Sero-Epidemiological and Socio-Cultural Studies on Lymphatic Filariasis in Benue State, Nigeria

Abstract

Lymphatic filariasis continues to constitute immense public health problem and obstacle to socio-economic development in endemic countries. The disease cause widespread and cl~onic suffering and social stigma resulting from ignorance and incorrect beliefs. Information on the physical and psychology disability resulting from lymphatic filariasis in Nigeria is scarce. This study was therefore designed to describe the degree of disease burden, extent of distribution and community knowledge, attitude and perception (KAP) using serological, clinical manifestations and quantitative questionnaires in Benue State. The serological diagnosis employed the use of the whole blood Immunochromatographic Card test (ICT) for detection of circulating filarial antigen (CFA). Eight hundred and forty-five (845) randomly selected persons in rural communities were tested using the ICT test kits with 264 (3 I .2%) testing positive. Infection was significantly higher in male subjects (X2=7.02, dFl, P < 05). The prevalence of hydrocoele and lymphoedema were employed as rapid community diagnosis procedures. Out of the 1,702 subjects examined, 107(6 28%) had various stages of scrotal swelling while 33 (1.94%) had various stages of elephantiasis of the limb Hydrocoele prevalence in investigated communities was not statistically significant (P > 0 05). Correlation analysis showed a weak positive association between ICT rates and hydsocoele prevalence (r=0.367, P < 0.016). On the other hand, correlation analysis showed a strong positive association between hydrocoele and lymphoedema rates (r = 0.847, P < 0.207). There was an observed decline in ICT positively, hydrocoele and lymphoedema prevalence rates beyond the 50-59 age group .,,,.... I.,,' ... ,I ' . The three diagnostic procedures gave a consistent pattern in the trend and distribution of the disease in Benue State. Quantitative questionnaires were administered to 118 persons with visible manifestations of the disease and 1,610 community members with no visible signs of the disease. The questionnaires were t-okvestigate lymphatic filariasis-related knowledge, attitude and practices (KAP). The socio-cultural traditional beliefs of the three major ethnic groups influence their knowledge on the causation, mode of transmission, prevention and psychosocial consequences of the disease. The Igede ethnic group's perception on lymphatic filariasis were significantly (P < 0.05) influenced by superstition when compared to the Tiv and Idoman groups. Gender variation in the KAP was observed amongst patients, though these were not significant (x2 = 5.91, df =1, P > . . . Xlll 0.05) Lymphoedema and hydrocoele significantly (P > 0.05) affects physical, psychological and social functioning in affected individuals Ranking exercise revealed preference of traditional medicine over modem medicine. Patients' KAP and choice of health providers were influenced by prevailing traditional and superstitious norms in the community. There was no significant correlation between the level of formal education of respondents and their response to causes, mode of transmission and prevention of lymphatic filariasis. This study provides a reliable estimate of the prevalence, distribution and burden of lymphatic filariasis in Benue State. The combination of hydrocoele and lymphoedema prevalence which are classical manifestations of the disease and rapid ICT filariasis test are being recommended for community mapping which is critical prerequisite for commencement of intervention activities. Morbidity control, in addition to control of physical disability, should also target and address psychological needs of affected persons in order to mitigate the consequences of lymphatic filariasis. These findings may be used in the development of group-specific health education programmes to change health behaviours and to achieve higher involvement of the community in the planned mass drug administration to eliminate lymphatic filariasis. Several areas of community misconceptions, lack of knowledge or erroneous beliefs and practices were identified in this study, the challenge for the Nigerian lymphatic filariasis elimination programme is to translate this information into practical ways of promoting and improving lymphatic filariasis prevention, control and management for individual and communities. ., ,,. ..T. -9' , . . , T xiv