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Lymphatic filariasis (LF), podoconiosis, and leprosy are highly stigmatized neglected tropical diseases that can cause lower limb swelling and deformity. Simple interventions to support self-care can reduce their physical impacts, but little is known about how to address the psychosocial needs of people living with the diseases, and about how to scale-up morbidity reduction programs. EnDPoINT is a multistage implementation study designed to address these knowledge gaps by developing and evaluating a holistic care package that can be integrated into the Ethiopian health system. This article presents the quantitative results from the EnDPoINT pilot, in which the effectiveness of the care package was assessed in 251 participants from one district in northern Ethiopian using a pre-post design. Reductions 12 months after care package initiation were seen in attacks of acute adenolymphangitis (adjusted odds ratio for attack in last month 0.005; 95% CI 0.001, 0.02; P < 0.001), lower limb and foot circumference (mean difference lower limb circumference −2.0 cm; 95% CI −2.3, −1.8; P < 0.001; foot circumference −2.3 cm; 95% CI −2.5, −2.0; P < 0.001), and lymphedema stage (mean reduction in stage −0.27; 95% CI −0.37, −0.19; P < 0.001). Significant improvements were also observed in scores assessing disability, quality-of-life, depression, stigma, discrimination, and social support. This study thus suggests that the EnDPoINT care package is highly effective in reducing morbidity in people living with LF, podoconiosis, and leprosy in northern Ethiopia.

Background Skin-presenting neglected tropical diseases (skin-NTDs) impose large burdens on affected people, families and communities. The NTD Roadmap 2021–2030 presents a strategic plan to guide collaborative, multisectoral action to overcome these burdens, defining targets to control, eliminate and/or eradicate skin-NTDs by 2030. One of its targets is for 40 countries to adopt integrated skin-NTD strategies. Despite this high-level support for integration, only four countries were implementing integrated skin-NTD strategies in 2020. Methods We hosted workshops at the 2021 annual meeting of the Coalition for Operational Research on NTDs, to discuss the operationalisation of Roadmap goals into national strategies and interventions for skin-NTD control. Speakers included NTD Programme Managers from NTD-endemic countries, technical experts and researchers of different aspects of skin-NTDs. Results Challenges include community perceptions of interventions, demonstrating the cost-effectiveness of integrated care, availability and accessibility of community-based and primary healthcare services, the quality of data on skin-NTD morbidity and changes to operational structures required for integration. Research priorities included the identification of optimal case detection platforms, evaluation of integrated care, understanding the impacts of integration on community members and community health staff and development of point-of-care diagnostics. Conclusions The operational research priorities are intended to support the scale-up of integrated skin-NTDs programmes.

Background Podoconiosis, lymphatic filariasis (LF) and leprosy are neglected tropical diseases (NTDs) that cause lymphoedema. When left untreated, they lead to substantial disability. This study determined the quality of life (QOL) and depression associated with lymphoedema in patients with podoconiosis, LF and leprosy. The study was conducted in northwestern Ethiopia. Methods This baseline cross-sectional study, nested within an interventional, non-comparative, longitudinal study, included patients with lymphoedema. Depression and QOL were assessed using versions of the 9-item Patient Health Questionnaire and Dermatologic Life Quality Index (DLQI), respectively, that had been translated into Amharic and validated. Factors associated with depression and QOL were assessed using multivariate linear regression analysis. Results Of the 251 patients with lymphoedema included in the study, 119 (47.4%) had moderate to severe depression and overall QOL was poor (mean±standard deviation [SD] DLQI score: 11.4±4.2). Disability was significantly associated with depression (β=0.26 [95% confidence interval {CI} 0.19 to 0.33]). Currently receiving treatment (β=−3.05 [95% CI −5.25 to −0.85), disability (β=−0.08 [95% CI −0.15 to −0.01]) and social support (moderate support: β=−2.27 [95% CI −3.66 to −0.89] and strong support: β=−2.87 [95% CI −5.35 to −0.38]) were significantly associated with better QOL. Conclusion High levels of depression and low QOL were found among patients with lymphoedema due the three NTDs in Ethiopia.

We conducted an implementation research study to integrate a holistic package of physical health, mental health and psychosocial care for podoconiosis, lymphatic filariasis and leprosy into routine healthcare in Gusha cluster, Guagusa Shikudad district, northwest Ethiopia. The healthcare package included training patients in lower limb hygiene and skin care and provision of shoes, hygiene supplies and medication. The implementation activities included training events, workshops, awareness raising, self-help groups, supportive supervision, staff secondments and advisory board meetings. The cost of implementing the care package in Gusha cluster, with a population of 30 558 people, was 802 655 Ethiopian birr (ETB) (£48 159) and the cost of delivering care to 235 participants was 204 388 ETB (£12 263), or 870 ETB (£52) per person. There was a 35% decrease in the mean disability scores (measured using the World Health Organization Disability Assessment Schedule 2.0) and a 45% improvement in the dermatology-specific quality of life (measured using the Dermatology Life Quality Index) at the 3-month follow-up compared with baseline. There were reductions in the number of days with symptoms, days off usual activities/work and days with reduced activity due to illness, all of which were statistically significant. Our pilot suggests that integration of the care package into routine healthcare in Ethiopia may be effective in improving health-related quality of life and disability and reducing time out of economic activity due to illness.

Leprosy, podoconiosis, and lymphatic filariasis (LF) are among the priority neglected tropical diseases (NTDs) in Ethiopia. The disability, psychosocial, and mental health status of people affected by these NTDs are still overlooked in global NTD discourse. The objective of this systematic review was to synthesize the existing evidence describing the disability, psychosocial, and mental health status of people affected by leprosy, podoconiosis, and LF prior to developing a holistic physical and psychosocial care package for these individuals. We searched papers reporting on disability, psychosocial, and mental health status linked to these 3 NTDs. The protocol was registered in PROSPERO with registration number CRD42019128400. Peer-reviewed articles were searched and extracted from Medline, PsycINFO, Global Health, and Embase. Articles published in English, irrespective of the year of publication, using a quantitative study methodology, were included. Abstracts and full texts were reviewed by 2 reviewers. Data were extracted and narratively summarized, as the studies were heterogeneous and used different outcome measures. Out of 1,318 titles/abstracts screened and 59 full text studies reviewed, 24 fulfilled the inclusion criteria. Fourteen studies provided evidence of the disability associated with leprosy, podoconiosis, or LF. Ten studies provided evidence on the association between the 3 NTDs and mental health or psychosocial outcomes. The prevalence of grade 2 disability varied from 3.9% to 86%. The most commonly reported mental health impacts were depression and mental distress. A high burden of mental illness was reported, varying from 12.6% to 71.7%; the suicidal ideation was also high (18.5%). In conclusion, disability and poor psychosocial and mental health status are associated with leprosy, podoconiosis, and LF. For optimum management of these NTDs, holistic care including both physical and psychosocial interventions is vital., Author summary Podoconiosis, lymphatic filariasis (LF), and leprosy are neglected tropical diseases (NTDs) that are commonly found among disadvantaged rural and some poor urban communities. These diseases lead to disabilities of the leg, which may result in reduced productivity. The longer the duration of the disease, the more severe the disability. People affected by these diseases also commonly experience stigma and discrimination, which, in turn, affect health-seeking behavior. Due to this disability, stigma, and discrimination, people affected by these 3 NTDs have a poor quality of life. We also found a range of mental health problems related to these 3 NTDs. Among these, the most common were mental distress and depression. As all 3 NTDs are associated with poor physical, psychosocial, and mental health outcomes, management should be holistic, incorporating physical, psychosocial, and mental health interventions. Following this review, we are working on the development of a holistic integrated care package for people affected by leprosy, podoconiosis, and LF in northwestern Ethiopia.

Background Lymphoedema caused by lymphatic filariasis (LF) or podoconiosis can result in physical disability and social exclusion, which is exacerbated by painful acute dermatolymphangioadenitis (ADLA) episodes. These conditions have a significant impact on patients, however, little is known about the indirect effects on their caregivers. This study, therefore, aimed to determine the impact on caregivers for patients with leg lymphoedema in a co-endemic district of Ethiopia. Methodology/Principal findings A cross-sectional survey of lymphoedema patients and their caregivers was conducted using semi-structured questionnaires in the Southern Nation Nationalities Peoples Region (SNNPR) of Ethiopia. Lymphoedema patient information on clinical severity (mild, moderate, severe), frequency of ADLAs, their socio-demographic characteristics and the identity of main caregiver(s) was collected. Caregiver information on socio-demographic characteristics, types of care provided, their quality of life (QoL) measured across nine domains, and productivity was collected, with key indicators compared in the presence and absence of patients’ ADLAs. A total of 73 patients and 76 caregivers were included. Patients were grouped by mild/moderate (n = 42, 57.5%) or severe (n = 31, 42.5%) lymphoedema, and reported an average of 6.1 (CI± 2.18) and 9.8 (CI± 3.17) ADLAs respectively in the last six months. A total of 48 (65.8%) female and 25 (34.2%) male patients were interviewed. Caregivers were predominately male (n = 45, 59.2%), and spouses formed the largest caregiving group for both female and male patients. In the absence of an ADLA, most caregivers (n = 42, 55.2%) did not provide care, but only one caregiver did not provide care during an ADLA. In the absence of an ADLA, the average time (hour:minute) spent by mild/moderate (00:17, CI: ± 00:08) and severe (00:10, CI: ± 00:07) patient caregiver per task was minimal. The time mild/moderate (00:47, CI: ± 00:11) and severe (00:51, CI: ± 00:16) patient caregivers spent per task significantly increased in the presence of an ADLA. In addition, caregivers’ QoL was negatively impacted when patients experienced an ALDA, and they had to forfeit an average of 6 to 7 work/school days per month. Conclusion/Significance Lymphoedema and ADLAs impact negatively on patients’ and their caregivers’ lives. This emphasises the importance of increasing access to effective morbidity management and disability prevention services to reduce the burden and help to address the Sustainable Development Goal (SDG) 5, target 5.4, which seeks to recognise and value unpaid care and domestic work., Author summary Lymphatic filariasis and podoconiosis can result in chronic severe lymphoedema of the limbs, which is aggravated by frequent painful episodes of acute bacterial infection known as ‘acute attacks’. The debilitating impact of these conditions on patients are well documented, however, the extent to which the hardship extends to their caregivers is unknown. To address this knowledge gap, a survey of 73 lymphoedema patients and their caregivers was conducted in an endemic region of Ethiopia. Patients were found to be predominately female and caregivers predominately male, mostly spouses. Caregivers provided a wide range of care, and the type, frequency and time spent on tasks significantly increased when patients experienced an acute attack. Caregivers reported a negative impact on their quality of life and provided care for an average of 15 days and forfeited an average of 7 days of work or school per month. This study has revealed a previously hidden burden of lymphoedema that not only affects patients, but their caregivers who are mostly family members. This emphasises the importance of increasing access to effective morbidity management and disability prevention programmes to reduce the burden and help to address the Sustainable Development Goal (SDG) 5, target 5.4, which seeks to recognise and value unpaid and domestic work.

Lymphatic filariasis and podoconiosis are the major causes of tropical lymphoedema in Ethiopia. The diseases require a similar provision of care, but until recently the Ethiopian health system did not integrate the morbidity management.To establish health-care services for integrated lymphoedema morbidity management, the health ministry and partners used existing governmental structures. Integrated disease mapping was done in 659 out of the 817 districts, to identify endemic districts. To inform resource allocation, trained health extension workers carried out integrated disease burden assessments in 56 districts with a high clinical burden. To ensure standard provision of care, the health ministry developed an integrated lymphatic filariasis and podoconiosis morbidity management guideline, containing a treatment algorithm and a defined package of care. Experienced professionals on lymphoedema management trained government-employed health workers on integrated morbidity management. To monitor the integration, an indicator on the number of lymphoedema-treated patients was included in the national health management information system.In 2014, only 24% (87) of the 363 health facilities surveyed provided lymphatic filariasis services, while 12% (44) provided podoconiosis services.To date, 542 health workers from 53 health centres in 24 districts have been trained on integrated morbidity management. Between July 2013 and June 2016, the national health management information system has recorded 46 487 treated patients from 189 districts.In Ethiopia, an integrated approach for lymphatic filariasis and podoconiosis morbidity management was feasible. The processes used could be applicable in other settings where these diseases are co-endemic.La filariose lymphatique et la podoconiose sont les principales causes du lymphœdème tropical en Éthiopie. Ces maladies requièrent une prestation de soins similaire, mais en 2012, le système de santé éthiopien n'a pas intégré la gestion de la morbidité.Le ministère de la Santé et ses partenaires ont utilisé les structures gouvernementales existantes pour mettre en place des services de santé en vue de la gestion intégrée de la morbidité liée au lymphœdème. Une cartographie intégrée de la maladie a été réalisée dans 659 des 817 districts pour repérer ceux où elle était endémique. Afin d'orienter l'affectation des ressources, des agents de vulgarisation sanitaire qualifiés ont intégré des évaluations de la charge de morbidité dans 56 districts présentant une charge clinique élevée. Pour assurer une prestation standard de soins, le ministère de la Santé a rédigé des directives sur la gestion intégrée de la morbidité liée à la filariose lymphatique et à la podoconiose. Ces directives comportent un algorithme de traitement et un programme de soins précis. Des professionnels possédant de l'expérience dans la gestion du lymphœdème ont formé des agents de santé employés par le gouvernement à la gestion intégrée de la morbidité. Pour suivre l'intégration, un indicateur relatif au nombre de patients pris en charge pour un lymphœdème a été inclus dans le système national d'information sanitaire.En 2014, seuls 24% (87) des 363 établissements de santé participant à l'enquête ont fourni des services liés à la filariose lymphatique et 12% (44) ont fourni des services liés à la podoconiose.À ce jour, 542 agents de santé provenant de 53 centres de santé répartis dans 24 districts ont été formés à la gestion intégrée de la morbidité. Entre juillet 2013 et juin 2016, le système national d'information sanitaire a enregistré 46 487 patients pris en charge dans 189 districts.La mise en place d'une approche intégrée pour la gestion de la morbidité liée à la filariose lymphatique et à la podoconiose a été possible en Éthiopie. Les processus utilisés pourraient être appliqués dans d'autres environnements où ces maladies sont co-endémiques.La filariasis linfática y la podoconiosis son las mayores causas del linfedema tropical en Etiopía. Las enfermedades requieren una atención sanitaria similar, pero en 2012 el sistema sanitario de Etiopía no integró la gestión de la morbilidad.Para establecer servicios sanitarios para la gestión integrada de la morbilidad por linfedema, el ministerio de salud y colaboradores utilizaron estructuras gubernamentales existentes. Se realizó un mapeo integrado de la enfermedad en 659 de 817 distritos para identificar los distritos endémicos. Para informar sobre la asignación de recursos, agentes formados de extensión sanitaria integraron evaluaciones sobre la carga de la enfermedad en 56 distritos con una carga clínica elevada. Para garantizar un suministro estándar de la atención, el ministerio de salud desarrolló unas directrices para la gestión integrada de la morbilidad de la filariasis linfática y la podoconiosis, las cuales contenían un algoritmo de tratamiento y un paquete definido de cuidados. Profesionales con experiencia en la gestión del linfedema formaron a trabajadores de la salud empleados por el gobierno sobre la gestión integrada de la morbilidad. Para controlar la integración, se incluyó un indicador del número de pacientes tratados de linfedema en el sistema nacional de información para la gestión de la salud.En 2014, solo el 24% (87) de los 363 centros sanitarios encuestados ofrecían servicios para la filariasis linfática, mientras que el 12% (44) ofrecían servicios para la podoconiosis.Hasta la fecha, 542 trabajadores sanitarios de 53 centros de salud en 24 distritos han sido formados acerca de la gestión integrada de la morbilidad. Entre julio de 2013 y junio de 2016, el sistema nacional de información para la gestión de la salud registró 46 487 pacientes tratados de 189 distritos.En Etiopía, fue viable un enfoque integrado de la gestión de la morbilidad para la filariasis linfática y la podoconiosis. Los procesos utilizados podrían ser aplicables en otros lugares donde estas enfermedades son coendémicas.يعتبر داء الفيلاريات اللمفي وداء الفيل هما السببان الرئيسيان للإصابة بمرض الوذمة اللمفية الاستوائي في إثيوبيا. ويتطلب هذان المرضان توفير رعاية مماثلة، إلا أنه في عام 2012 لم يقم النظام الصحي الإثيوبي بإدراج الإدارة المختصة بمعدلات الإصابة بالمرض.لإنشاء خدمات الرعاية الصحية للإدارة المتكاملة لمعدلات الإصابة بالوذمة اللمفية، قامت وزارة الصحة، بالتعاون مع شركائها، باستخدام الهياكل الحكومية القائمة. ولتحديد المناطق الموبوءة، تمت الاستعانة بالترسيم المتكامل للأمراض، وذلك في 659 منطقة من أصل 817 منطقة موبوءة. وللاطلاع على توزيع الموارد، قام العاملون المدربون في مجال الإرشاد الصحي بتقييمات متكاملة لعبء المرض في 56 منطقة لديها عبء سريري مرتفع. ولضمان توفير رعاية معيارية، قامت وزارة الصحة بتطوير الإرشادات الإدارية لمعدلات الإصابة بداء الفيلاريات اللمفي وداء الفيل بما يشتمل على خوارزمية للعلاج ومجموعة محددة للرعاية. ويقوم مختصون ذوو خبرة في إدارة مرض الوذمة اللمفية بتدريب العاملين الحكوميين في مجال الصحة، على الإدارة المتكاملة لمعدلات الإصابة المرض. ولمراقبة التكامل فإنه تم وضع مؤشر لعدد المرضى الذين تم علاجهم من مرض الوذمة اللمفية ضمن نظام المعلومات الوطني للإدارة الصحية.في عام 2014 قامت ‏24% (87) من أصل 363 منشأة صحية بإجراء مسح للخدمات المقدمة لمرضى داء الفيلاريات اللمفي، في حين قامت ‏12% (44) منشأة بتقديم خدمات لمرضي داء الفيل.حتى الآن تم تدريب 542 من العاملين في مجال الصحة من 53 مركزاً صحياً في 24 منطقة، على الإدارة المتكاملة لمعدلات الإصابة بالمرض. وفي الفترة ما بين يوليو/تموز 2013 ويونيو/حزيران 2016، سجل نظام المعلومات الوطني للإدارة الصحية 46487 مريضاً تم علاجهم من 189 منطقة.ثبتت جدوى استخدام النهج المتكامل لمعدلات الإصابة بداء الفيلاريات اللمفي وداء الفيل في إثيوبيا. ويمكن تطبيق العمليات المستخدمة في مواقع أخرى تستوطن فيها هذه الأمراض.淋巴丝虫病和象皮肿是造成埃塞俄比亚热带淋巴水肿的主要原因。 这些疾病需要提供类似的护理，但是在 2012 年，埃塞俄比亚卫生系统没有整合发病率管理。.为了建立用于综合发病率管理的医疗护理服务，卫生部和合作伙伴使用了现有的政府体系。 817 个地区中，659 个地区绘制了综合疾病地图，用以确定疾病流行地区。 为提供资源分配信息，经过培训的健康推广工作人员在 56 个临床负担高的地区开展了综合疾病负担评估。 为了确保提供标准护理，卫生部制定了综合淋巴丝虫病和象皮肿发病率管理指南，包含治疗算法和既定的护理包。 在淋巴水肿控制方面经验丰富的专家就综合发病率管理对政府雇佣的卫生工作人员进行了培训。 为了监控综合管理，国家卫生管理信息系统中纳入了一个显示接受淋巴水肿治疗的患者人数的指标。.2014 年，被调查的 363 个卫生机构中，仅 24% (87) 个提供淋巴丝虫病护理服务，12% (44) 个提供象皮肿护理服务。.截至目前，24 个地区 53 家卫生中心的 542 名卫生工作人员接受了综合发病率管理培训。 在 2013 年 7 月至 2016 年 6 月期间，国家卫生管理信息系统记录了来自 189 个地区的 46487 名接受治疗的患者。.在埃塞俄比亚，对淋巴丝虫病和象皮肿进行综合发病率管理的方法是可行的。 这些流程也可能适用于这类疾病并发流行的其他地区。.Лимфатический филяриатоз и подокониоз являются основными причинами тропической лимфедемы в Эфиопии. Заболевания требуют аналогичного лечения, но в 2012 году система здравоохранения Эфиопии не использовала комплексный подход к управлению заболеваемостью.С целью создания медицинских услуг для комплексного регулирования заболеваемости лимфедемой Министерство здравоохранения и партнеры использовали существующие правительственные структуры. Для выявления эндемичных районов было проведено комплексное картографирование болезней в 659 из 817 районов. Чтобы информировать о распределении ресурсов, подготовленные работники здравоохранения провели комплексные оценки бремени болезни в 56 районах с высокой клинической нагрузкой. Чтобы обеспечить оказание стандартной медицинской помощи, Министерство здравоохранения разработало руководство по комплексному управлению заболеваемостью лимфатическим филяриатозом и подокониозом, содержащее алгоритм лечения и определенный пакет медицинской помощи. Опытные специалисты по лечению лимфедемы обучили государственных работников здравоохранения комплексному управлению заболеваемостью. Для мониторинга интеграции в национальную информационную систему управления здравоохранением был включен показатель количества пациентов, получавших лечение при лимфедеме.В 2014 году только 24% (87) из 363 обследованных медицинских учреждений оказывали медицинскую помощь при лимфатическом филяриатозе и 12% (44) медицинских учреждений оказывали медицинскую помощь при подокониозе.На сегодняшний день 542 медицинских работника из 53 медицинских центров в 24 районах прошли подготовку по вопросам комплексного управления заболеваемостью. В период с июля 2013 года по июнь 2016 года в национальной информационной системе управления здравоохранением было зарегистрировано 46 487 получавших лечение пациентов из 189 районов.В Эфиопии был внедрен комплексный подход к регулированию заболеваемости лимфатическим филяриатозом и подокониозом. Используемые процессы могут применяться в других условиях, для которых эти заболевания являются эндемичными.

Podoconiosis is a neglected tropical disease (NTD) characterized by lower-leg swelling (lymphedema), which is caused by long-term exposure to irritant red-clay soils found within tropical volcanic high-altitude environments with heavy rainfall. The condition places a substantial burden on affected people, their families and communities, including disability, economic consequences, social exclusion, and stigma; mental disorders and distress are also common. This paper focuses on community-based care of podoconiosis, and, in particular, the role that community involvement can have in the reduction of stigma against people affected by podoconiosis. We first draw on research conducted in Ethiopia for this, which has included community-based provision of care and treatment, education, and awareness-raising, and socioeconomic rehabilitation to reduce stigma. Since people affected by podoconiosis and other skin NTDs often suffer the double burden of mental-health illness, which is similarly stigmatized, we then point to examples from the mental-health field in low-resource community settings to suggest avenues for stigma reduction and increased patient engagement that may be relevant across a range of skin NTDs, though further research is needed on this.

Background Lymphatic filariasis (LF) and podoconiosis are neglected tropical diseases (NTDs) that pose a significant physical, social and economic burden to endemic communities. Patients affected by the clinical conditions of LF (lymphoedema and hydrocoele) and podoconiosis (lymphoedema) need access to morbidity management and disability prevention (MMDP) services. Clear estimates of the number and location of these patients are essential to the efficient and equitable implementation of MMDP services for both diseases. Methodology/Principle findings A community-based cross-sectional study was conducted in Ethiopia using the Health Extension Worker (HEW) network to identify all cases of lymphoedema and hydrocoele in 20 woredas (districts) co-endemic for LF and podoconiosis. A total of 612 trained HEWs and 40 supervisors from 20 districts identified 26,123 cases of clinical morbidity. Of these, 24,908 (95.3%) reported cases had leg lymphoedema only, 751 (2.9%) had hydrocoele, 387 (1.5%) had both leg lymphoedema and hydrocoele, and 77 (0.3%) cases had breast lymphoedema. Of those reporting leg lymphoedema, 89.3% reported bilateral lymphoedema. Older age groups were more likely to have a severe stage of disease, have bilateral lymphoedema and to have experienced an acute attack in the last six months. Conclusions/Significance This study represents the first community-wide, integrated clinical case mapping of both LF and podoconiosis in Ethiopia. It highlights the high number of cases, particularly of leg lymphoedema that could be attributed to either of these diseases. This key clinical information will assist and guide the allocation of resources to where they are needed most., Author summary Patients affected by the clinical conditions of lymphatic filariasis (lymphoedema and hydrocoele) and podoconiosis (lymphoedema) require access to a minimum package of care to prevent progression of the disease, and to improve their quality of life. Clear estimates of the number and location of these patients is essential for the delivery of this care. To address this, a community-based cross-sectional study was conducted in Ethiopia using the Health Extension Worker (HEW) network to identify all cases of lymphoedema and hydrocoele in 20 co-endemic woredas (districts). A total of 26,123 cases of clinical morbidity were identified. Of these, 24,908 (95.3%) had leg lymphoedema, of which 89.3% were bilateral. The results of this study will help assist the Neglected Tropical Disease (NTD) programme at the Federal Ministry of Health (FMOH) in Ethiopia to effectively and equitably plan the delivery of a basic package of care to those suffering from the clinical manifestations of both diseases.

Introduction : Cleft lip with or without cleft palate (CLP) is a congenital malformation that causes significant morbidity in low and middle income countries. Amref Health Africa has partnered with Smile Train to provide CLP surgeries since 2006. Methods: We analyzed anonymized data of 37,274 CLP patients from the Smile Train database operated on in eastern and central Africa between 2006 and 2014. Cases were analyzed by age, gender, country and surgery type. The impact of cleft surgery was determined by measuring averted Disability-Adjusted Life Years (DALYs) and delayed averted DALYs. We used mean Smile Train costs to calculate cost-effectiveness. We calculated economic benefit using the human capital approach and Value of Statistical Life (VSL) methods. Results : The median age at time of primary surgery was 5.4 years. A total of 207,879 DALYs were averted at a total estimated cost of US$13 million. Mean averted DALYs per patient were 5.6, and mean cost per averted DALY was $62.8. Total delayed burden of disease from late age at surgery was 36,352 DALYs. Surgical correction resulted in $292 million in economic gain using the human capital approach and $2.4 billion using VSL methods. Conclusion : Cleft surgery is a cost-effective intervention to reduce disability and increase economic productivity in eastern and central Africa. Dedicated programs that provide essential CLP surgery can produce substantial clinical and economic benefits. Key words : Burden of disease, cleft lip and palate, reconstructive surgery, cost-effectiveness, economic benefit, cost-benefit