Kumar KN, Ramu K, Pani SP & Das PK (1997) Functional impairment caused by lymphatic filariasis in rural areas of South India. Tropical Medicine and International Health 2, 832838.
  • Ramaiah KD, Guyatt H, Ramu K, Vanamail P, Pani SP & Das PK (1999) Treatment costs and loss of work time to individuals with chronic lymphatic filariasis in rural communities in south India. Tropical Medicine and International Health 4, 1925.
  • Rauyajin O, Kamthornwachara B & Yablo P (1995) Socio-cultural and behavioural aspects of mosquito-borne lymphatic filariasis in Thailand: a qualitative analysis. Social Science and Medicine 41, 17051713.
  • United Nations Development Programme (2000) UNDP. Common Country Assessment for the Cooperative Republic of Guyana. http://www.undp.org.gy/ccassess.pdf (accessed on December 2, 2004).
  • WHO (1995) World Health Report 1995: Bridging the Gaps. WHO Geneva, Switzerland.
  • Wijesinghe RS, Wickremasinghe AR, Ekanayake S & Perera M (2007) Physical disability and psychosocial impact due to chronic filarial lymphoedema in Sri Lanka. Filaria Journal 6, 4. http://www.filariajournal.com/content/pdf/1475-2883-6-4.pdf (accessed on January 11, 2009).
  • Wynd S, Melrose W, Durrheim D, Carron J & Gyapong M (2007) Public health reviews. Understanding the community impact of lymphatic filariasis: a review of the sociocultural literature. Bulletin of the WHO 85, 493498.
  • Zagaria N & Savioli L (2002) Elimination of lymphatic filariasis: a public health challenge. Annals of Tropical Medicine and Parasitology 96(Suppl. 2), S3S13.