Neglected diseases: Tanzania’s fight against a silent threat

At only 27 years old, Shabanni Ramadhan noticed something unusual. A small swelling in his scrotum. At first, he brushed it aside. It seemed like just another benign swelling. And like many men his age, he was busy working to provide for his fledgling family, and the thought of seeking medical care was overshadowed by one stark reality: he had no money.

But what had begun as a minor discomfort grew steadily. Within a few years, the swelling became painful, especially during cold weather.

Shabanni describes the pain of what had progressively grown into an unmanageable fluid-filled swelling in his scrotum as “a terrible pain, like a needle pricking inside.”The swelling grew so large that it became impossible to hide, swinging heavily between his legs with every step.“At times, it was so severe I dreaded putting on trousers,”recollects the small-scale farmer from Rudiga, deep in Talanda, in Tanzania’s Pwani region.

Despite the pain, he forced himself to keep working, knowing his four children and wife relied solely on him. Shabanni’s condition, known as hydrocele, is one of the most common chronic manifestations of lymphatic filariasis, a neglected tropical disease caused by tiny worms transmitted through mosquito bites.

In many coastal areas of East Africa, mosquitoes breed abundantly. When they bite, they can transmit microscopic worms from one person to another.“Over time, the worms damage the body’s lymphatic system, leading to swelling of limbs (elephantiasis) or, in men, hydrocele,” explains Dr Anthony Gulinja, who works in the field of neglected tropical disease control. “Generally, this disfiguring swelling happens especially in legs, arms, breasts, or genitals.”Similar to how it happens with malaria, transmission occurs when mosquitoes pick up microscopic worms (microfilariae) from an infected person’s blood and pass them to others when they bite.

Read: Timely vaccine rollout milestone in malaria preventionDr Gulinja explains that, once inside the human body, the worms settle in the lymphatic system, where they quietly obstruct the flow of lymph.

Over time, this hidden damage can cause severe swelling (lymphedema), thickening of the skin, and in men, hydrocele—the painful swelling of the scrotum that Shabanni suffered with.“Many people show no visible symptoms for years; in fact, the infection often begins in childhood, when a mosquito bite introduces the parasites. The worms can remain unnoticed for decades, with the most devastating effects—painful and disfiguring swelling—only appearing later in adulthood,” added Dr Gulinja.

Shabanni describes how the illness crept in silently. He recalls that early feeling as if “something was crawling inside” before he could even feel the initial little pebble-sized swelling, which shifted to the touch.

By the time he was in his thirties, the mass had grown so large that people in his community could not help but notice. Children would tease him, joking that he was hiding a football in his trousers. Adults, too, sometimes mocked him with nicknames like “Shabanni Mshipa.”In Tanzania, lymphatic filariasis (LF) carries a heavy social stigma, particularly in rural communities where the disease is poorly understood.

Men suffering from hydrocele, the painful scrotal swelling caused by LF, are often ridiculed with crude nicknames such as “mtama wa mshipa” loosely translated as “veins full of millet”, a term that reduces their suffering to a public joke.

And although his close family did not stigmatize him, the physical burden of hydrocele took a heavy toll. The swelling made walking difficult and working in the fields nearly impossible.

He relied on painkillers from local dispensaries for temporary relief, and sometimes local traditional herbs for the pain, until he eventually discovered that surgery could remove the mass altogether.

Several times, he had tried to raise the Tsh200,000 ($80.95) needed for a hydrocelectomy—the surgery to remove the swelling—by appealing to family and friends, but without success.

Family and friends tried to contribute what little they could, but as peasant farmers growing mainly maize and sesame like Shabanni, the medical costs were far beyond their reach.“With no money for treatment,” he says softly, “I just endured.”As he struggled with the painful reality of how much the condition had taken over his life, a glimmer of hope finally came in 2024.

His brother in Bagamoyo told him about community announcements that free surgeries were being offered there, through a government programme in partnership with Uniting to Combat NTDs, aimed at eliminating lymphatic filariasis and its disabling complications.

Though skeptical at first, Shabanni decided to try, and when he arrived at the hospital, he was surprised to find many other men like him, all waiting for the same relief. On April 26, last year he underwent the hydrocelectomy.

A hydrocelectomy is a minor surgical procedure to remove the fluid-filled sac around the testicle that causes swelling. Done under local or general anesthesia, the surgeon makes a small cut in the scrotum or lower abdomen, drains the fluid, and either removes or stitches the sac to stop it from refilling.

Read: Africa’s healthcare funding crisis: 3 strategies to manage deadly diseasesThe wound is then closed with stitches, and the patient usually goes home the same day. The operation takes less than an hour, is safe, and offers permanent relief, though full recovery takes a few weeks.“The operation was done under local anaesthesia; I was awake but felt no pain. I thought it would be unbearable,” he says, “but I did not feel pain. I thank God.” The next day, he was discharged, having not paid a coin, and began his recovery.

Lymphatic filariasis affects millions of people worldwide, particularly in tropical and subtropical regions of Africa, Asia, the Western Pacific, and parts of the Americas.

In Tanzania, lymphatic filariasis, locally known as elephantiasis and hydrocele, remains one of the country’s most pressing neglected tropical diseases.

According to Dr Clarer Jones Mwansasu, the Neglected Tropical Diseases (NTD) Programme Manager for the Ministry of Health in Tanzania, the country has confirmed 15 NTDs out of the 21 recognised by the World Health Organisation, but the national program is prioritising five, including LF.“For lymphatic filariasis, we conduct annual mass drug administration using ivermectin,” she explains. “Everyone in at-risk communities is treated, regardless of whether they show symptoms, because prevention is key.”But for those like Shabanni who already live with the disease, the focus shifts to what doctors call morbidity management and disability prevention.

Unlike elephantiasis, where swelling of the limbs is irreversible and requires lifelong care, hydrocele is treatable through surgery.

In Tanzania, lymphatic filariasis has been a long-standing public health challenge. At its peak, between 2006 and 2015, the disease was present in 119 councils across the country.

Mass drug administration (MDA) began in 2000, and by 2025, the campaign had successfully halted transmission in 114 of those councils. Only five councils still require preventive treatment today, a major achievement considering that more than 31 million Tanzanians were once at risk.

Despite this progress, thousands just like Shabanni still live with the long-term effects of the disease. At baseline, an estimated 32,000 men in Tanzania required surgery for hydrocele.

As of 2024, more than 12,000 hydrocelectomies have been performed through outreach camps and routine health services, yet over 19,000 men remain in need of the operation.

For patients like Shabanni, these surgeries can mean the difference between living with daily pain and regaining the ability to work and move with dignity.

The country has also made strides in reducing its overall burden of neglected tropical diseases (NTDs). Since 2021, the number of Tanzanians requiring preventive chemotherapy for the five targeted NTDs, including LF, river blindness, schistosomiasis, soil-transmitted worms, and trachoma, has dropped by 76 per cent, from 52 million to about 17 million people, according to the Health ministry.

Beyond medical treatment, the programme also works on community sensitisation and behavioural change.

LF is deeply tied to poverty, and without awareness, people may delay seeking help or resign themselves to living with disabling pain. Health education, improved hygiene, and vector control are therefore crucial to prevent infections from recurring even after transmission has been interrupted.

MDA campaigns using combinations of antiparasitic medicines (ivermectin, albendazole, and diethylcarbamazine) aim to interrupt transmission. Prevention also includes mosquito control and improved hygiene for affected persons to prevent secondary infections.

Sustaining these efforts has not been easy. The NTD programme, which was integrated under one umbrella in 2009 to make better use of limited resources, still relies heavily on donor funding.

Partners such as USAID, the Bill and Melinda Gates Foundation, and the Reaching the Last Mile initiative have helped to scale up surgeries and supply chain support, under the Ministry of Health on community-based interventions.

Read: US funding cuts push Eastern Africa to the brink of a humanitarian catastropheThese gains, however, face sustainability challenges. Tanzania’s NTD master plan (2021–2026) emphasises strengthening domestic financing to reduce reliance on donors such as USAID, which historically supported much of the LF programme.

While government contributions have risen from just 0.6 per cent in 2021 to as high as 25 percent in recent years, maintaining surgeries, drug distribution, and disability management will require even stronger local ownership.

For patients still suffering the consequences of LF, like Shabanni, these commitments are crucial to ensuring treatment is available long after international partners exit.

The disease is a reminder of how something as small as a mosquito can devastate lives when health systems are weak and treatment is out of reach. With renewed efforts to eliminate neglected tropical diseases, more men like Shabanni may finally find relief.

Today, Shabanni says his life has changed. He can work again, walk freely, and participate fully in his community. Neighbours who once pitied him now see him as the young, strong man he is.“Before, they saw me as an old man, due to the weight of the hydrocele,” he says. “Now I have my dignity back.”He has one message for others still suffering in silence: “Go to the hospital. Do not be afraid. The surgery is not painful, and you will get your life back.”For now, he is focused on the future, his farming, his family, and rebuilding the years that disease stole from him.

For Tanzania, sustaining the fight against lymphatic filariasis and other neglected tropical diseases (NTDs) is not only a health issue, but an economic one.

While no formal return-on-investment analysis has been done locally, evidence from other African countries, according to Dr Mwansasu points to huge economic gains from eliminating NTDs.“Nigeria alone stands to gain nearly $19 billion in productivity by 2030 if it reaches elimination targets for diseases like LF, river blindness, and schistosomiasis. Similar benefits are projected for countries such as Ethiopia, Kenya, Rwanda, and Zimbabwe.”For Tanzania, where men like Shabanni lose productive years to conditions such as hydrocele, the case for continued investment is clear.

Yet the fight against LF faces new financial hurdles. For many years, Tanzania’s NTD program relied heavily on donor support, with USAID once covering more than 95 percent of funding.

By early this year, before the USAID setback, the share had already fallen to around 80 per cent, compelling the government to step in.

In recent years, Tanzania has established a budget line for NTDs within the national health budget and now requires councils to allocate local funds to support prevention and treatment. While these allocations are often too small, they represent a step toward domestic ownership and sustainability.

Tanzania’s NTD master plan, supported by the 2021–2026 Sustainability Plan, targets raising domestic financing of interventions to 60 percent by 2026.

Read: HIV patient testing falls in South Africa after US aid cuts, data showsThe goal is full country ownership—financial independence and control over funding decisions. Reaching this milestone would ensure Tanzania can both fund and steer its NTD programs. The question now is how close we are to the 2030 goals.”The government is also exploring new models to keep services running. These include integrating NTD activities into routine council health plans, promoting co-financing arrangements with partners, and tapping into broader development funding windows such as World Bank programs. The goal is to ensure that surgeries, drug distribution, and disability care continue, even as donor support fluctuates.

For patients like Shabanni, whose lives are disrupted by the various NTDs, these efforts go beyond policy. They mean the difference between living with debilitating conditions or accessing life-changing support or surgery.

Sustaining the gains Tanzania has made is not just about preventing new infections, it is about restoring dignity and productivity to those already affected. Provided by SyndiGate Media Inc. (Syndigate.info).