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Early Detection of Lymphatic Disturbance in Adolescent Infected with Lymphatic Filariasis in Myanmar Jan Douglass1, Susan Gordon1, Patricia Graves1, Ben Dickson1, Dr Ni Ni Aye2, Dr Khin Nan Lon2, Dr Khin Saw Aye2 Dr San San Win3, Dr Yi Yi Win2, Dr Tint Wai2 1 James
Cook University, Australia 2 Ministry of Health, Myanmar 3 World Health Organization, Myanmar
JCU Collaborating Centre for the control of lymphatic filariasis, soil transmitted helminths and other neglected tropical diseases
Filariasis Related Lymphedema
Stage 0??
Study Site Selection LF endemic Townships in Central Myanmar identified during MDA, September 2013
Study Design LF endemic Townships in Central Myanmar identified during MDA, September 2013 Morbidity Survey;
Prevalence of Lymphoedema and Hydrocele - Ben Dickson
Cross Sectional Survey; Screening for LF infection by ICT Age and Gender matched positive and negative adolescents Physical Measures of lower limbs Blood samples for dried filter paper and plasma Longitudinal Study;
Repeat measures and blood samples collected after the annual MDA, December 2014 and again after treatment of positive cases, March 2015
Interventional Study;
RCT of prevention strategies in young people at risk of developing chronic disease
Study - Aims 1. Determine if latent lymphedema can be detected in young people infected with LF 2. Identify the optimal point and form of intervention to prevent progression to chronic disease
Screening for LF
Immuno Chromatographic Test Card
Participant Selection
Baseline Characteristics (n=104) Age
Height (cm)
Weight (lbs)
20 200 18 150 16 100
14
50
12
0
10
Positive
Positive
Negative
Tonometer - Baseline
Baseline - Indurometer
p = 0.04
Non-dominant Calf after MDA and/or Deworming Treatment p = 0.04
p = 0.28
p = 0.89 p = 0.77
p = 0.10 p = 0.18
Conclusions and Future Directions Early Detection Study
• Uniform trend of tissue softening –Infected participants • Amend MMDP guidelines to –Include Stage 0 –Include preventative practices • Further research on –Identification of people at risk –Proactive intervention in early stages
Acknowledgements - Institutions • Ministry of Health, Union of the Republic of Myanmar • Vector Borne Disease Control, Mandalay • Public Health Laboratory, Mandalay • Department of Medical Research, Yangon • WHO, Myanmar Regional Office • Australian Embassy, Yangon
JCU WHO Collaborating Centre for the Control of Lymphatic Filariasis, Soil Transmitted Helminths and other Neglected Tropical Diseases
Local Research Assistants
Acknowledgements
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Delfin Technologies Finland Cellabs Australia JCU Division of Tropical Medicine
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Thank You www.myanmar-project.com/blog
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