Burden of hydrocoele assessed from medical and surgical records in a lymphatic filariasis endemic country, Samoa

Background: Samoa is a Pacific Island country that has long been known to have a high burden of lymphatic filariasis. Little has been documented about the burden of disability due to the chronic complications of the disease. We examined the rates of hydrocoele amongst the Samoan male population to better understand the situation. Methods: Information on numbers of suspected hydrocoele cases in men aged 18 years and older from 2006 to 2013 was sought using ICD-10 codes and/or keywords from three sources: the hospital patient information system plus the surgical clinic and operating theater records in Tupua Tamasese Meaole and Malietoa Tanumafili II hospitals in Samoa. Chart review of suspected hydrocoele cases was used to confirm the diagnosis of hydrocoele amongst suspected cases. The following data items were extracted from patient records where available: date of diagnosis, age, village, hydrocoele characteristics (duration, size, and volume), history and cause of injuries, whether lymphatic filariasis was a differential diagnosis, whether ultrasound scan was used to verify diagnosis, and details of any surgery performed. Population data were obtained from the Samoa Bureau of Statistics. Results: There were 535 suspected cases identified from the 3 sources between 2006 and 2013, of which 328 were diagnosed as hydrocoele; charts for 56 suspected cases (10.5%) could not be located. The mean age of men with hydrocoele was 49.2 years. The proportion of men aged ≥ 18 years diagnosed with hydrocoele over the study period was 0.62% (328/52,944). North West Upolu had the highest proportion amongst the four regions of Samoa (p < 0.001). The proportion of men presenting with hydrocoele increased with age (p < 0.001). 14.3% of patients had an injury that could have contributed to the hydrocoele. Only 4.0% of all patient records had lymphatic filariasis recorded as a differential diagnosis. 60.7% of all patients with hydrocoele had some form of surgery, with no difference between regions (p = 0.276). The majority of surgeries were hydrocoelectomies, where the tunica vaginalis is everted. The mean age of patients that had surgery was 48.2 years. It was difficult to estimate hydrocoele size and duration due to non-standardized way of reporting. Conclusions: This study used multiple sources to document the number of hydrocoele cases that presented annually to medical facilities in Samoa. This represents a minimum estimate of the burden since some cases may have not presented for treatment. The numbers presenting have fluctuated over the years (2006 to 2013), and improvements in the reporting system are needed. The health system needs to consider ways to address a large number of patients that still require surgery, as well as conducting follow-up of those that did receive surgery. Additionally, clinicians should consider lymphatic filariasis as a differential diagnosis for hydrocoeles

Enhanced surveillance for the Third United Nations Conference on Small Island Developing States, Apia, Samoa, September 2014

The Ministry of Health in Samoa, in partnership with the Pacific Community, successfully implemented enhanced surveillance for the high-profile Third United Nations Conference on Small Island Developing States held concurrently with the popular local Teuila festival during a widespread chikungunya outbreak in September 2014. Samoa’s weekly syndromic surveillance system was expanded to 12 syndromes and 10 sentinel sites from four syndromes and seven sentinel sites; sites included the national hospital, four private health clinics and three national health service clinics. Daily situation reports were produced and were disseminated through PacNet (the email alert and communication tool of the Pacific Public Health Surveillance Network) together with daily prioritized line lists of syndrome activity to facilitate rapid response and investigation by the Samoan EpiNet team. Standard operating procedures for surveillance and response were introduced, together with a sustainability plan, including a monitoring and evaluation framework, to facilitate the transition of the mass gathering surveillance improvements to routine surveillance. The enhanced surveillance performed well, providing vital disease early warning and health security assurance. A total of 2386 encounters and 708 syndrome cases were reported. Influenza-like illness was the most frequently seen syndrome (17%). No new infectious disease outbreaks were recorded. The experience emphasized: (1) the need for a long lead time to pilot the surveillance enhancements and to maximize their sustainability; (2) the importance of good communication between key stakeholders; and (3) having sufficient staff dedicated to both surveillance and response

Control and elimination of lymphatic filariasis in Oceania: prevalence, geographical distribution, mass drug administration, and surveillance in Samoa, 1998-2017

Lymphatic filariasis (LF) is a major public health problem globally and in the Pacific Region. The Global Programme to Eliminate LF has made great progress but LF is persistent and resurgent in some Pacific countries and territories. Samoa remains endemic for LF despite elimination efforts through multiple two-drug mass drug administrations (MDA) since 1965, including renewed elimination efforts started in 1999 under the Pacific Programme for Elimination of LF (PacELF). Despite eight rounds of national and two rounds of subnational MDA under PacELF, Samoa failed transmission assessment surveys (TAS) in all three evaluation units in 2017. In 2018, Samoa was the first to distribute countrywide triple-drug MDA using ivermectin, diethylcarbamazine (DEC), and albendazole. This paper provides a review of MDAs and historical survey results from 1998 to 2017 in Samoa and highlights lessons learnt from LF elimination efforts, including challenges and potential ways to overcome them to successfully achieve elimination