Physical, psychological, and social aspects of quality of life in filarial lymphedema patients in Colombo, Sri Lanka

The Impact of the COVID-19 Pandemic on People With Lymphedema in an Endemic Area for Lymphatic Filariasis in Brazil

Objectives: To investigate the repercussions of the COVID-19 pandemic on lymphedema patients from an endemic area of lymphatic filariasis. Methods: The study descriptive compared sociodemographic and clinical aspects, risk of falling and quality of life, prior and during the COVID-19 pandemic in 28 lymphedema patients, older than 18 years old and under investigation of filarial infection. For the evaluation of functional mobility, the Time Up and Go test and The Medical Outcome Study Short Form-36 Health for quality of life, was used. Results: An increase in interdigital and dermal lesions, a higher frequency of acute dermatolymphangioadenitis crises and risk of falling, worsening of quality of life in the domains of physical functioning, general health, vitality, and mental health during the pandemic was observed. Conclusion: Our findings of clinical worsening and quality of life of patients during the COVID-19 pandemic indicate the need to reinforce the goal of the Lymphatic Filariasis Program regarding the follow-up of these patients in the actions of the Global Program for the Elimination of Lymphatic Filariasis, due to the discontinuity in the care during the pandemic.

Health-related quality of life and associated factors among adult podoconiosis patients in Debre Elias district Northwest, Ethiopia

Background

Podoconiosis is endemic non-filarial elephantiasis and non-infective neglected tropical disease. It has a wide impact on the physical, social and psychological aspects of the well-being of a person. However, limited information is available about the disease burden on health-related quality of life and associated factors in Ethiopia.

Objective

This study aimed is to determine health-related quality of life and associated factors among adult podoconiosis patients in Debre Elias district, Northwest, Ethiopia.

Methods

A community-based cross-sectional study was conducted from February 1 to March 30, 2020 in the Debre Elias district. A multi-stage stratified; systematic random sampling technique was employed to select 403 podoconiosis patients. The data were collected through an interviewer-administered questionnaire. Data were entered into Epi data version 4.6 and exported to STATA version 14 for analysis. After the assumption check for the linear regression model, simple and multiple regression was done to see the association between the predictor and outcome variables. Predictor variables that had p-value <0.2 at simple linear regression were taken into multiple linear regression. β coefficient with 95% CI and p-value of <0.05 was considered as statistically significant variables in multiple linear regression analysis.

Result

The overall mean quality of life score among podoconiosis patients was 61.93±17.14. The mean quality of life score for the physical, psychological, social, and environmental domains were 75.57±21.86, 60.43±18.58, 30.34±10.46, and 81.38±22.77 respectively. Foot care had a statically significant association with all domains. Higher quality of life podoconiosis patients was associated with foot care. Lower quality of life was associated with the presence of anxiety, advanced stage of the disease, and frequent adenolymphangitis attack.

Conclusion

Social and psychological domains of quality of life were lowest as compared to physical and environmental domains of quality of life. Early medical treatment, psychosocial support, and home-based foot care should be encouraged to improve the quality of life in podoconiosis patients.

Podoconiosis: is a disease that affects the lymph vessels of the lower extremities and is caused by a person’s foot exposed to minerals found in red clay soil. Podoconiosis has been identified in 32 countries and globally 4 million people are affected with this disease. The disease is characterized by prominent swelling) of the lower extremities, it can be prevented through keeping good foot hygiene, wearing clean socks and shoes daily and covering floor in the home to avoid contact with irritant soil. Patients with podoconiosis significantly challenged by physical disability, poor mental health and social discrimination. This study identified quality of life and associated factors among adult podoconiosis patients in Debre Elias district Northwest, Ethiopia. Specifically, we addressed quality of life score for physical, psychological, social and environmental domain. We found from this study foot care had statically significant association with all domains. Lower quality of life was associated with presence of anxiety, advanced stage of the disease and frequent adenolymphangitis attack. Social and psychological domains of quality of life were lowest as compared to physical and environmental domains of quality of life. Therefore, this study encouraged early medical treatment, home-based foot care and psychosocial support to improve quality of life in podoconiosis patient.

The aetiological relationship between depressive symptoms and health-related quality of life: A population-based twin study in Sri Lanka

Objective

Depression often co-occurs with poor health-related quality of life (HRQL). Twin studies report genetic and individual-level environmental underpinnings in the aetiology of both depression and HRQL, but there is limited twin research exploring this association further. There is also little evidence on sex differences and non-Western populations are underrepresented. In this paper we explored the phenotypic and aetiological relationship between depressive symptoms and HRQL and possible sex differences in a low-middle-income Sri Lankan population.

Method

Data for 3,948 participants came from the Colombo Twin and Singleton Follow-up Study (CoTaSS-2). Using self-report measures of depressive symptoms and HRQL, we conducted univariate and bivariate sex-limitation twin analyses.

Results

Depressive symptoms showed moderate genetic (33%) and strong nonshared environmental influences (67%). Nonshared environment accounted for the majority of variance in all the subscales of HRQL (ranging from 68 to 93%), alongside small genetic influences (ranging from 0 to 23%) and shared environmental influences (ranging from 0 to 28%). Genetic influences were significant for emotional wellbeing (23%). Shared environmental influences were significant for four out of the eight HRQL variables (ranging from 22–28%), and they were more prominent in females than males. Depressive symptoms were significantly associated with lower HRQL scores. These correlations were mostly explained by overlapping nonshared environmental effects. For traits related to emotional functioning, we also detected substantial overlapping genetic influences with depressive symptoms.

Conclusions

Our study confirmed previous findings of a negative association between depressive symptoms and HRQL. However, some of the aetiological factors of HRQL differed from Western studies, particularly regarding the effects of shared environment. Our findings highlight the importance of cross-cultural research in understanding associations between psychological wellbeing and HRQL.

A qualitative study on the implementation of a holistic care package for control and management of lymphoedema: experience from a pilot intervention in northern Ethiopia

Background

Neglected Tropical Diseases (NTDs) such as podoconiosis, lymphatic filariasis (LF) and leprosy mainly affect communities in low resource settings. These diseases are associated with physical disability due to lymphoedema as well as poor mental health and psychosocial outcomes. Integration of care across these NTDs at primary health care level, which includes mental health and psychosocial care alongside physical health care, is increasingly recommended.

Methods

A holistic integrated care package was developed and piloted as part of the EnDPoINT project in Gusha district, Awi zone, Ethiopia. The intervention was conducted at the health care organization, health facility and community levels. To assess the impact of the care package in terms of acceptability, scalability, sustainability and barriers to implementation, a qualitative study was conducted in January 2020. This included four focus group discussions (29 participants) and ten key informant interviews with decision makers, health professionals, patients, and community representatives.

Results

The integrated lymphoedema care package was found to be efficient compared to vertical programs in saving time and resources. It also resulted in improved awareness of the causes, treatment and prevention of lymphoedema, in marked improvements in the lymphoedema, and in reduced stigma and discrimination. The care package was found to be acceptable to patients, health professionals and decision makers. The barriers to integrated care were unrealistic patient expectations, inadequate dissemination across health workers, and poor transportation access. Health professionals, decision makers and patients believed the integrated lymphoedema care package to be scalable and sustainable.

Conclusion

The integrated holistic care package was found to be acceptable to patients, health professionals and decision makers. We recommend its scale-up to other endemic districts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07088-7.

The impact of podoconiosis, lymphatic filariasis, and leprosy on disability and mental well-being: A systematic review

Leprosy, podoconiosis, and lymphatic filariasis (LF) are among the priority neglected tropical diseases (NTDs) in Ethiopia. The disability, psychosocial, and mental health status of people affected by these NTDs are still overlooked in global NTD discourse. The objective of this systematic review was to synthesize the existing evidence describing the disability, psychosocial, and mental health status of people affected by leprosy, podoconiosis, and LF prior to developing a holistic physical and psychosocial care package for these individuals. We searched papers reporting on disability, psychosocial, and mental health status linked to these 3 NTDs. The protocol was registered in PROSPERO with registration number CRD42019128400. Peer-reviewed articles were searched and extracted from Medline, PsycINFO, Global Health, and Embase. Articles published in English, irrespective of the year of publication, using a quantitative study methodology, were included. Abstracts and full texts were reviewed by 2 reviewers. Data were extracted and narratively summarized, as the studies were heterogeneous and used different outcome measures. Out of 1,318 titles/abstracts screened and 59 full text studies reviewed, 24 fulfilled the inclusion criteria. Fourteen studies provided evidence of the disability associated with leprosy, podoconiosis, or LF. Ten studies provided evidence on the association between the 3 NTDs and mental health or psychosocial outcomes. The prevalence of grade 2 disability varied from 3.9% to 86%. The most commonly reported mental health impacts were depression and mental distress. A high burden of mental illness was reported, varying from 12.6% to 71.7%; the suicidal ideation was also high (18.5%). In conclusion, disability and poor psychosocial and mental health status are associated with leprosy, podoconiosis, and LF. For optimum management of these NTDs, holistic care including both physical and psychosocial interventions is vital.

Podoconiosis, lymphatic filariasis (LF), and leprosy are neglected tropical diseases (NTDs) that are commonly found among disadvantaged rural and some poor urban communities. These diseases lead to disabilities of the leg, which may result in reduced productivity. The longer the duration of the disease, the more severe the disability. People affected by these diseases also commonly experience stigma and discrimination, which, in turn, affect health-seeking behavior. Due to this disability, stigma, and discrimination, people affected by these 3 NTDs have a poor quality of life. We also found a range of mental health problems related to these 3 NTDs. Among these, the most common were mental distress and depression. As all 3 NTDs are associated with poor physical, psychosocial, and mental health outcomes, management should be holistic, incorporating physical, psychosocial, and mental health interventions. Following this review, we are working on the development of a holistic integrated care package for people affected by leprosy, podoconiosis, and LF in northwestern Ethiopia.

The Effect of Lymphoedema Exercises and Foot Elevation on the Quality of Life of Patients with Elephantiasis

Filariasis is a chronic infectious disease caused by filarial worms. Swelling in the legs in patients with filariasis can result in a significantly lower quality of life. The recommended treatments for patients who experience swelling or lymphoedema are lymphoedema exercises and foot elevation. This research is a quantitative study with a quasi-experimental design including pre- and posttreatment tests with a control group. This study used a cluster sampling method, which is a nonprobability sampling technique. The samples in this study were 48 respondents divided into two groups: 24 respondents from the Nebe Village comprising the intervention group and 24 respondents from the Bangkoor Village comprising the control group. The intervention group conducted lymphoedema exercises and foot elevation three times a week for 15–20 min for 1 month and measured their quality of life using the LFSQQ questionnaire. Measurements of pitting edema and ankle diameter were also carried out. Paired t-test revealed an improvement in the quality of life between pretest and posttest in the intervention and control groups (p=0.001). The quality of life in the pre-post intervention group improved from 67.42 to 81.58. In addition, the quality of life in the pre-post control group only improved from 62.50 to 72.58. The level of pitting edema decreased from severe (+++) to moderate (++) and from mild (+) to normal (0), and there was no difference in ankle diameter in each group (p=1.000). The quality of life improved before and after the administration of lymphoedema exercises and foot elevation for each group. Pitting edema decreased before and after lymphoedema exercises and foot elevation for each group. There was no decrease in ankle diameter after lymphoedema exercises and foot elevation in the intervention and control groups.

Application of the Lower Extremity Functional Scale and Its Correlation with Lymphedema Health-Related Quality of Life on Lower Limb Filarial Lymphedema Patients

Introduction: This study carried out as a part of the lymphedema (LE)—osteoarthritis project to know the feasibility and applicability of lower extremity functional scale (LEFS) and LE health-related quality of life (LEHRQoL) among filarial LE patients of the lower extremity.

Materials and Methods: Following inclusion and exclusion criteria 30 LE patients and 30 controls were recruited in the study. After obtaining informed written consent, Tamil version of the two “self-reporting assessment tools” LEFS and LEHRQoL were applied to all the participants by two examiners independently. Feasibility was assessed by the time schedule. Internal consistency and the correlation between two examiners was assessed by calculating Cronbach's alpha and Karl Pearson correlation coefficient and Spearman rank correlation respectively.

Results: The mean time taken for completing the LEFS and LEHRQoL questionnaire was 5 minutes and 2 seconds and 12 minutes and 8 seconds respectively. Internal consistency reliability assessment showed good internal consistency for both the examiners (Cronbach's alpha 0.816 and 0.812). There was a strong positive correlation for the cases (r = 0.956, p < 0.001; r = 0.908, p < 0.001) and controls (r = 0.992, p < 0.001; r = 0.985, p < 0.001) between the two examiners.

Conclusions: LEFS and LEHRQoL were well accepted among filarial LE patients and the patients with low literacy were able to respond without any difficulty to both assessment tools. LEFS was found suitable for the assessment of lower extremity functions of the LE patients as in other diseases affecting the lower limb and it also indirectly brought out the impact on the QoL.

Assessment of quality of life using WHOQOL-BREF in patients with visceral leishmaniasis

BACKGROUND

This study was aimed to assess the impact of quality of life using WHOQOL-BREF in patients with Visceral leishmaniasis (VL).

METHODS

A total of 95 VL cases and 95 healthy participants filled out the questionnaires. Data on socio-demographic aspects along with disease duration were collected. Data were compared using a t-test, analysis of variance and chi-square test.

RESULTS

VL patients experienced very high impact on their quality of life. Study cohort had male preponderance (72.63%). Majority (64.21%) were aged < 40 years. Longer disease duration was found to have significantly poor quality of life (p < 0.05). The physical domain was found to be most affected domains of quality of life (QOL). QOL was affected most in illiterate, married, housewife, rural population and patients with longer disease duration (p < 0.05). The psychological and environmental domains were significantly affected in > 40 years of age group married patients (p < 0.05).

CONCLUSIONS

VL significantly impaired the patients' (QOL) in all four domains (physical, psychological, social relationship and environmental). Physical domain was significantly the most affected domain.

Lymphatic Filariasis

Lymphatic filariasis (LF) is a parasitic infection that is spread by mosquitos infected with worm larvae. Several factors will affect the global prevalence of LF in the future. A growing body of evidence suggests that climate change will influence the spread of parasitic diseases and their vectors. Lymphatic filariasis is the leading cause of permanent disfigurement and the second most common cause of long-term disability in the world.

Morbidity management and disability prevention for lymphatic filariasis in Sri Lanka: Current status and future prospects

Background

Sri Lanka was acknowledged to have eliminated lymphatic filariasis (LF) as a public health problem in 2016, largely due to its success in Mass Drug Administration (MDA) to interrupt disease transmission. Analysis of the Strengths, Weaknesses, Opportunities and Threats (SWOT) of the national Morbidity Management and Disability Prevention (MMDP) program, the other pillar of the LF control program, was carried out with the objective of evaluating it and providing recommendations to optimize the use of available resources.

Methodology

A situation analysis of the MMDP activities provided by the state health sector was carried out using published records, in-depth interviews with key informants of the Anti Filariasis Campaign, site-visits to filariasis clinics with informal discussions with clinic workforce and personal communications to identify strengths and weaknesses; and opportunities to overcome weaknesses and perceived threats to the program were explored.

The principal strength of the MMDP program was the filariasis clinics operational in most endemic districts of Sri Lanka, providing free health care and health education to clinic attendees. The weaknesses identified were the low accessibility of clinics, incomplete coverage of the endemic region and lack of facilities for rehabilitation. The perceived threats were diversion of staff and resources for control of other vector-borne infections, under-utilization of clinics and non-compliance with recommended treatment. Enhanced high level commitment for MMDP, wider publicity and referral systems, integration of MMDP with other disease management services and collaboration with welfare organizations and research groups were identified as opportunities to overcome weaknesses and challenges.

Conclusions

The recommended basic package of MMDP was functional in most of the LF-endemic region. The highlighted weaknesses and challenges, unless addressed, may threaten program sustainability. The identified opportunities for improvement of the programme could ensure better attainment of the goal of the MMDP program, namely access to basic care for all affected by lymphatic filarial disease.

Lymphatic filariasis (LF) is a tropical disease causing swelling of limbs (lymphoedema, elephantiasis) and male genitalia (hydrocele). It is a disabling and deforming disease caused by parasitic worms transmitted by mosquitoes. The Sri Lankan Anti Filariasis Campaign was successful in reducing LF transmission to very low levels by annual mass drug administration, resulting in recent achievement of elimination status. The other pillar of LF elimination is the management of morbidity and disability prevention (MMDP) among those with lymphatic filarial disease. The strengths, weaknesses and threats of the MMDP program were evaluated and opportunities for improvement were explored in June 2017. The filariasis clinics established in the endemic area, providing care for patients with lymphoedema and elephantiasis, were identified as the main strength. Hospital surgical units were important in the treatment of hydrocele. The weaknesses were low accessibility of clinics, incomplete coverage of endemic districts, lack of facilities for rehabilitation and lack of morbidity targets. The threats were diversion of staff and resources, under-utilization of clinics, social stigma and loss of alliances. Enhanced commitment to improve coverage and access to clinics in the endemic areas, wider publicity, referral systems, integration of MMDP into other disease management services, collaborations with welfare organizations and research groups were the opportunities identified.