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

淋巴丝虫病是一种非常痛苦、致残和毁容的疾病，威胁着全球49个国家的8.93亿人。抑郁症在LF患者中发病率很高，因为这种疾病的污名化性质可能导致社会排斥和歧视。与单独的丝虫病调整生命年全球疾病负担估计相比，在残疾调整生命年（DALYs）估计中包括抑郁症时，LF致残率是其两倍。许多国家已经实现了第一种消除战略(1)，即通过大规模给药阻断疾病传播。现在，努力的重点转移到第二个LF消除战略(2)，通过发病率管理和残疾预防（MMDP）来减轻痛苦、残疾和毁容。这导致了淋巴水肿管理和预防的增强自我保健（ESC）协议的发展。ESC方案包括深呼吸和自我按摩练习，这已被证明对癌症相关淋巴水肿有益。为了有效和成功地实施MMDP或增强的自我保健协议，需要在国家内进行良好的病例估计。由于资金和资源有限，马拉维无法进行全国范围的LF监测。这促使了以下研究目标：(i)探索预测LF病例数量的替代方法，（ii）预测无法获得实际病例数据的地区的病例数，并利用这些数据（iii）绘制马拉维LF的地理分布图。成功实施MMDP的一个潜在障碍是患者的依从性。在其他慢性疾病中，抑郁症已被证明会降低对治疗的依从性，从而降低健康结果。目前尚不清楚心理健康如何影响消除LF战略(2)或更广泛的被忽视热带病消除议程。因此，以下目标将得到解决：（iv）确定LF患者中抑郁症的患病率以及性别、年龄、疾病严重程度和社会经济地位的差异；(v)衡量ESC方案对淋巴水肿和抑郁症状况的影响；（vi）评估抑郁症对ESC方案长期依从性的影响。

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.