By Daniel Dickinson
In Dar es Salaam, Tanzania
Clinics treat the disease
Seventy-year-old Mohammed Abdallah Totoro shuffles with an exaggerated limp to his tailor's shop in the market square of Kisarawe, a hill town in the coastal region of Tanzania.
There is a conspicuous bulge in his baggy green trousers that reaches to his knees which is causing his ungainly walk.
This bulge is his scrotum which has ballooned out of all proportion due to the disease lymphatic filariasis, more commonly known as elephantiasis.
The swelling, which has thickened and hardened the skin of his scrotum, is an example of well developed elephantiasis.
I am not embarrassed by this disease
"I don't feel any pain, but it is uncomfortable and I do notice how heavy it is to carry around," he said.
High infection rates
Mr Totoro is one of around 1,000 men who suffer from elephantiasis in the Kisarawe district, where the infection rate is currently running at 1%.
"I am rather shocked by the way my scrotum has swollen," he said.
"I wasn't expecting such a thing to come out of my body, but I am not embarrassed by this disease."
Medication is available
In fact far from embarrassment many men who have suffered from elephantiasis of the scrotum have traditionally seen it as a sign of virility.
Dr David Kihwele, the director of programmes at UMATI, Tanzania's family planning association, said: "Some men have the misguided idea that the swelling boosts the sexual pleasure of their partner."
Anecdotal evidence in Kisarawe suggests the reverse is happening and many couples are splitting up as the male partner is no longer satisfying the sexual needs of the woman.
A public awareness programme has now been launched by the Tanzania's National Institute of Medical Research to sensitise men to the causes of elephantiasis and to encourage them to take preventative medication.
Elephantitis of the scrotum is a particular problem along the coastal region of Tanzania and is rarely seen up country, a fact that baffles many researchers.
It has been difficult to get the message through that the disease is caused by mosquitos
The medical community is still not in unanimous agreement as to why it exists only on the coast.
However, the disease is carried by mosquitoes, which are particularly prevalent in low lying humid areas, so the focus has been on educating people about the dangers of being bitten.
It is an uphill struggle according to Kisarawe's District Health Officer Severini Tarimo.
"It has been difficult to get the message through that the disease is caused by mosquitos and that to help prevent mosquitos from multiplying in great numbers sanitation must be improved.
"People must recognise that where there is stagnant water, mosquitos will thrive."
There are still many people who are unwilling to make the link between mosquitos and elephantiasis.
They believe that the disease has been caused by other external factors, including lifting heavy loads or riding bicycles, factors that are sometimes responsible for hernias, a different type of scrotal swelling.
Severini Tarimo is trying to raise awarness
Once elephantiasis of the scrotum has taken grip the only way to cure it is by surgery. Preventing it is a lot more straightforward and involves taking medication just once a year.
But even that has met with some resistance in coastal communities, said Severini Tarimo.
"Some men are very suspicious of the campaign to prevent elephantiasis.
"They believe the drugs we administer are for family planning and in some cases they say that the pills make them infertile."
The number of men taking the drug in Kisarawe is now falling because of this belief, a development which is likely to increase the risk of elephantiasis.
It is hoped the public awareness campaign will reverse that trend and ultimately rid the area of the disfiguring affects of the disease.