SummaryThe progression of lymphoedema to elephantiasis associated with increased incidence of episodic adenolymphangitis (ADL) is of great concern, as it causes physical suffering, permanent disability and economic loss to lymphatic filariasis patients. This randomized clinical trial aimed to assess the efficacy in terms of reduction of oedema and ADL frequency of three treatment regimens among lymphoedema patients from Orissa, India. The regimens were: (I) oral penicillin -one tablet of 800 000 U penicillin G potassium twice daily for 12 days-repeated every 3 months for 1 year; (II) diethylcarbamazine -6 mg/kg bodyweight for 12 days-repeated every 3 months for 1 year; and (III) topical antiseptic, i.e. betadine ointment. Foot care was part of all regimens. All three drug regimens are efficacious in reducing oedema and frequency of ADL episodes. Although the efficacy was slightly higher in regimen I, the difference was not significant. About half of all patients had reduced oedema after the 90 days of treatment, with oedema reduction of 75-100% in 20%. A major proportion of the remaining patients had oedema reduced by less than 25%. The proportion of people whose oedema reduced was slightly but not significantly lower in regimen II. anova revealed that lymphoedema reduction varied according to grade; being greatest at grade 1 lymphoedema, followed by grade 2. All three regimens significantly reduced ADL frequency after 1 year of treatment. This may be because of foot care as well as use of antibiotics. The estimated costs of treatment per patient for a period of 3 months are US$2.4, 1.5 and 4.0 respectively for regimen I, II and III. Thus affordable treatments with simple antibiotics and foot care can give substantial relief to the patients and reverse early lymphoedema.

In India, the programme to eliminate lymphatic filariasis, which is largely based on mass administrations of diethylcarbamazine, has, in terms of coverage and compliance, been generally much less successful in urban areas than in rural communities. An innovative strategy to make the programme more effective in urban settings, largely based on an inclusive partnership and community participation, has recently been developed. An evaluation of the strategy's implementation in Orissa, which employed both quantitative and qualitative methods of data collection, revealed significantly higher coverage and compliance in an urban area where the strategy had been implemented than in a similar urban area where there had been no such intervention. Application of this strategy in other urban settings in general, and in small towns in particular, is recommended in India.

The global programme to eliminate lymphatic filariasis has alleviation of suffering and disability as one of its components, and many efforts are being taken across the globe in this direction. However, there is no effective tool to assess the impact of these efforts on patients' quality of life and/or lessening of disability and suffering. The present paper reports the use of the Dermatology Life Quality Index (DLQI) in filarial lymphoedema patients. DLQI scores were collected from 203 patients recruited from a clinic and from the community. The DLQI score ranged from 0 to 17, and a mean score of 2.7 (SD 4.4) or 9.0% disability. This score is lower than many skin diseases reported so far. The scores for individual questions vary, but the degree of consistency of responses between questions is high. The differences between sexes, place of recruitment and grades of lymphoedema are not significant. Although the DLQI measures the quality of life due to lymphoedema, this study further warrants development of a good quality-of-life index for lymphoedema patients.