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

Abstract

BackgroundLymphatic filariasis (LF) infects approximately 120 million people worldwide. As many as 40 million have symptoms of LF disease, including lymphedema, elephantiasis, and hydrocele. India constitutes approximately 45% of the world's burden of LF. The Indian NGO Church's Auxiliary for Social Action (CASA) has been conducting a community-based lymphedema management program in Orissa State since 2007 that aims to reduce the morbidity associated with lymphedema and elephantiasis. The objective of this analysis is to evaluate the effects of this program on lymphedema patients' perceived disability.Methodology/Principal FindingsFor this prospective cohort study, 370 patients ≥14 years of age, who reported lymphedema lasting more than three months in one or both legs, were recruited from villages in the Bolagarh sub-district, Khurda District, Orissa, India. The World Health Organization Disability Assessment Schedule II was administered to participants at baseline (July, 2009), and then at regular intervals through 24 months (July, 2011), to assess patients' perceived disability. Disability scores decreased significantly (p<0.0001) from baseline to 24 months. Multivariable analysis using mixed effects modeling found that employment and time in the program were significantly associated with lower disability scores after two years of program involvement. Older age, female gender, the presence of other chronic health conditions, moderate (Stage 3) or advanced (Stage 4–7) lymphedema, reporting an adenolymphangitis (ADL) episode during the previous 30 days, and the presence of inter-digital lesions were associated with higher disability scores. Patients with moderate or advanced lymphedema experienced greater improvements in perceived disability over time. Patients participating in the program for at least 12 months also reported losing 2.5 fewer work days per month (p<0.001) due to their lymphedema, compared to baseline.SignificanceThese results indicate that community-based lymphedema management programs can reduce disability and prevent days of work lost. These effects were sustained over a 24 month period.

The Effect of Hygiene-Based Lymphedema Management in Lymphatic Filariasis-Endemic Areas: A Systematic Review and Meta-analysis

“…Budge et al administered the WHO Disability Assessment Schedule II at regular intervals to 370 lymphedema patients in order to assess perceived disability due to lymphedema. Disability scores decreased significantly (p<0.0001) in patients enrolled in a community-based lymphedema management program, particularly among patients with moderate to advanced lymphedema [ 39 ]. Additionally, patients reported losing an average of 2.5 fewer work days per month (p<0.001) after the implementation of a community-based lymphedema management program [ 39 ].…”

Terapia complexa descongestiva com uso de material alternativo na redução e controle do linfedema em pacientes de área endêmica de filariose: um ensaio clínico

“…It is noticed that there is still no consensus as to the best instrument to evaluate the patient with lymphedema [32][33][34] . Whoqol bref was used in this study, advocated by WHO because it is an instrument already validated for the Brazilian population, but it is a generic instrument.…”

Assessment of knowledge and practice of morbidity management among lymphatic filariasis patients

“…Limb hygiene and early identification of entry lesion have been shown as important measures in preventing ADLA attacks. [11][12][13] Though 50% patients practiced limb elevation, none of them practiced it during daily household activities such as cutting vegetables, watching television, chatting which would help them in reducing edema without allotting specified time in a day. Immobilization of the edematous limb in dependent position causes venous hypertension which results in further lymph stasis.…”