Efficacy of home-based lymphoedema management in reducing acute attacks in subjects with lymphatic filariasis in Burkina Faso

Abstract

One of the two main goals of the Global Programme to Eliminate Lymphatic Filariasis (LF) is to provide care for those suffering from the devastating clinical manifestations of this filarial infection. Among the 120 million infected people worldwide, up to 16 million have lymphoedema. The WHO strategy for managing lymphoedema is based on rigorous skin hygiene, exercise, antibiotics and antifungals when indicated. The aim is to reduce acute attacks of adenolymphangitis and cellulitis responsible for lymphoedema progression and disability. The objective of our study was to assess the effectiveness of home-based lymphoedema management implemented by the national health system of Burkina Faso. Any patient was eligible to participate in the study if suffering from LF-related lymphoedema of a lower limb at any stage, and receiving care as part of the health education and washing project between April 2005 and December 2007. The primary readout was the occurrence of an acute attack in the month preceding the consultation reported by the patient or observed by the care-giver. In all, 1089 patients were enrolled in the study. Before lymphoedema management intervention, 78.1% (95%CI: 75.5-80.5) of the patients had an acute attack in the month preceding the consultation; after four and half months of lymphoedema management, this was reduced to 39.1% (95%CI: 36.2-42.1). A reduction of acute attacks related to the number of consultations or related to the patients' age and gender was not observed. Our results suggest that the home-based lymphoedema management programme in the primary health care system of Burkina Faso is effective in reducing morbidity due to LF in the short-term (4.5 months). The lymphoedema management requires no additional human resources, but whether its effect can be sustained remains to be seen.

Impact of a Community-Based Lymphedema Management Program on Episodes of Adenolymphangitis (ADLA) and Lymphedema Progression - Odisha State, India

“…These findings are consistent with other studies which have also found a decrease in ADLA episodes following enrollment in a lymphedema management program [2], [3], [13], [14], [23], [24]. Other programs have found a similar plateauing of the ADLA rate 3–12 months after beginning lymphedema management [13], [14]. Although our results show a significant decrease in the rate of ADLA episodes over the 2 years since the lymphedema management program was implemented, we recognize that this decrease may be partially influenced by patient receipt of anti-filarial drugs during the two MDAs that took place over the course of the study [21].…”

“…The rate of ADLA was lowest six months after enrollment, yet a decrease was sustained over the two year period of the study. These findings are consistent with other studies which have also found a decrease in ADLA episodes following enrollment in a lymphedema management program [2], [3], [13], [14], [23], [24]. Other programs have found a similar plateauing of the ADLA rate 3–12 months after beginning lymphedema management [13], [14].…”

“…Patients enrolled in a clinic-based lymphedema management program in Léogâne, Haiti demonstrated significant decreases in the incidence of ADLA episodes and reduction of leg volume over a 4-year period [13]. A study of a home-based lymphedema management program in Burkina Faso also demonstrated significant reductions in the percent of patients experiencing at least one ADLA episode over a month's time [14]. The studies completed to date vary in their methods of data collection, follow-up intervals, and study length.…”

“…Lymphedema management programs have been shown to decrease the frequency of ADLA episodes and lymphedema severity both in clinical-trial [11], [12] and field settings [13], [14]. Patients enrolled in a clinic-based lymphedema management program in Léogâne, Haiti demonstrated significant decreases in the incidence of ADLA episodes and reduction of leg volume over a 4-year period [13].…”

Impact of Community-Based Lymphedema Management on Perceived Disability among Patients with Lymphatic Filariasis in Orissa State, India

“…While previous studies have demonstrated improvements in patient quality of life and a reduction in ADL episodes after beginning lymphedema management, most have assessed patients over relatively short periods of time (≤1 year) and on a smaller scale [14], [15]. The objective of this study, therefore, was to evaluate the longer-term impact of a large-scale, community-based lymphedema management program on perceived disability and productivity among lymphedema patients using a validated disability-assessment tool [16].…”