Can We Overcome the Key Programme Issues to Improve Filarial Lymphoedema Follow-Up Schemes?

Abstract

Introduction: Lymphoedema management is one of the two main strategies executed by the national programme to Eliminate Lymphatic Filariasis (PELF). We addressed three key programmatic issues at national level ( 1) locating patients, (2) educating patients, family members on practice of lymphoedema self-care (3) well sustained daily self-care. Methods: All 117 lymphoedema patients of Matara recorded by Yahathugoda, et al. (2005) were assembled for instruction on Community Home Based Care (CHBC). 107 of them introduced to the CHBC programme again at their homes. The lymphoedema management protocol (Dreyer, et al. 2002) had five components: (1) hygiene, (2) prevention and cure of entry lesions (EL), (3) exercise, (4) elevation of affected limbs (5) protection of limbs. 27 patients were followed-up under two schemes, 14 in Daily follow-up (DFU) scheme and 13 in Monthly follow-up (MFU) scheme. To measure the impacts of the two different schemes, a KAP score of management protocol, number of EL and acute attacks, limb volume, its appearance, changes in the quality of life and gained benefits were assessed after one year. Results and Discussion: (1) Locating patients: Only 51.4% participated in the community gatherings. Non-attendees were shy to be in public. However, visiting patients at home to introduce the programme was successful. (2) Education of patients and family members: Both groups showed similar overall KAP scores on lymphoedema care while the scores on most important techniques such as frequency of cleaning, rinsing and drying of limb/s, management of toe webs etc., were significantly higher in DFU group. (3) Encouragement and support for daily self care: Number positive for EL and mean acute attacks per year reduced from 50.0% to 14.3% (P=0.063) and 5.0 episodes to 0.2 (P< 0.001) respectively in DFU group whereas MFU showed 53.8% to 23.1 % (P=0.13) and 3.3 to 1.3 (P<0.021) reduction. The mean oedema volume in DFU group reduced significantly from 2,426.2 mL to 2,262.7 mL (P<0.02), whereas it slightly increased from 2,672.3 mL to 2,704.1 mL in MFU group. Photographs with obvious improvements in limb size and skin appearance will be valuable for propaganda and education. The modified DLQI mean score reduced significantly from 4.6 to 2.0, (P<0.01) in DFU group, whereas MFU group was very close to the significant level (P=0.07). Benefit score at one year revealed that the patients in DFU group received significantly higher benefits compared to MFU group. Conclusion: Daily instruction has significantly motivated the patient and his/her family bringing a new hope.