Effectiveness of a Simple Lymphoedema Treatment Regimen in Podoconiosis Management in Southern Ethiopia: One Year Follow-Up

Abstract

BackgroundPodoconiosis is a non-filarial elephantiasis caused by long-term barefoot exposure to volcanic soils in endemic areas. Irritant silicate particles penetrate the skin, causing a progressive, debilitating lymphoedema of the lower leg, often starting in the second decade of life. A simple patient-led treatment approach appropriate for resource poor settings has been developed, comprising (1) education on aetiology and prevention of podoconiosis, (2) foot hygiene (daily washing with soap, water and an antiseptic), (3) the regular use of emollient, (4) elevation of the limb at night, and (5) emphasis on the consistent use of shoes and socks.Methodology/Principal FindingsWe did a 12-month, non-comparative, longitudinal evaluation of 33 patients newly presenting to one clinic site of a non-government organization (the Mossy Foot Treatment & Prevention Association, MFTPA) in southern Ethiopia. Outcome measures used for the monitoring of disease progress were (1) the clinical staging system for podoconiosis, and (2) the Amharic Dermatology Life Quality Index (DLQI), both of which have been recently validated for use in this setting. Digital photographs were also taken at each visit. Twenty-seven patients completed follow up. Characteristics of patients completing follow-up were not significantly different to those not. Mean clinical stage and lower leg circumference decreased significantly (mean difference -0.67 (95% CI −0.38 to −0.96) and −2.00 (95% CI −1.26 to −2.74), respectively, p<0.001 for both changes). Mean DLQI diminished from 21 (out of a maximum of 30) to 6 (p<0.001). There was a non-significant change in proportion of patients with mossy lesions (p = 0.375).Conclusions/SignificanceThis simple, resource-appropriate regimen has a considerable impact both on clinical progression and self-reported quality of life of affected individuals. The regimen appears ideal for scaling up to other endemic regions in Ethiopia and internationally. We recommend that further research in the area include analysis of cost-effectiveness of the regimen.

The Association of Beliefs About Heredity with Preventive and Interpersonal Behaviors in Communities Affected by Podoconiosis in Rural Ethiopia

“…37 Treatment of affected individuals comprises foot hygiene, bandaging where indicated, use of socks and shoes, exercises to improve lymph flow, and elevation of the legs while sleeping, and treatment seems effective in improving clinical outcomes and quality of life. 38 Accordingly, the MFTPA orally delivered health education curriculum emphasizes the importance of wearing shoes and properly cleaning feet each day. The curriculum has not included any emphasis on improving understanding of the causes of the condition.…”

Factors Associated with Lymphoedema Management Success Among Podoconiosis Patients in Wolaita Zone, Southern Ethiopia

“…In addition, patients who had positive attitude towards podoconiosis management were six times more likely to show success in treatment outcome of lymphoedema management, AOR= 5.64 (3.18, 9.99). In one year follow-up study done by Sikorski et al (2014) to see the effectiveness of a simple lymphoedema treatment regimen in podoconiosis management in Wolaita Zone, Southern Ethiopia, it was observed that patients' self commitment was an important condition to see clinical outcomes of lymphoedema treatment in podoconiosis management [17].…”

“…The questionnaire was designed to include questions about socio-demographic characteristics, clinical history, and treatment seeking behavior, shoe wearing habits and personal hygiene practices, treatment duration and outcome, and perception Among Podoconiosis Patients in Wolaita Zone, Southern Ethiopia of the subjects after treatment. Lymphoedema management success was then determined based on self reported response and observation [17].…”

“…Whitfield's ointment), elevation of the limb at night, and emphasis on the importance of consistent use of shoes and socks. In addition, educational and social support messages on prevention and treatment of the disease are given, and social and spiritual support are offered [14][15][16][17]. The success rate of lymphoedema management can be evaluated by assessing the presence or absence of posttreatment outcomes (benefits) [16,17].…”

“…In addition, educational and social support messages on prevention and treatment of the disease are given, and social and spiritual support are offered [14][15][16][17]. The success rate of lymphoedema management can be evaluated by assessing the presence or absence of posttreatment outcomes (benefits) [16,17]. These are: decrement of bad odor of leg, reduction of foot swelling, subsidence of pain, disappearance of entry lesions, reduction in frequency of acute attack, improvement in selfconfidence, being hopeful for his/her future life, and returning back to his/her regular work/school [16].…”