Adama Zoundi makes his living as a tailor, carefully considering how the clothes he cuts and stitches will suit his clients. But when it comes to himself, Zoundi is more likely to reflect on how he might conceal his image, rather than enhance it.

Forty-one years old and single – his wife left him in 1998 – Zoundi lives in the family compound of his parents. It is there that he plies his trade as a tailor, largely out of sight of the community at large.

Zoundi suffers from lymphatic filariasis, a mosquito-borne parasitic disease that in one form is known as elephantiasis. He was diagnosed with the illness in 1983.

“I could feel my left leg swelling,” he said. “Later I felt pain and fever.”

Zoundi’s leg inflated to twice its size. As the parasites in his system destroyed his tissues, his skin developed sores that became infected and painful.

Filariasis affects more than 120 million people worldwide, one-third of whom live in Africa, according to the World Health Organisation (WHO). About 40 million people around the world are seriously incapacitated and disfigured by the disease. It is endemic in West Africa.

Burkina Faso this year is continuing a nationwide programme that it began in 2005 to eradicate the disease, which threatens the health of one-third of the country’s 13 million people. About 80 percent of the population will benefit from free medicine given by the government to combat the illness, said Dr. Dominique Kyelem, head of the national program for the eradication of lymphatic filariasis.

The disease

The Global Alliance to Eliminate Lymphatic Filariasis was created in 2000 and brings together national ministries of health, WHO, companies in the private sector, international development agencies, nongovernmental organisations and others. As of 2006, 29 African countries had initiated programmes to determine endemic areas or had begun mass drug administration strategies, accord to WHO.

Filariasis manifests in various forms, some of which are more treatable than others. Two pharmaceutical companies, GlaxoSmithKline and Merck & Co., Inc. pledged to make drugs available to eliminate the disease worldwide as part of the global campaign. The contribution is among the largest drug donations in history and is valued at more than US$1 billion, WHO says.

Health authorities say that in tropical and subtropical areas where filariasis is well-established, the prevalence of infection is increasing. They say the rapid and unplanned growth of cities creates numerous breeding sites for the mosquitoes that transmit the disease. In addition, health infrastructure in many countries has deteriorated over the years, thwarting early treatment that might stem its spread.

It is necessary to receive several mosquito bites over a long period of time to contract the illness. “Unlike transmission of mosquito-borne malaria, transmission of filariasis is much less efficient” for various reasons, said Dr. Gautam Biswas, a medical officer and filariasis specialist with WHO in Geneva.

The parasites transmitted by the mosquitoes reproduce and lodge in the body’s lymphatic system - the network of nodes and vessels that maintains the fluid balance between the tissues and blood. This is a key component for the body’s immune defence system.

People are generally infected as children, but the disease might take years to manifest itself. More men suffer from the illness than women. Although many people never show outward signs of the disease they could have hidden lymphatic and kidney damage.

Those infected can also become disfigured with swelling of the limbs and breasts (lymphoedema) and genitals (hydrocele) or swollen limbs with dramatically thickened, hard, rough and fissured skin (elephantiasis).

Financial problems

Health authorities say the disease often prevents people from working because of their disabilities and triggers social isolation that furthers the cycle of poverty.

“As filariasis is more prevalent in economically weaker [areas], this economic loss leads to further deprivation,” Biswas said. “A study published in India estimated an annual loss of US$1 billion due to such productivity loss.”

Zoundi said he has suffered ridicule as people compared his leg to a tree stump or talked of witchcraft being to blame for his disability. In addition, he said although he tries to work as much as possible there are times when he cannot.

“For three days in January it was a nightmare,” he said. “I couldn’t work. And when you cannot respect your schedule two or three times, clients will go away.”

In Burkina Faso, the government says about 15,000 people suffer from elephantiasis, and another 20,000 others struggle with hydrocele, or swollen genitals. Although elephantiasis is not curable, it is manageable through medication and proper hygiene to prevent infections, which are the main cause of pain and fever. Surgery can help alleviate the suffering of those who have hydrocele.

Although Zoundi receives the national filiariasis programme’s medication, which is administered in the form of four pills once a year, he cannot afford the specific medication he needs to treat elephantiasis. His leg is swollen, cracked and oozes pus.

“I was regularly going to the hospital every two weeks until I went bankrupt,” he said.

Each month, Zoundi said he needs about 18,000 CFA ($25) for medication, which he cannot afford. At one point his illness was so acute that he had to spend three months in hospital. He was forced to leave prematurely because he could no longer pay for his care and needed to resume work.

He is still able to go to the hospital once a month to have his leg cleaned and treated with special ointment. Health workers gave Zoundi a bucket so he could clean his leg himself at home.

Fighting filariasis

The annual treatment eliminates the filariasis parasite over a six-year period. Although some manifestations of the disease, such as elephantiasis, are more difficult to treat, health authorities say the international campaign has made considerable progress. By 2005, 42 endemic countries had initiated mass drug administration, treating over 380 million people.

Biswas with WHO said that transmission of filariasis in Africa is mostly through the Anopheles mosquito, which also transmits malaria. He said distribution of insecticide treated material for malaria in filarial endemic areas would have a supplemental effect to the mass drug administration strategy.

“West Africa has many parasitic infections, which are diseases of the poorest of the poor,” Biswas said. “These diseases can be controlled and some eliminated as public health problems by using simple, cost-effective interventions. Integrated approaches would produce rapid up-scaling of interventions with minimal investment.”