Determining the Burden of Mental Health in Lymphatic Filariasis Endemic Communities and the Impact of Enhanced Self-care Protocols in Malawi

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Lymphatic filariasis (LF) is profoundly painful, disabling and disfiguring disease, threatening 893 million people in 49 countries across the globe. The prevalence of depressive illness is high amongst individuals affected by LF, due to the stigmatizing nature of the disease which can lead to social exclusion and discrimination. LF has been shown to be twice as disabling when depressive illness is included in Disability-adjusted Life Years (DALYs) estimates in comparison to filariasis DALY Global Burden of Disease estimates alone. Many countries have achieved the first elimination strategy (1) interrupting disease transmission through mass drug administration. Now, efforts much shift to focus on the second LF elimination strategy (2) to alleviate suffering, disability and disfigurement through morbidity management and disability prevention (MMDP). This has led to the development of an enhanced self-care (ESC) protocols for lymphoedema management and prevention. ESC protocols include deep-breathing and self-massage exercises which have proven to be beneficial in cancer related-lymphoedema. To effectively and successfully implement MMDP or enhanced self-care protocols, good case estimates within countries are required. Whole country LF surveillance is unfeasible in Malawi due to limited funding and resources. This has prompted the following research objectives (i) to explore alternative methods to predict the number of LF cases, (ii) to predict case numbers in regions where real case data is unavailable, and use this (iii) to map the geographical distribution of LF in Malawi. One potential barrier to successful MMDP implementation is patient adherence. In other chronic diseases, depressive illness has been shown to reduce adherence to treatment and therefore reduce health outcomes. Understanding how mental health impacts on LF elimination strategy (2) or within wider Neglected Tropical Disease elimination agendas, is lacking. Therefore, the following objectives will be addressed (iv) to determine the prevalence of depressive illness in persons affected by LF and differences in gender, age, the severity of disease and socio-economic status, (v) to measure the impact of ESC protocols on the condition of lymphoedema and depressive illness over time and (vi) to assess the impact of depressive illness on adherence of ESC protocol over time.