A Longitudinal Analysis of the Effect of Mass Drug Administration on Acute Inflammatory Episodes and Disease Progression in Lymphedema Patients in Léogane, Haiti

Eddy, Brittany A.; Blackstock, Anna J.; Williamson, John; Addiss, David G.; Streit, Thomas G.; Rochars, Valery Madsen Beau De; Fox, LeAnne M.

doi:10.4269/ajtmh.13-0317

Cited by 4 publications

(3 citation statements)

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“…FR-LE studies which provided frequent monitoring and support were associated with greater improvements than studies which offered minimal or no support services. The study by Suma, Shenoy [ 55 ] which retrospectively reviewed participants in a previous drug based RCT indicated that without monitoring, program effectiveness is lost over time, an effect also found in a later follow up of the study by Addiss, Louis-Charles [ 36 ] which could not be included in this review [ 61 ]. Ultimately, the long term success of any self-care intervention will depend on individual ownership of and adherence to the daily self-care practices and the level of family or local support available.…”

Section: Discussionmentioning

confidence: 99%

Self-Care for Management of Secondary Lymphedema: A Systematic Review

2016

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BackgroundLymphedema is a debilitating and disfiguring sequela of an overwhelmed lymphatic system. The most common causes of secondary lymphedema are lymphatic filariasis (LF), a vector-borne, parasitic disease endemic in 73 tropical countries, and treatment for cancer in developed countries. Lymphedema is incurable and requires life-long care so identification of effective lymphedema management is imperative to improve quality of life, reduce the burden on family resources and benefit the local community. This review was conducted to evaluate the evidence for effective lymphedema self-care strategies that might be applicable to management of all types of secondary lymphedema.Methodology/Principal FindingsSearches were conducted in Medline, CINAHL and Scopus databases in March 2015. Included studies reported before and after measures of lymphedema status or frequency of acute infections. The methodological quality was assessed using the appropriate Critical Appraisal Skills Program checklist. Descriptive synthesis and meta-analysis were used to evaluate effectiveness of the outcomes reported. Twenty-eight papers were included; two RCTs were found to have strong methodology, and overall 57% of studies were rated as methodologically weak. Evidence from filariasis-related lymphedema (FR-LE) studies indicated that hygiene-centred self-care reduced the frequency and duration of acute episodes by 54%, and in cancer-related lymphedema (CR-LE) home-based exercise including deep breathing delivered significant volume reductions over standard self-care alone. Intensity of training in self-care practices and frequency of monitoring improved outcomes. Cultural and economic factors and access to health care services influenced the type of intervention delivered and how outcomes were measured.Conclusions/SignificanceThere is evidence to support the adoption of remedial exercises in the management of FR-LE and for a greater emphasis on self-treatment practices for people with CR-LE. Empowerment of people with lymphedema to care for themselves with access to supportive professional assistance has the capacity to optimise self-management practices and improve outcomes from limited health resources.

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Section: Discussionmentioning

confidence: 99%

Self-Care for Management of Secondary Lymphedema: A Systematic Review

2016

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“…Lastly, a number of incidents during field work suggested that some individuals with chronic morbidity in the later part of the study hid themselves to avoid examination, as previous examinations had not provided alleviation of their disease symptoms. Several cross-sectional follow-up studies in the past have suggested that DEC might have a positive effect on lymphedema and hydrocele, but cohort studies following individual patients over a period of time have not been able to confirm this [ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Lymphatic filariasis control in Tanga Region, Tanzania: status after eight rounds of mass drug administration

et al. 2014

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BackgroundLymphatic filariasis (LF) control started in Tanga Region of Tanzania in 2004, with annual ivermectin/albendazole mass drug administration (MDA). Since then, the current project has monitored the effect in communities and schools in rural areas of Tanga District. In 2013, after 8 rounds of MDA, spot check surveys were added in the other 7 districts of Tanga Region, to assess the regional LF status.MethodsLF vector and transmission surveillance, and human cross sectional surveys in communities and schools, continued in Tanga District as previously reported. In each of the other 7 districts, 2–3 spot check sites were selected and about 200 schoolchildren were examined for circulating filarial antigens (CFA). At 1–2 of the sites in each district, additional about 200 community volunteers were examined for CFA and chronic LF disease, and the CFA positives were re-examined for microfilariae (mf).ResultsThe downward trend in LF transmission and human infection previously reported for Tanga District continued, with prevalences after MDA 8 reaching 15.5% and 3.5% for CFA and mf in communities (decrease by 75.5% and 89.6% from baseline) and 2.3% for CFA in schoolchildren (decrease by 90.9% from baseline). Surprisingly, the prevalence of chronic LF morbidity after MDA 8 was less than half of baseline records. No infective vector mosquitoes were detected after MDA 7. Spot checks in the other districts after MDA 8 showed relatively high LF burdens in the coastal districts. LF burdens gradually decreased when moving to districts further inland and with higher altitudes.ConclusionLF was still widespread in many parts of Tanga Region after MDA 8, in particular in the coastal areas. This calls for intensified control, which should include increased MDA treatment coverage, strengthening of bed net usage, and more male focus in LF health information dissemination. The low LF burdens observed in some inland districts suggest that MDA in these could be stepped down to provide more resources for upscale of control in the coastal areas. Monitoring should continue to guide the programme to ensure that the current major achievements will ultimately lead to successful LF elimination.

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“…Acute adenolymphangitis, or acute dermatolymphangioadenitis (ADLA), known commonly as ‘acute attacks’, is the term used to describe recurrent inflammatory episodes in lymphoedema [17]. ADLA is most likely triggered by skin lesions acting as entry points for bacteria, fungi or viruses, although often no clear cause is identified [18,19]. Episodes are typically characterized by hot, painful and reddened swelling of the leg, chills, malaise, anorexia and sometimes lower leg skin peeling, and are one of the most serious complications of podoconiosis; resulting in worsening disability [8, 20].…”

Section: Introductionmentioning

confidence: 99%

The impact of acute adenolymphangitis in podoconiosis on caregivers: A case study in Wayu Tuka woreda, Oromia, Western Ethiopia. ‘If she was healthy, I would be free.’

et al. 2019

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Background Podoconiosis, also known as mossy foot or endemic non-filarial elephantiasis, is a preventable form of lower-leg lymphoedema caused by prolonged (typically barefoot) exposure to soil derived from volcanic rocks. Acute adenolymphangitis (also called ‘acute attack’) is a serious complication of podoconiosis resulting in significant symptoms and worsening disability. Despite the well-known morbidity associated with podoconiosis, to date there have been no studies looking at the impact, or burden, of podoconiosis on caregivers. This study explored the experiences and impact of acute attacks on the caregivers of those with podoconiosis in one endemic district of Ethiopia. Methods/Principal findings This qualitative study was based in Wayu Tuka woreda (district), Oromia, Western Ethiopia. 27 semi-structured interviews of those with podoconiosis and their caregivers were conducted in June 2018. Here we report the findings from the caregiver’s interviews. Data were analysed using NVivo 12. Directed content analysis, a qualitative approach related to thematic analysis, was used to analyse the results. This study highlights a previously unreported impact of acute attacks on the caregivers of those affected by podoconiosis. The findings demonstrate the significant social and financial pressures placed on podoconiosis-affected families which are exacerbated during acute attacks. This study also highlighted the emotional burden experienced by caregivers, the range of care activities placed on them and the limited support available. Conclusions This study found a significant impact on the caregivers of those with podoconiosis, especially during acute attacks, in Wayu Tuka woreda . It also highlighted the limited support available to caregivers. Further research is needed to understand whether this impact applies to podoconiosis caregivers across Ethiopia, and beyond, and to establish if there are wider implications of this important consequence of podoconiosis, for example on the economy and caregivers’ mental and physical health.

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A Longitudinal Analysis of the Effect of Mass Drug Administration on Acute Inflammatory Episodes and Disease Progression in Lymphedema Patients in Léogane, Haiti

Cited by 4 publications

References 47 publications

Self-Care for Management of Secondary Lymphedema: A Systematic Review

Self-Care for Management of Secondary Lymphedema: A Systematic Review

Lymphatic filariasis control in Tanga Region, Tanzania: status after eight rounds of mass drug administration

The impact of acute adenolymphangitis in podoconiosis on caregivers: A case study in Wayu Tuka woreda, Oromia, Western Ethiopia. ‘If she was healthy, I would be free.’

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