| dc.description.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. | en_US |
