Evaluating the Burden of Lymphedema Due to Lymphatic Filariasis in 2005 in Khurda District, Odisha State, India

Background: Over 1.1 billion people worldwide are at risk for lymphatic filariasis (LF), and the global burden of LF-associated lymphedema is estimated at 16 million affected people, yet country-specific estimates are poor. Methodology/Principal Findings: A house-to-house morbidity census was conducted to assess the burden and severity of lymphedema in a population of 1,298,576 persons living in the LF-endemic district of Khurda in Odisha State, India. The burden of lymphedema in Khurda is widespread geographically, and 1.3% (17,036) of the total population report lymphedema. 51.3% of the patients reporting lymphedema were female, mean age 49.4 years (1–99). Early lymphedema (Dreyer stages 1 & 2) was reported in two-thirds of the patients. Poisson regression analysis was conducted in order to determine risk factors for advanced lymphedema (Dreyer stages 4–7). Increasing age was significantly associated with advanced lymphedema, and persons 70 years and older had a prevalence three times greater than individuals ages 15–29 (aPR: 3.21, 95% CI 2.45, 4.21). The number of adenolymphangitis (ADL) episodes reported in the previous year was also significantly associated with advanced lymphedema (aPR 4.65, 95% CI 2.97–7.30). This analysis is one of the first to look at potential risk factors for advanced lymphedema using morbidity census data from an entire district in Odisha State, India. Significance: These data highlight the magnitude of lymphedema in LF-endemic areas and emphasize the need to develop robust estimates of numbers of individuals with lymphedema in order to identify the extent of lymphedema management services needed in these regions. Author Summary: The results presented in this article demonstrate the need to assess the clinical disease burden due to lymphatic filariasis (LF) in areas of the world where this disease occurs. There are effective strategies that can be implemented to reduce the suffering and morbidity associated with chronic filarial infections. These include lymphedema management programs that teach basic hygiene to decrease limb infections that contribute to lymphedema progression. These interventions should be implemented on a broader scale and can be integrated with other chronic disease prevention programs at subnational and national levels. However, knowledge of the scale and distribution of individuals suffering with lymphedema in countries with LF is required to decide where and how these health services should be implemented. Countries with LF are encouraged to conduct burden assessments to decide how best to implement lymphedema management programs. Providing health services for those with lymphedema is an important component of reducing LF as a public health problem.