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

Abstract

BackgroundLymphedema management programs have been shown to decrease episodes of adenolymphangitis (ADLA), but the impact on lymphedema progression and of program compliance have not been thoroughly explored. Our objectives were to determine the rate of ADLA episodes and lymphedema progression over time for patients enrolled in a community-based lymphedema management program. We explored the association between program compliance and ADLA episodes as well as lymphedema progression.Methodology/Principal FindingsA lymphedema management program was implemented in Odisha State, India from 2007–2010 by the non-governmental organization, Church's Auxiliary for Social Action, in consultation with the Centers for Disease Control and Prevention. A cohort of patients was followed over 24 months. The crude 30-day rate of ADLA episodes decreased from 0.35 episodes per person-month at baseline to 0.23 at 24 months. Over the study period, the percentage of patients who progressed to more severe lymphedema decreased (P-value = 0.0004), while those whose lymphedema regressed increased over time (P-value<0.0001). Overall compliance to lymphedema management, lagged one time point, appeared to have little to no association with the frequency of ADLA episodes among those without entry lesions (RR = 0.87 (0.69, 1.10)) and was associated with an increased rate (RR = 1.44 (1.11, 1.86)) among those with entry lesions. Lagging compliance two time points, it was associated with a decrease in the rate of ADLA episodes among those with entry lesions (RR = 0.77 (95% CI: 0.59, 0.99)) and was somewhat associated among those without entry lesions (RR = 0.83 (95% CI: 0.64, 1.06)). Compliance to soap was associated with a decreased rate of ADLA episodes among those without inter-digital entry lesions.Conclusions/SignificanceThese results indicate that a community-based lymphedema management program is beneficial for lymphedema patients for both ADLA episodes and lymphedema. It is one of the first studies to demonstrate an association between program compliance and rate of ADLA episodes.

Integrated Control and Management of Neglected Tropical Skin Diseases

“…Clinical diagnosis is accurate in settings where only podoconiosis is endemic; in settings where the two diseases may overlap, the combination of clinical history, physical examination, and blood tests for antifilarial antibody (Wb123 assay) have been used to reach a diagnosis. [33]…”

The Effect of a Regimen of Antifungal Cream Use on Episodes of Acute Adenolymphangitis (ADL) among Lymphedema Patients: An Application Using Marginal Structural Models

“…At baseline, about 27% of patients had inter-digital entry lesions, 14% had advanced stage lymphedema (stages 4-6), and patients reported having lymphedema symptoms for an average of 25 years (data not shown). A previous paper concerning this cohort [16] provides more detail on demographic and LF disease characteristics.…”

“…Several papers have illustrated the effectiveness of lymphedema management programs in decreasing the frequency of ADL over time [12][13][14][15], Two studies evaluating the association between overall compliance and ADL found no association [6,12]. Another study found that among patients with inter-digital entry lesions, those who were compliant overall to a lymphedema management program had a lower rate of ADL episodes over time [16], but did not find this relationship among those without inter-digital entry lesions.…”

Economic benefits and costs of surgery for filarial hydrocele in Malawi

“…[4][5][6][7][8][9][10][11][12] Community programs to promote leg hygiene have been successful at trivial cost. [13][14][15] An economic study of such a community program in Odisha, India estimated that the lifetime benefits of disability prevented, restored work capacity, and reduced medical expense would be 130 times the cost of the intervention. [16] In regions endemic with W. bancrofti, the most common manifestation of LF is hydrocele.…”