Impact of two follow-up schemes on morbidity management and disability prevention (MMDP) programme for filarial lymphedema in Matara, Sri Lanka

• Published in: Parasitology international 2018-04, Vol.67 (2), p.176-183
• Main Authors: Yahathugoda, Thishan C., Weerasooriya, Mirani V., Samarawickrema, Wilfred A., Kimura, Eisaku, Itoh, Makoto
• Format: Article
• Language: English
• Subjects: ADL; Assessment of physical & psychological improvement; Disabled Persons - education; Disabled Persons - psychology; Disease Management; Elephantiasis, Filarial - complications; Elephantiasis, Filarial - epidemiology; Elephantiasis, Filarial - parasitology; Elephantiasis, Filarial - physiopathology; ELs; Follow-Up Studies; Humans; Lymphatic filariasis; Middle Aged; Morbidity; Morbidity management; Programmatic issues; Quality of Life; Sri Lanka - epidemiology
• ISSN: 1383-5769; 1873-0329
• DOI: 10.1016/j.parint.2017.11.005

Alleviating morbidity due to lymphatic filariasis (LF)—especially in elderly patients who are rather ignorant—is presently the biggest challenge for the national filariasis campaign. We introduced two follow-up schemes and compared each other to address three key programmatic issues (1) locating patients, (2) educating patients, family members on practice of lymphoedema self-care (3) well sustained daily self-care. Hundred and seven lymphoedema patients were introduced to the new Community Home Based Care (CHBC) programme as a part of MMDP programme at their homes. Twenty seven of 107 patients were selected by purposive sampling and followed-up under two schemes, 14 in Daily follow-up (DFU) scheme and 13 in Monthly follow-up (MFU) scheme. Impact was assessed using a KAP score, number of entry lesions (EL) and number of ADL episodes, limb volume, its appearance, changes in the quality of life and gained benefits. Visiting patients in their homes to introduce lymphoedema care programme was a success. KAP scores of the more important activities on lymphoedema care were significantly higher in DFU scheme. Number of patients (51.9%; 14/27) who had EL/s at baseline reduced significantly to 18.5% (5/27) at one year follow-up. The mean numbers of ADL episodes/year reduced significantly in both schemes. Six photographs of 27 showed obvious improvement in lymphoedema and its grade. Mean volume of lymphoedema reduced significantly in both schemes at one year no significant difference between schemes. Benefit score at one year revealed that the patients in DFU scheme received significantly higher amount of benefits compared to MFU scheme. In conclusion daily instruction has significantly motivated the patient and his/her family bringing a new hope. [Display omitted] •A significant alleviation of AIEs and EL was observed in both Daily Follow-up (DFU) and Monthly Follow-up (MFU) schemes.•DFU scheme was better since it provided significantly higher knowledge on lymphoedema management, higher benefit score, significant reduction of limb volume, and significant improvement in QoL compared to MFU scheme.•Monitoring patients on daily basis is difficult at national level, however identifying a reasonable caretaker from the community to do daily touch & talk or sending Public Health Field Officers to patients' homes at least once a month is possible.