Type Of Lymphedema Research Articles

Atypical Milroy's disease with predominant unilateral involvement: a case report

Milroy's disease (MD), known as hereditary lymphedema type I, is a rare autosomal dominant primary lymphedema. It accounts for about twenty percent of all primary lymphedema. MD typically presents clinically with bilateral lower extremity lymphedema. Our case report describes a rare case of MD presenting with unilateral upper and lower extremity lymphedema in a patient admitted to our clinic. A 24-year-old woman who had been followed for lymphedema since the age of 8 was diagnosed with MD at our hospital by physical examination, venous Doppler ultrasound, whole-body lymphoscintigraphy, and molecular genetic testing. Partial improvement was observed with complete decongestive therapy, considered the gold standard treatment for lymphedema. Genetic counseling may be beneficial for the patient and family. Although MD is uncommon in the literature, many more studies are needed to identify carrier variants in the community.

Lymphovenous Anastomosis for the External and Internal Types of Head and Neck Lymphedema: A Case Series and Preliminary Clinical Results.

Head and neck lymphedema (HNL), including external and internal types, could be a possible consequence for patients who have received neck dissection and radiotherapy for head and neck cancer. Initially, the common presentations are heaviness or tightness, followed by swelling in appearance, or difficulty speaking and swallowing in internal edema cases. Lymphovenous anastomosis (LVA) is an established approach to treat extremity lymphedema. We hereby present our preliminary experience in using LVA to treat HNL. Between March 2021 and January 2024, six patients with HNL were treated with LVA via a preauricular or submandibular incision of the obstructed side. Lymphedema Symptom Intensity and Distress Surveys-Head and Neck (LSIDS-H&N) were used for evaluation. In addition, for the external type, MD Anderson Cancer Center Head and Neck Lymphedema (MDACC HNL) rating scale was used for evaluation. For the internal type, Swallowing Quality of Life was used for evaluation. With an average follow-up period of 15.4 ± 15.9 months, LSIDS-H&N improved from 1.11 ± 0.54 to 0.44 ± 0.66 (P = 0.02). For patients with the external type, within an average follow-up period of 15 ± 16.1 months, the MDACC HNL rating scale improved from level 2 to 0 or 1a (P = 0.008). For patients with the internal type, within an average follow-up period of 21 ± 17.3 months, Swallowing Quality of Life improved from 130.5 ± 9.2 to 151 ± 19.8 (P = 0.5). Based on our preliminary results, LVA could be a potential solution to both external and internal HNL.

Size adjustment suture technique for lymphaticovenular anastomosis.

In this report, we describe a super microsurgical technique that enables rapid and accurate anastomosis while adjusting for caliber differences when anastomosing a small-caliber lymphatic vessel and a vein with a larger caliber, which is frequently encountered in surgeries such as lymphaticovenous anastomosis (LVA). The suture size adjustment technique was performed in 30 anastomoses of lymphatic vessels and veins, whose diameter of lymph duct was at least two times smaller than that of the vein. The type of lymphedema, caliber of lymphatic vessels and veins anastomosed, caliber ratio, vein wall thickness, modified caliber ratio after vein wall thickness subtracted, presence of additional anastomosis, and anastomosis time were examined. On average, the lymphatic vessels had a diameter of 0.61 mm, while the veins were 1.43mm in diameter. The mean caliber ratio of vein to lymphatic vessel was 2.3, while the modified caliber ratio of vein-to-lymphatic vessel was 1.5 on average. The average venous wall thickness was 0.51. The average anastomosis time was 9.1min and no additional anastomosis due to leakage was necessary in any case. We successfully performed an anastomosis of lymphatic vessels and veins with different calibers, which can maintain long-term patency while adjusting the caliber difference and suppressing leakage at the anastomosis site. Finally, the caliber of the vein is commonly larger than that of the lymphatic vessel to be anastomosed in many cases of LVA surgery, indicating that the proposed anastomosis method could be of therapeutic use in many cases.

A Practical Approach to the Diagnosis of Lymphedema: A Narrative Review.

Lymphedema often presents as progressive, unremitting swelling and skin changes that are extremely distressing to patients. Hereditary lymphedema (HL) constitutes a type of primary lymphedema that is passed down through generations. The primary aims of this narrative review are to illustrate a framework to distinguish lymphedema from other causes of swelling and to differentiate the hereditary lymphedemas from each other. A literature search was undertaken using relevant search terms. The articles were evaluated to generate a diagnostic algorithm to approach the swelling of an extremity using clinical and laboratory data. First, the stemmer sign should be evaluated. If it is negative, other causes should be considered. History and additional physical exam findings suggest either a primary or secondary cause of lymph-edema. The hereditary lymphedemas have been classified by age of onset and then stratified by clinical criteria and genetic testing.

Coping Mechanisms for Lymphedema: An Analysis of Patient Experiences.

Background and objective Lymphedema is a condition caused by impaired lymphatic function. Acquired lymphedema is often due to neoplasia, infection, trauma, or radiation damage. Most patients rely on advice from fellow patients and personal research to manage their symptoms. We believe coping mechanisms for lymphedema can be more streamlined and made easily accessible if the most common effective strategies are determined and collected in a single repository for reference. To that end, we aimed to assess the experiences of lymphedema patients and the coping mechanisms they employed. Methods Feedback from lymphedema patients was obtained using a 19-item questionnaire-based survey distributed to multiple online lymphedema support groups. It focused on the type of lymphedema and its effect on the respondents and sought data to characterize coping mechanisms that individuals with lymphedema use and their effectiveness. Results The respondents (n=400) had a median age of 55 years (range: 18-83 years). The overall mean BMI was 35.8 kg/m2, with respondents with lower extremity (LE) lymphedema having a greater mean BMI (38.4 vs. 31.0, p<0.05). Most of the respondents were female (n=382, 95.5%). LElymphedema was more common (n=280, 70%) than the upper extremity (UE) variant (n=120, 30%). Within the LE group, 99 were unilateral (35.4%) and 181 were bilateral (64.6%). Moderate restriction was the most reported level with 44% in the unilateral group and 64% in the bilateral group. Stretching, low-impact exercise, manual lymphatic drainage (MLD), and compression bandages were the most commonly used coping methods and most of the respondentsrated them as somewhat effective. Of note, 30% of respondents in either group rated increased water intake as either slightly, moderately, or very helpful; 25% of respondents also rated decreased alcohol intake as very helpful. The use of a therapist and familyand doctor support was rated as extremely helpful. Within the UE group, 105 were unilateral (87.5%) and 15 were bilateral (12.5%). The most common cause of UE lymphedema was breast cancer-related (98/120, 81.7%) followed by melanoma treatment. Mild restriction was the most reported level (n=48, 45.7%). The UE group had similar results as the LE group in terms of coping mechanisms, dietary changes, and psychosocial support. Conclusion Based on the experiences of the lymphedema patients surveyed, the management of the condition is multifactorial and hence not compatible with a one-size-fits-all strategy. LE lymphedema was more common than the UE variant; but both groups reported engaging in stretching, low-impact exercise, manual lymphatic drainage, and compression bandages with similar rates of satisfaction reported in both groups. Dietary changes were not commonly employed. Therapy, doctor, and family support were the most commonly used support mechanisms, with high satisfaction among both groups. The overall coping mechanisms and their ratings in terms of efficacy between UE and LE groups were similar although the impact of quality of life was greater for bilateral conditions. We believe our findings represent the first steps to providing information potentially useful to aid future and current lymphedema patients in finding the coping methods that work best for them.

Obesity and secondary lymphedema

Obesity causes all types of lymphedema to deteriorate. Obesity-associated lymphedema is by now the most frequent secondary lymphedema and constitutes an entity in its own right. Obesity and its comorbidities, due to mechanical and inflammatory effects, decrease lymphatic transport and create avicious circle of lymph stasis, local adipogenesis, and fibrosis. The therapeutic strategy must therefore address both lymphedema and obesity and its comorbidities.

Suffering of patients developing lymphedema following gynecological cancer surgery.

Lymphedema developing in the lower extremities following gynecological cancer surgery (LE-GCS) produces various kinds of sufferings, including impacts on quality of life (QOL) and body image. This research will serve as a basic resource for the care of patients with this type of lymphedema (LE). A qualitative discursive research method: Thirteen patients suffering from LE-GCS were interviewed in a semi-organized manner. Analysis involved extracting and codifying from transcripts and expressions related to the suffering of LE. Next, these codes were arranged into categories and subcategories under the supervision of qualitative researchers. Furthermore, this study was conducted with the approval of the Research Ethics Review Specialist Committee, which targets individuals affiliated with the public university corporation of Shiga Prefectural University. Based on the interviews with 13 patients aged 47-79 (median age 62), two core categories were created: 1). Suffering of LE Developing in Lower Extremities (570 codes, seven categories, 23 subcategories); and 2). Supports that Allow Patients to Face Suffering of LE (254 codes, four categories, 14 subcategories). Patients with LE-GCS live with the fear that LE exacerbation will produce adverse life changes, and this may exceed the fear of cancer itself. The aggravation of their condition results in immense pain as well as reduced mobility, change in appearance, and loss of self-worth. The symptoms fluctuate, and may lead to chronic misery, which does not manifest, but occasionally flares-up because of both, worsening physical disability as well as ordinary events. Additionally, every patient subjectively described the strength they found within themselves to face the suffering. They cited the support of family and friends, existence of compassionate therapists and doctors, acquisition of knowledge, and self-care.

Paediatric lymphoedema: An audit of patients seen by the paediatric and primary lymphoedema group of vascular European Reference Network (VASCERN)

Little is known about the overall prevalence of lymphoedema in children and the types of paediatric lymphoedema seen by specialist centres. Therefore, this study was aimed to provide a profile of children with primary or secondary lymphoedema seen by the expert centres of the paediatric and primary lymphoedema working group (PPL-WG) of VASCERN and to compare the profile between the different countries.A retrospective review of all children (aged up to 18 years) seen for the first time by the expert centres over one year (2019) was carried out. Lymphoedema-, patient- and genetics-related data was collected and described for the whole group and compared between the different European countries/UK.In 2019, a total of 181 new children were seen by eight expert centres. For primary lymphoedema, the phenotype was based on the St George's classification of lymphatic anomalies. The percentages diagnosed according to each category were: 7.2% for syndromic lymphoedema, 2.8% for systemic/visceral involvement, 30.4% for congenital, 35.9% for late-onset lymphoedema and 19.3% for vascular/lymphatic malformations. 4.4% had secondary lymphoedema. Nearly 10% of all children had had at least one episode of cellulitis. The median delay from onset of symptoms to being seen by an expert centre was 2.4 years. In 44.4% of the children with primary lymphoedema a genetic test was performed, of which 35.8% resulted in a molecular diagnosis. Across the different centres, there was a wide variety in distribution of the different categories of paediatric lymphoedema diagnosed and the frequency of genetic testing.In conclusion, this paper has demonstrated that there is a large delay between the onset of paediatric lymphoedema and the first visit in the expert centres and that an episode of cellulitis is a relatively common complication. Diagnostic variation across the centres may reflect different referral criteria. Access to genetic testing was limited in some centres. It is recommended that these issues are addressed in the future work of the PPL-WG to improve the referral to the expert centres and the consistency in service provision for paediatric lymphoedema in Europe.

The All-Ireland Guidelines for the diagnosis, assessment and management of lymphoedema.

The last decade has produced a plethora of lymphoedema-based research. As such, a new All-Ireland Guideline for lymphoedema diagnosis, assessment and management was required to replace the 2008 CREST Guideline. A research team was commissioned to work with healthcare staff and service users following international research standards practice. An evidence-based clinical practice guideline was developed to aid clinicians in the diagnosis, assessment, and management of lymphoedema. Recommendations were formulated based on the evidence available to answer each clinical question and were assigned a grade based on the strength of the evidence. In the absence of sufficient evidence and in an effort to maximise clinical applicability, recommendations were also based on expert opinion, which was gathered via guideline member consensus. The recommendations from the guideline, which aim to provide healthcare professionals with clear, evidence-based guidance on the diagnosis, assessment and management of patients with all types of lymphoedema, should be communicated at all levels regarding responsibility for implementation in clinical care and service development. Audit should be a core component of the implementation. A budget impact analysis should be completed to determine additional costs required to fully implement the guideline.

Primary lymphangioma, lymphedema of the lower limb of the fetus in the practice of ultrasound

Scientifically based and experimentally confirmed data on the morphogenesis of the lymphatic system are necessary to clarify critical periods of development characterized by an increased risk of congenital anomalies of the lymphatic system in order to plan and implement effective prevention, diagnosis and correction of related abnormalities. Among the studied anomalies of lymphatic vessels, lymphangioma is most often mentioned — a congenital benign tumor consisting of many cysts of various sizes. Detection of primary fetal lymphangioma in the early stages of intrauterine development is extremely rare. The purpose of the study: to report a case of early diagnosis of congenital cystic lymphangioma and lymphedema of the left lower limb of the fetus. Congenital (primary) peripheral lymphedema, limb lymphangioma is associated with a malformation of the lymphatic system. Taking into account the fact that operative methods of correction of all types of primary lymphedema are considered unreasonable and ineffective, the main attention requires timely detection of this congenital malformation during screening studies of the fetus and the issuance of recommendations for the management of pregnancy, up to termination for medical reasons. It is necessary to raise the issue of genetic counseling of the couple and conducting the necessary genetic studies. The use of modern diagnostic methods allows for the prevention and treatment of abnormalities in the development of the lymphatic system at an earlier stage of the intrauterine period.

Treatment of Primary Congenital Lymphedema Via the Godoy Method: A Case Report of 17-year Follow-up

The present research aimed to report the treatment of primary congenital lymphedema using the Godoy method with a 17-year follow-up period. A 2-month-old male patient with bilateral primary congenital lymphedema of the lower limbs was sent to the Clinica Godoy-Brazil for specialized treatment. The physical examination revealed bilateral lower limb edema affecting the feet and middle third of the legs. The patient was made to use hand-crafted stockings made of grosgrain fabric. When the child reached 10 years of age, mechanical lymphatic therapy was conducted. A considerable reduction in the edema was achieved but with periods of improvement and worsening. In the last 4 years of the 17 years of treatment, the limbs have remained within or near the range of normality. The present findings demonstrate that the Godoy method is effective in controlling edema in cases of primary congenital lymphedema. When the family has difficulties, others who take care of the child should get involved to ensure the treatment of this type of lymphedema.

Epidemiological data on lower limb lymphedema

Objective: The aim of the present study was to evaluate epidemiological data of patients seen at a clinic specialized in the treatment of lymphedema. Methods: A retrospective, cross-sectional study was conducted involving data from 150 consecutive patients with lower limb lymphedema in clinical stages II and III treated at the Godoy Clinic in São Jose do Rio Preto. The follow data were collected: sex, age, type of lymphedema (primary or secondary), cause of secondary lymphedema (cancer, trauma, venous disease) and limb dominance. The diagnosis of lymphedema was based on the clinical history and physical examination; in cases of doubt, lymphoscintigraphy of the lower limbs was requested. Descriptive statistics were performed and results were expressed as percentages. Results: Twenty-five (16.66%) of the patients were male and 125 (83.33%) were female. Mean age was 42.52 years (41.8 years among the men and 42.67 years among the women). One hundred nine cases (72.66%) were primary lymphedema and 41 (27.33%) were secondary. Among the secondary cases, 27 (18%) were related to cancer treatment, 10 (6.6%) were linked to trauma and four (2.6%) were cases of phlebolymphedema. Mean age was 51.4 years among the patients with cancer treatment-related lymphedema, 41 years among those with trauma-related lymphedema and 64.25 years among those with phlebolymphedema. The left leg was affected in 61 cases (40.66%), the right leg was affected in 37 cases (24.66%) and lymphedema was bilateral in 52 cases (34.66%). Conclusion: Primary lymphedema was predominant and affected women more than men. Primary lymphedema occurred at an earlier age compared to cancer treatment-related lymphedema and phlebolymphedema. The left leg was affected more often, followed by bilateral lymphedema and, finally, the right leg alone.

Healthcare Practitioners' Knowledge of Lymphedema.

Objectives Lymphedema is neglected in medical education, and a review on healthcare practitioners' (HCPs) knowledge is necessary to shed light on gaps and to provide evidence for establishing educational programs on lymphedema. Methods This systematic review was performed based on the PRISMA guideline in PubMed, Scopus, Web of Science, and Google Scholar databases. There was no limitation on the type of lymphedema or HCPs. The quality assessment was performed based on QATSDD. Data regarding study characteristics, questionnaire context, and findings of the study were summarized from each article. Results After the screening, 16 articles were included that 12 were cross-sectional, two were qualitative, and two were interventional pilot studies. Breast cancer and other cancer-related lymphedema, lymphatic filariasis, and podoconiosis were included, and the majority of articles were focused on primary HCPs. The overall knowledge was low and average in five and 11 articles, respectively, and prior education was a significant factor related to higher knowledge of lymphedema in two studies. Conclusion Structured education of lymphedema is needed to increase the knowledge of HCPs and to enhance their collaboration in multidisciplinary care teams. Improvement of HCPs' knowledge may lead to better outcomes of lymphedema patients' management which are neglected.

Therapeutic Management of Breast Cancer Related Upper Limb Lymphedema

Lymphedema represents a chronic condition with impaired lymphatic transport, having primary and secondary etiologies. The most common type of secondary lymphedema in western countries is represented by breast cancer related upper limb lymphedema. This condition, once installed, determines limb structure changes, progressive functional impairment, specific complications, consequently impacting the quality of patient’s life. An accurate diagnosis is mandatory, using both clinical and imagistic methods with clear definition disease extent as per standardized staging systems, in order to further provide an adequate therapeutic strategy. The main therapeutic goal in patients with lymphedema is represented by limb volume reduction with subsequent symptoms relief, improving quality of life and avoiding complications such as recurrent infections. Through this paper, we aim to present a comprehensive overview of current therapeutic options of breast cancer upper limb related lymphedema. Therapeutic approach comprises of non-surgical (conservative) therapy, which is mandatory as initial therapy and surgical procedures for selected cases. Most patients with lymphedema benefit from conservative treatment alone. In non-responsive cases, in patients with progressive disease, in late stage complicated lymphedema, and also recently added as prophylactic strategy, surgical treatment, trough recent developed techniques, offer very good results in long-term control of disease. Surgical options are classified firstly in physiologic procedures that aim to create new lymphatic channels, promote physiologic drainage of the lymph and should be considered early in the course of the disease, and secondly ablative procedures that reduce through liposuction or various excision techniques the volume of the affected limb. Both types of techniques can be combined to ensure the best functional outcome of the patient.

Lymphedema and Sports: A Case Series of Athletic Patients.

Background: Lymphedema is a chronic progressive condition without a cure. Although the disease can cause significant morbidity, it is not a contraindication to participating in sports. The purpose of this study was to illustrate patients who are able to perform vigorous athletic activities to encourage individuals newly diagnosed with lymphedema. Methods and Results: Our Lymphedema Program database was reviewed for patients who performed significant sports, outside of routine exercise and fitness. Inclusion criteria were a confirmed diagnosis of lymphedema, age >16 years, and body mass index (BMI) <30. Age, gender, type of lymphedema (i.e., primary or secondary), location of disease, BMI, and athletic activities were recorded. Fourteen patients met inclusion criteria: seven males and seven females. Average age was 34 years (range 17-77) and lymphedema was primary (n = 11) or secondary (n = 3). All subjects had lower extremity disease: right leg (n = 6), left leg (n = 5), bilateral (n = 3). The average BMI was 23 (range 18-27). Sports performed by the cohort included marathon running (n = 3), soccer team (n = 2), skiing (n = 2), basketball team, rugby, swimming team, college lacrosse team, hockey team, college tennis team, and surfing. Conclusions: Patients with lower extremity lymphedema are able to engage in competitive sports and a wide range of athletic activities. Individuals typically have a normal BMI and active lifestyle. Patients with lymphedema should be encouraged to participate in athletic pursuits that they enjoy and to maintain a normal BMI.

Mapping of Podoconiosis Cases and Risk Factors in Kenya: A Nationwide Cross-sectional Study.

Podoconiosis is a type of tropical lymphedema that is clinically distinguished from lymphatic filariasis (LF) because it is ascending and commonly bilateral but asymmetric. The disease is a result of a genetically determined inflammatory reaction to long-term exposure to mineral particles in irritant red clay soils derived mainly from volcanic soils. We conducted the first nationwide mapping of the prevalence and risk factors of podoconiosis in Kenya. We performed a population-based cross-sectional survey to determine the national prevalence of podoconiosis and included 6,228 individuals from 48 villages in 24 sub-counties across 15 counties. Participants answered a questionnaire about the history of symptoms compatible with podoconiosis, received a point-of-care antigen test, and underwent a physical examination if they had lymphedema. A confirmed case of podoconiosis was defined as a case in a resident of the study village who had lower limb bilateral and asymmetric lymphedema lasting more than 1 year, negative test results for Wuchereria bancrofti antigen, and other causes of lymphedema ruled out. Of all the individuals surveyed, 89 had lymphedema; of those, 16 of 6228 (0.3%; 95% confidence interval [CI], 0.1-0.5) were confirmed to have podoconiosis. A high prevalence of podoconiosis was found in western (Siaya, 3.1%; Busia, 0.9%) and central (Meru, 1.1%) regions, and a low prevalence was observed in northern (Marsabit, 0.2%), eastern (Makueni, 0.2%), and coastal (Tana River, 0.1%) regions. The identified risk factors were age 56 years or older (adjusted odds ratio [aOR], 5.66; 95% CI, 2.32-13.83; P < 0.001) and rarely wearing shoes (aOR, 18.92; 95% CI, 4.55-78.71; P < 0.001). These results indicated that the podoconiosis prevalence is low and localized in Kenya; therefore, elimination is achievable if appropriate disease prevention, management, and behavioral strategies are promoted.

Conservative treatment of lymphedema: the state of the art.

This article aims to discuss the possibilities of conservative and non-pharmacological treatments for lymphedema. A non-systematic review of the literature was carried out, including studies involving human subjects with different types of lymphedema. Several approaches to lymphedema treatment have been reported and Complex Decongestive Therapy (CDT) has been considered the most effective treatment for limb lymphedema. Other conservative treatments have been proposed such as Taping, Extracorporeal Shock Wave Therapy, Acupuncture, Photobiomodulation Therapy, Endermologie, Intermittent Pneumatic Compression, and Low-frequency, Low-intensity Electrotherapy. The choice of the therapeutic approach to be employed should consider lymphedema characteristics, the therapist's experience, and the patient's wishes. In addition, since this is a chronic condition, the patient must adhere to the treatment. To this end, the therapeutic proposal may be the key to better control of limb volume.

Clinical Characteristics of and Services Provided for Patients with Lymphedema Referred to a Physiotherapy Program During the Years 2009 Through 2019.

Background: Lymphedema is a chronic and progressive disease whose diagnosis involves determination of clinical and demographic characteristics. The aim of this retrospective study was to analyze the clinical characteristics of patients with lymphedema and their various diagnoses. We studied patients who were referred for physiotherapy services at any point during the years 2009 through 2019. Methods: Retrospective data were collected from the files of 430 lymphedema patients. The type, cause, localization, stage, and severity of lymphedema and physiotherapy needs were analyzed and reported. Results: Primary and secondary lymphedema were observed in 18 (4.2%) and 412 (95.8%) patients, respectively. The patients' mean body mass index score was 30.66 kg/m2. The data indicated that the most common cause of secondary lymphedema was breast cancer and its treatments (n = 196, 47.6%). Other causes were chronic venous insufficiency (CVI) (n = 140, 34%), lipolymphedema (n = 11, 2.7%), and other types of cancers (n = 65, 15.7%). According to the affected body regions, 416 patients had unilateral/bilateral upper and lower extremity lymphedema and 14 had head and neck lymphedema. The patients were followed with a home-based physiotherapy program (n = 353, 82.1%) or they underwent treatments through an outpatient program (n = 77, 17.9%). Conclusions: Most patients admitted to the clinic had a diagnosis of breast cancer and CVI. The severity and stages of lymphedema were variable. The data indicated that most patients were followed through a home-based physiotherapy program. These results may set a frame for understanding the treatment and care needs of patients with lymphedema.

High levels of depressive symptoms among people with lower limb lymphoedema in Rwanda: a cross-sectional study.

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.

Predicting the environmental suitability and population at risk of podoconiosis in Africa.

Podoconiosis is a type of tropical lymphedema that causes massive swelling of the lower limbs. The disease is associated with both economic insecurity, due to long-term morbidity-related loss of productivity, and intense social stigma. The geographical distribution and burden of podoconiosis in Africa are uncertain. We applied statistical modelling to the most comprehensive database compiled to date to predict the environmental suitability of podoconiosis in the African continent. By combining climate and environmental data and overlaying population figures, we predicted the environmental suitability and human population at risk of podoconiosis in Africa. Environmental suitability for podoconiosis was predicted in 29 African countries. In the year 2020, the total population in areas suitable for podoconiosis is estimated at 114.5 million people, (95% uncertainty interval: 109.4–123.9) with 16.9 million in areas suitable for both lymphatic filariasis and podoconiosis. Of the total 5,712 implementation units (typically second administrative-level units, such as districts) defined by the World Health Organization in Africa, 1,655 (29.0%) were found to be environmentally suitable for podoconiosis. The majority of implementation units with high environmental suitability are located in Angola (80, 4.8%), Cameroon (170, 10.3%), the DRC (244, 14.7%), Ethiopia (495, 29.9%), Kenya (217, 13.1%), Uganda (116, 7.0%) and Tanzania (112, 6.8%). Of the 1,655 environmentally suitable implementation units, 960 (58.0%) require more detailed community-level mapping. Our estimates provide key evidence of the population at risk and geographical extent of podoconiosis in Africa, which will help decision-makers to better plan more integrated intervention programmes.