Managing Lymphedema Induced by Lymphatic Filariasis: Implementing and Improving Care at the Individual and Programmatic Levels

Abstract

Providing and improving the care of patients suffering from lymphedema remains an essential goal for the clinical management of populations affected by lymphatic filariasis. Although the Essential Package of Care (EPC) recommended by the WHO leads to important positive benefits for many of these lymphedema patients, it is important to continue to address the challenges that remain both in quantifying these effects and in ensuring optimal care. This report, based on the authors' scientific and field experience, focuses on the impact and significance of lymphedema, its clinical presentation, current treatment approaches, and the importance of lymphedema care to the Global Program to Eliminate Lymphatic Filariasis. It emphasizes specific practical issues related to managing lymphedema, such as the importance of beginning treatment in the condition's early stages and the development of effective approaches to assess patients' progress toward improving both their clinical status and their overall quality of life. Priorities for research are also examined, particularly the need for tools to identify patients and to assess disease burden in endemic communities, the creation of EPC accessibility to as many patients as possible (i.e., targeting 100% "geographic coverage" of care), and the empowerment of patients to ensure the sustainability, and ultimately the provision of care from sectors of the national public health systems of endemic countries.

Figure 1.

The elements of the Essential Package of Care (EPC) for LF lymphedema patients. ADL = adenolymphangitis; LF = lymphatic filariasis; MDA = mass drug administration.

Figure 2.

The tissue compartments involved in lymphatic filariasis lymphedema. The various causative and pathological elements contributing to the clinical changes and the target areas for care intervention. ADL = adenolymphangitis.

Figure 3.

Examples of implementing elements of the Essential Package of Care (EPC). (A) Fikre Hailekiros (Ministry of Public Health) training healthcare workers on EPC in Malawi. (B) Applying water to a lymphedematous leg to begin the EPC in India (the hygiene component of EPC). (C) Washing the soap from an affected limb in South Sudan (the hygiene component of EPC). (D) Applying antibiotic cream to folds and interdigital areas of a patient in South Sudan (the wound care component). (E) Carrying out appropriate massage in South Sudan (addressing edema of the limb). (F) Sultan Mahmood (Ministry of Public Health) instructing physiotherapy procedures in Bangladesh (exercise and belly breathing component, etc.)

Figure 4.

Constructing adaptable shoes for filariasis patients with lymphedema. (A) The shoemaker at the Lalgadh Leprosy Hospital, Madhesh Province, southern Nepal, draws an outline of the patient’s foot on the solid sole for the new shoe. (B) The completed adapted shoe can be seen with adjustable wide Velcro^® bands that allow for changes in the size of the foot.