Footcare among lymphoedema patients attending a filariasis clinic in South India: a study of knowledge and practice

Lymphoedema and its management in cases of lymphatic filariasis: the current situation in three suburbs of Matara, Sri Lanka, before the introduction of a morbidity-control programme

Using in-depth interviews, information on the current state of lymphoedema management was collected from 101 cases of lymphatic filariasis with lymphoedema in three suburbs of Matara. The interviews were conducted prior to the introduction of a programme of community home-based care (CHBC) that incorporates modern lymphoedema-management strategies. Thirty-two of the interviewees had severe lymphoedema (of grade III or above). The male interviewees had significantly more entry lesions than the female. Most of the subjects had suffered from episodes of limb pain with fever, although the incidence of these episodes appeared unrelated to the severity of the lymphoedema. The frequency of the episodes of limb-pain/fever in the 12 months prior to the interviews appeared unrelated either to the level of daily hygiene, which was generally poor, or to the frequency of bathing. Many (65%) of the subjects paid no attention to limb care when bathing, and 44% did not use footwear. Over 80% made no effort to keep their afflicted limbs elevated, and 95% did not exercise. Most of the female interviewees felt shameful of their condition and were, in consequence, less likely to attend government clinics, for treatment, than the male interviewees. The drug treatment that the interviewees had received was often inadequate, and most had stopped seeking treatment because they had not perceived any significant treatment-attributable improvement in their condition. Modern lymphoedema-management strategies (based on regular washing, careful drying, and treatment, with antifungal, antibiotic or emollient creams, of the affected limbs, limb elevation, exercise, and use of footwear) had not reached the study communities and the local physicians were not aware of them. When dermatology life-quality indexes (DLQI) were calculated for the interviewees, the 26 most impaired subjects gave scores of 5-15 (mean=8.6). The DLQI for these subjects will be regularly re-evaluated, as a measure of the effectiveness of the CHBC programme that has now begun.

Treatment-seeking behavior and treatment practices of lymphatic filariasis patients with lymphoedema in the Colombo district, Sri Lanka

This cross-sectional, descriptive study describes the treatment-seeking behavior of 413 lymphoedema patients attending 2 filariasis clinics in the Colombo district, Sri Lanka. A pretested, interviewer-administered questionnaire obtained information regarding sources and types of treatment taken, time taken for diagnosis, and details regarding diethylcarbamazine citrate (DEC) treatment. There was a mean delay of 2.37 years (SD 1.37) in diagnosing filariasis after the first appearance of limb swelling. General practitioners were the most frequent first-contact health care providers and the most visited source overall, followed by government hospitals and Ayurvedic practitioners. Approximately 95% of patients were on DEC treatment ranging from 10 days to 43 years (mean 2.5 years SD +/- 1.1). Sixty-one percent of patients reported always having taken the recommended DEC course. Nonsteroidal anti-inflammatory drugs, diuretics, and antibiotics were liberally prescribed. Approximately 97% had sought treatment from a medical practitioner for an acute adenolymphangitis attack. Despite the area being endemic for filariasis, there was a delay in treatment and inappropriate use of DEC in patients with chronic filarial lymphoedema.

Morbidity management in the Global Programme to Eliminate Lymphatic Filariasis: a review of the scientific literature

The Global Programme to Eliminate Lymphatic Filariasis (GPELF) has two major goals: to interrupt transmission of the parasite and to provide care for those who suffer the devastating clinical manifestations of the disease (morbidity control). This latter goal addresses three filariasis-related conditions: acute inflammatory episodes; lymphoedema; and hydrocele. Research during the last decade has confirmed the importance of bacteria as a cause of acute inflammatory episodes in filariasis-endemic areas, known as acute dermatolymphangioadenitis (ADLA). Current lymphoedema management strategies are based on the central role of ADLA as a trigger for lymphoedema progression. Simple intervention packages are in use that have resulted in dramatic reductions in ADLA rates, a lower prevalence of chronic inflammatory cells in the dermis and subdermis, and improvement in quality of life. During the past decade, the socioeconomic impact of ADLA and lymphoedema in filariasis-endemic areas has received increasing attention. Numerous operational research questions remain to be answered regarding how best to optimize, scale up, monitor, and evaluate lymphoedema management programmes. Of the clinical manifestations targeted by the GPELF, hydrocele has been the focus of the least attention. Basic information is lacking on the effectiveness and complications of hydrocele surgery and risk of post-operative hydrocele recurrence in filariasis-endemic areas. Data on the impact of mass administration of antifilarial drugs on filarial morbidity are inconsistent. Several studies report reductions in acute inflammatory episodes, lymphoedema, and/or hydrocele following mass drug administration, but other studies report no such association. Assessing the public health impact of mass treatment with antifilarial drugs is important for programme advocacy and morbidity control strategies. Thus, although our knowledge of filariasis-related morbidity and its treatment has expanded in recent years, much work remains to be done to address the needs of more than 40 million persons who suffer worldwide from these conditions.

Using knowledge, attitudes and practice (KAP) surveys on lymphatic filariasis to prepare a health promotion campaign for mass drug administration in Alor District, Indonesia

We report the results of two surveys of people's knowledge, attitudes and practices (KAP) regarding lymphatic filariasis (LF) in Alor District, eastern Indonesia. The results of the surveys were used to prepare and evaluate the social mobilization component of a pilot mass drug administration (MDA) in five villages. In the study area, the filarial parasites Brugia timori and Wuchereria bancrofti are highly endemic. Frequent and severe adverse reactions after MDA may occur especially in areas endemic for B. timori and therefore, a special communication strategy was designed to inform and to educate communities about LF and its control. The first KAP survey was conducted as a baseline pre-MDA with diethylcarbamazine and albendazole and the second as a post-intervention evaluation in order to obtain information on the impact of the communication campaign. Before the information campaign and the subsequent MDA, 54% of the study population had heard of one of the three main terms for LF, whereas after health education and MDA, 89% had heard of at least one of the three terms. Similarly, pre-MDA, 21% reported having had previously taken the treatment for filariasis, while post-MDA, 88% reported having taken the treatment during the pilot treatment period. The historical fears and traumatic experiences associated with past LF treatment campaigns in Indonesia were averted since both the communication campaign and the MDA were designed appropriately for and together with the community. As a result, compliance was sufficient in the first round to successfully begin the elimination process.