Mapping morbidity moves Ghana and Côte d’Ivoire toward NTD elimination
Mabinty Kalokoh, a 30-year-old woman from Sierra Leone’s northern Bombali district, who suffers from occasional painful episodes of swelling and fever, vestiges of a neglected tropical disease called lymphatic filariasis
Mabinty Kalokoh, a 30-year-old woman from Sierra Leone’s northern Bombali district, who suffers from occasional painful episodes of swelling and fever, vestiges of a neglected tropical disease called lymphatic filariasis. Photo: Ruth Fertig, HKI

Last year, we told you Mabinty's story of living with lymphatic filariasis (LF). Although she has received treatments as part of community wide-distribution to stop further spread of the disease, Mabinty still suffers the effects of LF: the fever and painful swelling during an acute attack sometimes leave her immobilized and unable to work. Besides diagnosing and providing medicine for LF, another key treatment component is morbidity management—in other words, monitoring and mitigating negative physical effects of the disease, like the periodic acute episodes of pain and swelling that Mabinty experiences.

After receiving health care to treat her lymphatic filariasis symptoms and manage her morbidity has enabled Mabinty to return to field and provide food for her family. Photo: Ruth Fertig, HKI
Receiving care to treat her lymphatic filariasis symptoms and manage morbidity has enabled Mabinty to return to the field and provide food for her family. Photo: Ruth Fertig, HKI 

“I don’t know how I got it,” Mabinty says of the time when she first noticed symptoms. “I thought it came from God.”

Mabinty didn’t know what to make of her symptoms and how to make the symptoms go away, so she first visited a traditional healer whose remedies didn’t help her. Only later did she see a doctor who could diagnose her accurately. For people living in small villages, like Mabinty, access to clinics and hospitals can be a challenge. This results not only in many people being unable to get the support they need to alleviate their suffering from LF, but it also hinders local and national health systems’ ability to appreciate the scope of morbidity and geographically target resources. To fully understand those needs, each country’s health system needs evaluation to identify progress and challenges.

Last year, USAID’s Act to End NTD | West program partner, the AIM Initiative, completed this type of evaluation in Ghana and Côte d’Ivoire for health programs related to two diseases—LF and trachoma. These reports—situation analyses—are important tools for identifying barriers that prevent people like Mabinty from getting the health services and care they need.

Ghana’s situation analysis focused on the health system’s capacity to manage LF-associated morbidity, prevent disability from the disease, and achieve disease elimination. The Côte d’Ivoire situation analysis did the same, for both LF and trachoma. Both reports included a desk review and quantitative data collection, but the largest component of each assessment came from interviews, conducted using the WHO MMDP Situation Analysis Tool. In talking with over 30 people per country from locally active NGOs and different levels of the health systems, the Act | West team gathered input on the following areas:

● National health sector
● Previous activities to address LF or trachoma
● National data system
● Case findings
● Treatment and morbidity management and disease prevention programs
● Health facilities
● Community structures
● NGO involvement

Incorporating so many perspectives from people working at all levels of each health system, especially those who work directly with people like Mabinty, gave each situation analysis a wide range of critical information for health officials in Ghana and Côte d’Ivoire. For Ghana, the analysis found that data reporting and accuracy remain significant challenges. The report recommended strategies to strengthen the data systems and identify ways to collaborate with community leaders, NGOs and research institutions to maximize effectiveness. Data reporting and quality were also issues for Côte d’Ivoire, as well as lack of integration across diseases and within the health system, particularly related to trachoma. The report recommended ways to improve data systems and MMDP services provision through an integrated approach.

With these reports, health officials in both countries have a clearer picture of their current needs, which will enable them to better serve people living with the effects of LF and trachoma and to ensure that everyone who needs it has access to quality care.

Situation analyses are valuable because they give national NTD programs a more complete picture of where LF and trachoma morbidity management services are most needed, how well equipped the health system is to provide these services, and which gaps need to be filled to better reach people who need treatment and care. In Mabinty’s case, earlier access to diagnosis and treatment could have reduced the disabling pain she still suffers today. With the information from these reports, national NTD programs will be better equipped to help more people like Mabinty learn how to care for their symptoms to minimize suffering and still be able to live full and active lives and ultimately become advocates for those in their communities who are afflicted with LF.

Interested in learning more?

Learn about our work in Ghana and Cote d’Ivoire.

Read about the International Coalition for Trachoma Control’s protocol and methods for situation analysis for trachoma.

Share Mabinty’s story and help us end neglected tropical diseases like LF.