An Overlooked Opportunity for Detecting Additional Cases of Lymphatic Filariasis, Onchocerciasis and Schistosomiasis: A Collaboration Model Between the National NTD Control Programs and Traditional Healers in Cameroon

Abstract

In most African countries, traditional healers (TH) remain a primary source of care in rural areas. Cameroon is highly endemic for NTDs, with 15 of the 20 diseases recognized by the World Health Organization. One critical but often overlooked opportunity lies in the role of traditional healers within community health systems. In this study, we assessed whether training THs and providing referral tools could help identify suspected cases of onchocerciasis, lymphatic filariasis, and schistosomiasis in Cameroon.
TH were trained by experts to identify the clinical signs and symptoms of these three diseases. Each suspected case was sent to a district health with a "pink card" from their TH, where they underwent a clinical assessment to validate or invalidate the initial diagnosis made by the TH. Referral completion rate was defined as the number of pink cards found in the clinics divided by the total number of pink cards distributed for referral.
In Bafia, the referral completion rate was 50%, compared with 30% in Bankim. Of the 90 cases referred, 60%, 52%, and 57% were accurately suspected for Lymphatic Filariasis, Onchocerciasis, and Schistosomiasis, respectively. Overall, 58% of the suspected cases were correctly identified. In Bafia, 19% of lymphatic filariasis cases were clinically and laboratory confirmed, compared with 0% in Bankim, yielding an overall diagnosis rate of 13%; this difference was statistically significant (p = 0.03). For onchocerciasis, 4% of cases were clinically and laboratory-confirmed in both districts, with no statistically significant difference observed (p = 1.00). Regarding schistosomiasis, 4% in Bafia were clinically and laboratory confirmed, 29% in Bankim, and 9% overall; this difference approached but did not reach statistical significance (p = 0.08).
Our findings suggest that engaging TH in a structured referral pathway for NTD detection is feasible in the rural parts of Cameroon.