Reasons for loss to follow-up of patients with podoconiosis in the Amhara Region, northern Ethiopia.

Abstract

Podoconiosis is a non-infectious form of tropical lymphoedema characterised by swelling of the feet and lower legs. Treatment is simple and effective yet evidence indicates that a proportion of patients become lost to follow-up. This study was a quantitative questionnaire-based study which aimed to identify the most common reasons for loss to follow-up of patients. A total of 191 participants registered with the International Orthodox Christian Charities (IOCC) who had become lost to follow-up were included in a cross-sectional survey based in the Amhara Region, northern Ethiopia. The most common reason was distance, stated by 26.7% (51/191). This was significantly associated with living further from the treatment site (p=0.02). Having had podoconiosis for longer was protective against this (p=0.03). For each additional hour of travel time a patient lived from the treatment centre, the odds of them reporting 'distance' as the main reason for becoming lost to follow-up increased by 1.61 (95% CI: 1.25-2.08). The consequences of podoconiosis are exacerbated by walking long distances, but in most areas, this is currently required of patients in order to receive treatment. We recommend expansion of services to widen treatment availability, since provision of transport to and from treatment centres is unlikely to be feasible.