Tinotenda*’s childhood in Shamva, a mining town in north-eastern Zimbabwe, was normal – that is, full of promise and wild dreams.

That wide open future began to contract when she started to experience discomfort in one of her legs. “At first, I only felt some pain – the leg was not swollen yet. At the local clinic, I was told I was suffering from elephantiasis, and it needed to be drained,” the mother-of-one recounted. “But as I grow older, it became more swollen, the veins are protruding, and more visible, and when some watery liquid comes out, the pain is more intense.”  

“To mobilise people, we educated them about the disease, its causes and effects, and why they needed to take the drugs for them to be protected.”

– Sithulile Bhebe

She was forced to leave school before graduating. Years later, she is plagued by intense, regular pain. Walking independently is increasingly becoming a grim, laborious effort.

As she ages, and as her daily agony worsens, Tinotenda finds that her condition limits her ability to make ends meet. “Whenever I visit the clinic, they normally inject me, or give me painkillers, which will take away the pain for that particular time,” said Tinotenda. “When I am not in pain, I can work for myself, but when the pain returns, I cannot do anything. I even eat while sleeping [reclining], because the discomfort will be too much for me.”

Professor Francisca Mutapi, deputy director of the organisation Tackling Infections to Benefit Africa (TIBA) told VaccinesWork. “Lymphatic filiariasis (LF), commonly known as elephantiasis, is a disease caused by parasitic worms, called roundworms, which are transmitted by mosquitoes. The disease causes swelling of limbs and genitals in men, accompanied by severe pain and fever. The swelling leads to disfigurement and disability.”

The World Health Organization (WHO) estimates that 51 million people were infected with LF in 2018 – a big number, but a 74% drop since 2000, when a WHO-led programme for LF elimination was launched. That programme has proven how effective preventive chemotherapy can be at halting the spread of the causative parasites, but those drugs are limited in their effect on the adult worms. That means that for many, like Tinotenda, the elimination drive has come too late: 36 million people worldwide are estimated to live with swelling of the limbs or genitals as a consequence of LF.

In her room, isolated by the prolonged ache, the outspoken woman depends on her child for assistance, even simply to use the bathroom. In her child’s absence, moving around becomes virtually impossible.

A 2023 WHO report recognised bilharzia, intestinal worms, elephantiasis, and blinding trachoma as the top four NTDs in Zimbabwe.

Recently, when elephantiasis was reported in parts of the country, the Ministry of Health and Child Care sprang into action. From 16 to 28 September, they undertook a ward-based mass drug administration campaign (MDA), targeting 1.4 million in seven districts. The MDA, according to WHO was, “guided by a comprehensive population and community-based survey conducted in 2021. This survey identified districts with low treatment coverage for lymphatic filariasis, schistosomiasis, and intestinal worms, highlighting areas where intervention is urgently needed.”

Two MDAs were previously rolled out in 2016 and 2017. Where 39 districts were found endemic to elephantiasis in 2015, a 2021 mapping exercise identified just 16 “priority districts”, with only two of those classed as endemic.

Mass prevention

“Mass drug administration” really does mean medication at scale. For the recent MDA against lymphatic filariasis, WHO reported the deployment of 8,789 boxes of 200 tablets of albendazole tablets to cover 1,757,800 people, as well as 6,116 bottles of 500 Ivermectin.

Early one September morning – before the punishing sun’s rays scorched the already parched earth – Sithulile Bhebe and three colleagues set off on bicycles to let the townsfolk of Gwanda, the commercial and industrial hub of Matabeleland South province, know that the campaign was about to start.

“The three of us went around the villages, riding on bicycles, visiting door-to-door, writing names of the eligible recipients, and mobilising them to attend the elephantiasis MDA campaign,” said Bhebe. “Many of the people were happy and ready to get the tablets, which will enable them to be protected against the disease. In total, our area of focus constitutes around 216 qualified people. To mobilise people, we educated them about the disease, its causes and effects, and why they needed to take the drugs for them to be protected.”

In total, the 12-day MDA campaign reached at least 1 million people, recording a 73% success rate.

Rebecca Mwabvu, General Manager, Global Health, Higherlife Foundation, one of the MDA partners, is confident that such campaigns are transforming lives. “With our investments in education and rural transformation, it is only wise and prudent for the organisation to play a critical role in eliminating LF. Failure to eliminate this disease means education outcomes and socio-economic activities are all compromised.”

Besides the MDA, Professor Mutapi encourages adopting other methods to fight the disease. “The control of LF should involve measures to prevent infection, treat infection to kill parasites and prevent the development of disease and management of disease. MDA targets the treatment of infection by killing the parasites and reducing transmission of the parasites.”

Professor Mutapi advocates for special care and education for people disabled by LF, like Tinotenda – to help them cope with their disabilities. “There should also be efforts to provide healthcare and self-care guidance for people for whom MDA is no longer effective, as they are already suffering from the chronic disease conditions such as swelling, pain and fever.”

But for Tinotenda, it’s hard not to dream of the future that never materialised. “I believe if I didn’t have the elephantiasis disease, maybe I could have had a better life.”

*Name changed for confidentiality