ArticlePLoS neglected tropical diseases2026
Geographical disparities and programmatic determinants of hydrocele surgery and lymphoedema management coverage for lymphatic filariasis in the Democratic Republic of the Congo, 2018-2024: A national analysis of routine programme data.
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Abstract
backgroundLymphatic filariasis (LF) is a significant neglected tropical disease in the Democratic Republic of the Congo (DRC). Although progress has been made toward interrupting transmission through mass drug administration, LF-related morbidities-particularly hydrocele, lymphoedema, and recurrent acute dermatolymphangioadenitis-continue to cause substantial disability, comorbid infections, and reduced quality of life. National evidence on the burden of LF morbidities and factors associated with access to morbidity management remains limited.
methodsWe conducted a national retrospective analysis of routinely collected programmatic data from the National Neglected Tropical Diseases Control Programme in the DRC between 2018 and 2024. Data included estimates and management of LF-related hydrocele and lymphoedema across endemic provinces. Descriptive analyses assessed morbidity burden, geographic distribution, and temporal trends. Care cascade analyses were performed to quantify attrition across key stages of morbidity management. Multivariable linear regression models at provincial level were used to identify programmatic and health-system factors associated with hydrocele surgery coverage and lymphoedema management coverage.
resultsA total of 8,471 hydrocele cases and 5,310 lymphoedema cases were identified nationwide. During the study period, 2,013 hydrocele surgeries (23.8%) were performed, while 877 lymphoedema patients (16.5%) received the essential package of care. Marked geographic disparities were observed, with several high-burden provinces exhibiting particularly low coverage. Care cascade analyses revealed substantial attrition between case identification and receipt of care for both conditions. In multivariable analyses, hydrocele surgery coverage was positively associated with external partner support and availability of trained surgical personnel, while higher caseloads, post-Transmission Assessment Survey (post-TAS) surveillance phase, and geographic inaccessibility were associated with lower coverage. Lymphoedema management coverage was strongly associated with community-based care activities, health worker training, and availability of basic hygiene supplies.
conclusionsLF-related morbidities remain a substantial and unevenly addressed public health burden in the DRC, including in provinces that have achieved or are approaching interruption of transmission. Strengthening and scaling up morbidity management and disability prevention services-particularly for lymphoedema and hydrocele-are essential to improve patient quality of life and to meet World Health Organization requirements for elimination of lymphatic filariasis as a public health problem.
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