Abstract
BackgroundLymphatic filariasis (LF) is one of the primary causes of lymphoedema in sub-Saharan Africa, and has a significant impact on the quality of life (QoL) of those affected. In this paper we assess the relative impact of lymphoedema on mobility and income in Chikwawa district, Malawi.MethodsA random sample of 31 people with lymphoedema and 31 matched controls completed a QoL questionnaire from which both an overall and a mobility-specific score were calculated. Two mobility tests were undertaken, namely the 10 m walking test [10MWT] and timed up and go [TUG] test, and a subset of 10 cases-control pairs wore GPS data loggers for 3 weeks to measure their mobility in a more natural setting. Retrospective economic data was collected from all 31 case-control pairs, and each participant undertaking the GPS activity recorded daily earnings and health expenditure throughout the observation period.ResultsCases had a significantly poorer overall QoL (cases = 32.2, controls = 6.0, P < 0.01) and mobility-specific (cases = 43.1, controls = 7.4, P < 0.01) scores in comparison to controls. Cases were also significantly slower (P < 0.01) at completing the timed mobility tests, e.g. mean 10MWT speed of 0.83 m/s in comparison to 1.10 m/s for controls. An inconsistent relationship was observed between mobility-specific QoL scores and the timed test results for cases (10MWT correlation = −0.06, 95% CI = (−0.41, 0.30)), indicating that their perceived disability differed from their measured disability, whereas the results were consistent for controls (10MWT correlation = −0.61, 95% CI = (−0.79, −0.34)). GPS summaries indicated that cases generally walk shorter distances at slower speeds than control, covering a smaller geographical area (median area by kernel smoothing: cases = 1.25 km2, controls = 2.10 km2, P = 0.16). Cases reported earning less than half that earned by controls per week (cases = $0.70, controls = $1.86, P = 0.064), with a smaller proportion of their earnings (16% vs 22%, P = 0.461) being spent on healthcare.ConclusionsThose affected by lymphoedema are at a clear disadvantage to their unaffected peers, experiencing a lower QoL as confirmed by both subjective and objective mobility measures, and lower income. This study also indicates that objective measures of mobility may be a useful supplement to self-assessed QoL questionnaires when assessing the future impact of lymphoedema management interventions.
Highlights
Lymphatic filariasis (LF) is one of the primary causes of lymphoedema in sub-Saharan Africa, and has a significant impact on the quality of life (QoL) of those affected
In addition to the swelling, which can cause discomfort and problems with mobility [2], those with filarial lymphoedema are frequently affected by repeated episodes of acute dermatolymphangioadenitis (ADLAs), referred to as acute attacks
Individuals affected by LF clinical conditions from two health centre catchment areas (Nchalo and Bereu) in Chikwawa district, Southern Region, Malawi were included in this study, which was conducted in May 2015
Summary
Lymphatic filariasis (LF) is one of the primary causes of lymphoedema in sub-Saharan Africa, and has a significant impact on the quality of life (QoL) of those affected. In addition to the swelling, which can cause discomfort and problems with mobility [2], those with filarial lymphoedema are frequently affected by repeated episodes of acute dermatolymphangioadenitis (ADLAs), referred to as acute attacks. These attacks, which include pain, fever and increased swelling of affected areas can be extremely debilitating and are further associated with the progression of the severity of the lymphoedema. Lymphoedema management primarily consists of simple hygiene measures such as frequent washing and exercise, with there being strong evidence that these measures lower the number of acute attacks, improve self-assessed quality of life, and decrease swelling [10]
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