Abstract
BackgroundThere is a growing body of evidence that mental distress and disorder are common among people with lower limb lymphoedema, although no research has been conducted on this subject in Rwanda.MethodsThis research was embedded within a mapping study to determine the national prevalence and geographical distribution of podoconiosis in Rwanda. Using a cluster sampling design, adult members of households within 80 randomly selected sectors in all 30 districts of Rwanda were first screened and 1143 patients were diagnosed with either podoconiosis (n=914) or lower limb lymphoedema of another cause (n=229). These 1143 participants completed the Patient Health Questionnaire (PHQ)-9 to establish the prevalence of depressive symptoms.ResultsOverall, 68.5% of participants reported depressive symptoms- 34.3% had mild depressive symptoms, 24.2% had moderate, 8.8% moderately severe and 1.2% severe depressive symptoms. The mean PHQ-9 score was 7.39 (SD=5.29) out of a possible 0 (no depression) to 27 (severe depression). Linear regression showed unemployment to be a consistently strong predictor of depressive symptoms; the other predictors were region (province), type of lymphoedema and, for those with podoconiosis, female gender, marital status and disease stage.ConclusionsLevels of depressive symptoms were very high among people with lower limb lymphoedema in Rwanda, which should be addressed through holistic morbidity management and disability prevention services that integrate mental health, psychosocial and economic interventions alongside physical care.
Highlights
Podoconiosis is a neglected tropical disease (NTD) that is common among barefoot subsistence farmers who have long-term exposure to irritant red clay tropical soils[1] in areas where ancient volcanic deposits have weathered at high altitude[2] and where there is heavy rainfall
This study aims to address this gap by reporting on the prevalence of depressive symptoms among people with lower limb lymphoedema in Rwanda, as well as providing comparisons between people affected by podoconiosis and those with lower limb lymphoedema of another cause
For the additional question on the Patient Health Questionnaire (PHQ)-9, which asks how difficult any symptoms of depression made it for the respondent to carry out their work, take care of things at home, or get along with other people, the mean score was 1.68 (SD=0.77), on a scale of 0, 1, 2 and 3
Summary
Podoconiosis is a neglected tropical disease (NTD) that is common among barefoot subsistence farmers who have long-term exposure to irritant red clay tropical soils[1] in areas where ancient volcanic deposits have weathered at high altitude[2] and where there is heavy rainfall. Podoconiosis results in lower limb lymphoedema, i.e. swelling of the lower leg and feet, as do other NTDs such as lymphatic filariasis (LF) and leprosy, which—unlike podoconiosis—are caused by parasites and Bacilli, respectively. In addition to the physical disability associated with lower limb lymphoedema, there is a large mental health and psychosocial burden for patients as well as their families and communities, which can include mental distress,[8] depression,[9] stigma[10,11,12,13,14] and loss of economic productivity.[15,16,17] For example, a recent study in Cameroon by our group found that 38.6% of people with podoconiosis or lymphoedema of another cause displayed. There is a growing body of evidence that mental distress and disorder are common among people with lower limb lymphoedema, no research has been conducted on this subject in Rwanda
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