Management of patients with lymphoedema caused by filariasis in north-eastern Tanzania

TY - JOUR

T1 - Management of patients with lymphoedema caused by filariasis in north-eastern Tanzania

AU - Bernhard, Lise

AU - Bernhard, Peter

AU - Magnussen, Pascal

PY - 2003/1/1

Y1 - 2003/1/1

N2 - Background. Lymphatic filariasis is a widely distributed tropical disease with around 120 million people infected worldwide. It is caused by the organism Wuchereria bancrofti, a worm that lives in and causes malfunction of the human lymphatic system and is transmitted by mosquitoes in warm and humid climates. Most infected individuals have no symptoms, but some 44 million people have lymphoedema of the upper or lower limb, breast, scrotum or genitals, or hydrocele, the latter being the most common chronic manifestation. In most countries, there is no available treatment for chronic lymphoedema. Methods. In the north-eastern part of Tanzania a lymphoedema clinic was established. A subset of patients received either complex decongestive physiotherapy carried out either by a physiotherapist or by the patients themselves under supervision of the physiotherapist. Forty-six patients (with 59 lymphoedematous legs) were treated and followed for nine months. All patients were instructed in hygiene, elevation and exercises for the affected limb. Results. Both groups had significant reduction in leg volumes (P < 0.05) after treatment. The median reduction after three weeks of intensive treatment was 0.45 litres for the group treated by the physiotherapist and 0.85 litres for the group who treated themselves. The latter group sustained a greater reduction having lost a median of 0.32 litres after nine months of follow-up, compared to a median of 0.18 litres in the group treated only by the physiotherapist. The difference between the two groups was significant after three, six and nine months (P < 0.05). Conclusion. Giving more responsibility to patients in the handling of lymph drainage and bandaging resulted in a greater sustained reduction in leg volume than in the group where the patients were not taught to do the treatment themselves. Following initial treatment, adherence to the programme and follow-up was limited by the impracticality of the compressive stockings and their tendency to deteriorate rapidly due to harsh environments.

AB - Background. Lymphatic filariasis is a widely distributed tropical disease with around 120 million people infected worldwide. It is caused by the organism Wuchereria bancrofti, a worm that lives in and causes malfunction of the human lymphatic system and is transmitted by mosquitoes in warm and humid climates. Most infected individuals have no symptoms, but some 44 million people have lymphoedema of the upper or lower limb, breast, scrotum or genitals, or hydrocele, the latter being the most common chronic manifestation. In most countries, there is no available treatment for chronic lymphoedema. Methods. In the north-eastern part of Tanzania a lymphoedema clinic was established. A subset of patients received either complex decongestive physiotherapy carried out either by a physiotherapist or by the patients themselves under supervision of the physiotherapist. Forty-six patients (with 59 lymphoedematous legs) were treated and followed for nine months. All patients were instructed in hygiene, elevation and exercises for the affected limb. Results. Both groups had significant reduction in leg volumes (P < 0.05) after treatment. The median reduction after three weeks of intensive treatment was 0.45 litres for the group treated by the physiotherapist and 0.85 litres for the group who treated themselves. The latter group sustained a greater reduction having lost a median of 0.32 litres after nine months of follow-up, compared to a median of 0.18 litres in the group treated only by the physiotherapist. The difference between the two groups was significant after three, six and nine months (P < 0.05). Conclusion. Giving more responsibility to patients in the handling of lymph drainage and bandaging resulted in a greater sustained reduction in leg volume than in the group where the patients were not taught to do the treatment themselves. Following initial treatment, adherence to the programme and follow-up was limited by the impracticality of the compressive stockings and their tendency to deteriorate rapidly due to harsh environments.

KW - Bandaging

KW - Complex decongestive physiotherapy

KW - Elephantiasis

KW - Filariasis

KW - Lymphoedema

UR - http://www.scopus.com/inward/record.url?scp=4444284470&partnerID=8YFLogxK

U2 - 10.1016/S0031-9406(05)60500-7

DO - 10.1016/S0031-9406(05)60500-7

M3 - Journal article

AN - SCOPUS:4444284470

SN - 0031-9406

VL - 89

SP - 743

EP - 749

JO - Physiotherapy

JF - Physiotherapy

IS - 12

ER -