Effectiveness of a Simple Lymphoedema Treatment Regimen in Podoconiosis Management in Southern Ethiopia: One Year Follow-Up
Identifieur interne : 003444 ( Pmc/Checkpoint ); précédent : 003443; suivant : 003445Effectiveness of a Simple Lymphoedema Treatment Regimen in Podoconiosis Management in Southern Ethiopia: One Year Follow-Up
Auteurs : Catherine Sikorski [Royaume-Uni] ; Meskele Ashine [Éthiopie] ; Zewdie Zeleke [Éthiopie] ; Gail Davey [Éthiopie]Source :
- PLoS Neglected Tropical Diseases [ 1935-2727 ] ; 2010.
Abstract
Podoconiosis 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.
We 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).
This 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.
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DOI: 10.1371/journal.pntd.0000902
PubMed: 21152059
PubMed Central: 2994920
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id="aff2"><addr-line>Mossy Foot Treatment and Prevention Association, Wolaita Sodo, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>Mossy Foot Treatment and Prevention Association, Wolaita Sodo</wicri:regionArea><wicri:noRegion>Wolaita Sodo</wicri:noRegion></affiliation></author><author><name sortKey="Zeleke, Zewdie" sort="Zeleke, Zewdie" uniqKey="Zeleke Z" first="Zewdie" last="Zeleke">Zewdie Zeleke</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Mossy Foot Treatment and Prevention Association, Wolaita Sodo, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>Mossy Foot Treatment and Prevention Association, Wolaita Sodo</wicri:regionArea><wicri:noRegion>Wolaita Sodo</wicri:noRegion></affiliation></author><author><name sortKey="Davey, Gail" sort="Davey, Gail" uniqKey="Davey G" first="Gail" last="Davey">Gail Davey</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>School of Public 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wicri:step="Checkpoint">003444</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Effectiveness of a Simple Lymphoedema Treatment Regimen in Podoconiosis Management in Southern Ethiopia: One Year Follow-Up</title><author><name sortKey="Sikorski, Catherine" sort="Sikorski, Catherine" uniqKey="Sikorski C" first="Catherine" last="Sikorski">Catherine Sikorski</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>University College London Medical School, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>University College London Medical School, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Ashine, Meskele" sort="Ashine, Meskele" uniqKey="Ashine M" first="Meskele" last="Ashine">Meskele Ashine</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Mossy Foot Treatment and Prevention Association, Wolaita Sodo, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>Mossy Foot Treatment and Prevention Association, Wolaita Sodo</wicri:regionArea><wicri:noRegion>Wolaita Sodo</wicri:noRegion></affiliation></author><author><name sortKey="Zeleke, Zewdie" sort="Zeleke, Zewdie" uniqKey="Zeleke Z" first="Zewdie" last="Zeleke">Zewdie Zeleke</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Mossy Foot Treatment and Prevention Association, Wolaita Sodo, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>Mossy Foot Treatment and Prevention Association, Wolaita Sodo</wicri:regionArea><wicri:noRegion>Wolaita Sodo</wicri:noRegion></affiliation></author><author><name sortKey="Davey, Gail" sort="Davey, Gail" uniqKey="Davey G" first="Gail" last="Davey">Gail Davey</name><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia</addr-line></nlm:aff><country xml:lang="fr">Éthiopie</country><wicri:regionArea>School of Public Health, Addis Ababa University, Addis Ababa</wicri:regionArea><wicri:noRegion>Addis Ababa</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS Neglected Tropical Diseases</title><idno type="ISSN">1935-2727</idno><idno type="eISSN">1935-2735</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Podoconiosis 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.</p></sec><sec><title>Methodology/Principal Findings</title><p>We 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).</p></sec><sec><title>Conclusions/Significance</title><p>This 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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Price, Ew" uniqKey="Price E">EW Price</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Price, Ew" uniqKey="Price E">EW Price</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fuller, Lc" uniqKey="Fuller L">LC Fuller</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author><author><name sortKey="Tekola, F" uniqKey="Tekola F">F Tekola</name></author><author><name sortKey="Newport, Mj" uniqKey="Newport M">MJ Newport</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wilson, Sf" uniqKey="Wilson S">SF Wilson</name></author><author><name sortKey="Guarner, J" uniqKey="Guarner J">J Guarner</name></author><author><name sortKey="Valme, Al" uniqKey="Valme A">AL Valme</name></author><author><name sortKey="Louis Charles, J" uniqKey="Louis Charles J">J Louis-Charles</name></author><author><name sortKey="Jones, Tl" uniqKey="Jones T">TL Jones</name></author><author><name sortKey="Addiss, Dg" uniqKey="Addiss D">DG Addiss</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Destas, K" uniqKey="Destas K">K Destas</name></author><author><name sortKey="Ashine, M" uniqKey="Ashine M">M Ashine</name></author><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tekola, F" uniqKey="Tekola F">F Tekola</name></author><author><name sortKey="Hailemariam, D" uniqKey="Hailemariam D">D HaileMariam</name></author><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yakob, B" uniqKey="Yakob B">B Yakob</name></author><author><name sortKey="Deribe, K" uniqKey="Deribe K">K Deribe</name></author><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yakob, B" uniqKey="Yakob B">B Yakob</name></author><author><name sortKey="Deribe, K" uniqKey="Deribe K">K Deribe</name></author><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Addiss, Dg" uniqKey="Addiss D">DG Addiss</name></author><author><name sortKey="Brady, Ma" uniqKey="Brady M">MA Brady</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dreyer, G" uniqKey="Dreyer G">G Dreyer</name></author><author><name sortKey="Addiss, D" uniqKey="Addiss D">D Addiss</name></author><author><name sortKey="Dreyer, P" uniqKey="Dreyer P">P Dreyer</name></author><author><name sortKey="Noroes, J" uniqKey="Noroes J">J Noroes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mcpherson, T" uniqKey="Mcpherson T">T McPherson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author><author><name sortKey="Burridge, E" uniqKey="Burridge E">E Burridge</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Desta, K" uniqKey="Desta K">K Desta</name></author><author><name sortKey="Ashine, M" uniqKey="Ashine M">M Ashine</name></author><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tekola, F" uniqKey="Tekola F">F Tekola</name></author><author><name sortKey="Ayele, Z" uniqKey="Ayele Z">Z Ayele</name></author><author><name sortKey="Hailemariam, D" uniqKey="Hailemariam D">D HaileMariam</name></author><author><name sortKey="Fuller, Lc" uniqKey="Fuller L">LC Fuller</name></author><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Finlay, Ay" uniqKey="Finlay A">AY Finlay</name></author><author><name sortKey="Khan, Gk" uniqKey="Khan G">GK Khan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Henok, L" uniqKey="Henok L">L Henok</name></author><author><name sortKey="Davey, G" uniqKey="Davey G">G Davey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chandrasena, T" uniqKey="Chandrasena T">T Chandrasena</name></author><author><name sortKey="Premaratna, R" uniqKey="Premaratna R">R Premaratna</name></author><author><name sortKey="Muthugala, M" uniqKey="Muthugala M">M Muthugala</name></author><author><name sortKey="Pathmeswaran, A" uniqKey="Pathmeswaran A">A Pathmeswaran</name></author><author><name sortKey="De Silva, N" uniqKey="De Silva N">N de Silva</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Negl Trop Dis</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosntds</journal-id><journal-title-group><journal-title>PLoS Neglected Tropical Diseases</journal-title></journal-title-group><issn pub-type="ppub">1935-2727</issn><issn pub-type="epub">1935-2735</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21152059</article-id><article-id pub-id-type="pmc">2994920</article-id><article-id pub-id-type="publisher-id">10-PNTD-RA-0936R3</article-id><article-id pub-id-type="doi">10.1371/journal.pntd.0000902</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline"><subject>Evidence-Based Healthcare/Health Services Research and Economics</subject><subject>Public Health and Epidemiology/Health Services Research and Economics</subject></subj-group></article-categories><title-group><article-title>Effectiveness of a Simple Lymphoedema Treatment Regimen in Podoconiosis Management in Southern Ethiopia: One Year Follow-Up</article-title><alt-title alt-title-type="running-head">Effectiveness of a Podoconiosis Treatment Regimen</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Sikorski</surname><given-names>Catherine</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ashine</surname><given-names>Meskele</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Zeleke</surname><given-names>Zewdie</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Davey</surname><given-names>Gail</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>University College London Medical School, London, United Kingdom</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Mossy Foot Treatment and Prevention Association, Wolaita Sodo, Ethiopia</addr-line></aff><aff id="aff3"><label>3</label><addr-line>School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>McCarthy</surname><given-names>James S.</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1">Queensland Institute for Medical Research, Australia</aff><author-notes><corresp id="cor1">* E-mail: <email>gailinaddis@hotmail.com</email></corresp><fn fn-type="con"><p>Conceived and designed the experiments: MA GD. Performed the experiments: CS MA ZZ. Analyzed the data: CS GD. Contributed reagents/materials/analysis tools: MA ZZ. Wrote the paper: CS GD.</p></fn></author-notes><pub-date pub-type="collection"><month>11</month><year>2010</year></pub-date><pub-date pub-type="epub"><day>30</day><month>11</month><year>2010</year></pub-date><volume>4</volume><issue>11</issue><elocation-id>e902</elocation-id><history><date date-type="received"><day>26</day><month>2</month><year>2010</year></date><date date-type="accepted"><day>1</day><month>11</month><year>2010</year></date></history><permissions><copyright-statement>Sikorski et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</copyright-statement></permissions><abstract><sec><title>Background</title><p>Podoconiosis 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.</p></sec><sec><title>Methodology/Principal Findings</title><p>We 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).</p></sec><sec><title>Conclusions/Significance</title><p>This 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.</p></sec></abstract><abstract abstract-type="summary"><title>Author Summary</title><p>Podoconiosis is a type of leg swelling that occurs in the tropics among subsistence farmers who spend long hours in contact with irritant soil derived from volcanic parent rock. People with this disease often live in very remote areas far from health facilities, and do not realize that the condition can be treated. A patient association in southern Ethiopia has pioneered low cost treatment. We followed 27 patients with podoconiosis through their first year of treatment. The regimen emphasizes understanding the disease process and self-treatment through foot hygiene, elevation of the limb at night, use of emollients, socks and shoes. We made clinical observations, measured quality of life and took digital photographs at the start and after 12 months of self-treatment. Leg circumference decreased by an average of 2 cm, the stage of disease decreased (indicating improvement) by almost one full stage. Quality of life improved dramatically, with patients reporting levels of life quality equivalent to non-patients. Even in a very resource-scarce setting, we have shown that patients benefit physically and psychologically from understanding the disease and being shown how to look after their feet.</p></abstract><counts><page-count count="5"></page-count></counts></article-meta></front></pmc><affiliations><list><country><li>Royaume-Uni</li><li>Éthiopie</li></country><region><li>Angleterre</li><li>Grand Londres</li></region><settlement><li>Londres</li></settlement></list><tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Sikorski, Catherine" sort="Sikorski, Catherine" uniqKey="Sikorski C" first="Catherine" last="Sikorski">Catherine Sikorski</name></region></country><country name="Éthiopie"><noRegion><name sortKey="Ashine, Meskele" sort="Ashine, Meskele" uniqKey="Ashine M" first="Meskele" last="Ashine">Meskele Ashine</name></noRegion><name sortKey="Davey, Gail" sort="Davey, Gail" uniqKey="Davey G" first="Gail" last="Davey">Gail Davey</name><name sortKey="Zeleke, Zewdie" sort="Zeleke, Zewdie" uniqKey="Zeleke Z" first="Zewdie" last="Zeleke">Zewdie Zeleke</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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