Community level morbidity control of lymphoedema using self care and integrative treatment in two lymphatic filariasis endemic districts of South India

A non randomized interventional study

Saravu R. Narahari, Kuthaje S. Bose, Madhur G. Aggithaya, Gaddam Kumara Swamy, Terence J. Ryan, Bhaskaran Unnikrishnan, Reynold G. Washington, Balu Palicheralu Sreenivasa Rao, Shrikrishna Rajagopala, Kadengodlu Manjula, Usha Vandana, Thaivalath Anandan Sreemol, Mathew Rojith, Shanappa Y. Salimani, Mohammed Shefuvan

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Currently there is no global program to manage lymphoedema as a result of lymphatic filariasis (LF). The primary aim of this study was to determine the efficacy of a previously proposed integrative treatment protocol, using locally available resources to address the morbidity, in a community village setting. Methods: Two LF endemic districts of south India, Gulbarga in Karnataka (GK) and Alleppey in Kerala (AK), were selected for the study. All known patients were invited to an LF camp. Patients with grade two late or three lymphoedema were enrolled. All patients were given training in the integrative procedure which involved patient education and the domiciliary protocol. Results: A total of 730 patients (851 limbs) completed the three and half month follow up. There was a statistically significant (1%) reduction up to mid thigh level volume measurement for both small (0.7-1.1 liters) and large (1.8-5.0 liters) limbs, p < 0.000. In AK inflammatory episodes at the three months interval reduced from 37.5% (127 patients) to 28.3% (96 patients) and in GK from 37.6% (147 patients) to 10.2% (40 patients), p < 0.000. All patients had reduced bacterial entry points. There was an overall improvement in quality of life in all domains of LF specific quality of life questionnaire p < 0.000. Conclusions: Self care and integrative treatment is possible in resource poor Indian village settings. Further work is needed to explore factors leading to better compliance by randomizing the interventions such as washing and emollient compression vs Ayurvedic and yoga interventions before integrative treatment is considered for national health programmes in developing countries.

Original languageEnglish
Article numbertrt054
Pages (from-to)566-577
Number of pages12
JournalTransactions of the Royal Society of Tropical Medicine and Hygiene
Volume107
Issue number9
DOIs
Publication statusPublished - 01-09-2013

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Filarial Elephantiasis
Lymphedema
Self Care
India
Morbidity
Therapeutics
Extremities
Quality of Life
Emollients
Yoga
National Health Programs
Patient Education
Clinical Protocols
Thigh
Developing Countries
Compliance

All Science Journal Classification (ASJC) codes

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Narahari, Saravu R. ; Bose, Kuthaje S. ; Aggithaya, Madhur G. ; Kumara Swamy, Gaddam ; Ryan, Terence J. ; Unnikrishnan, Bhaskaran ; Washington, Reynold G. ; Sreenivasa Rao, Balu Palicheralu ; Rajagopala, Shrikrishna ; Manjula, Kadengodlu ; Vandana, Usha ; Sreemol, Thaivalath Anandan ; Rojith, Mathew ; Salimani, Shanappa Y. ; Shefuvan, Mohammed. / Community level morbidity control of lymphoedema using self care and integrative treatment in two lymphatic filariasis endemic districts of South India : A non randomized interventional study. In: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2013 ; Vol. 107, No. 9. pp. 566-577.
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title = "Community level morbidity control of lymphoedema using self care and integrative treatment in two lymphatic filariasis endemic districts of South India: A non randomized interventional study",
abstract = "Background: Currently there is no global program to manage lymphoedema as a result of lymphatic filariasis (LF). The primary aim of this study was to determine the efficacy of a previously proposed integrative treatment protocol, using locally available resources to address the morbidity, in a community village setting. Methods: Two LF endemic districts of south India, Gulbarga in Karnataka (GK) and Alleppey in Kerala (AK), were selected for the study. All known patients were invited to an LF camp. Patients with grade two late or three lymphoedema were enrolled. All patients were given training in the integrative procedure which involved patient education and the domiciliary protocol. Results: A total of 730 patients (851 limbs) completed the three and half month follow up. There was a statistically significant (1{\%}) reduction up to mid thigh level volume measurement for both small (0.7-1.1 liters) and large (1.8-5.0 liters) limbs, p < 0.000. In AK inflammatory episodes at the three months interval reduced from 37.5{\%} (127 patients) to 28.3{\%} (96 patients) and in GK from 37.6{\%} (147 patients) to 10.2{\%} (40 patients), p < 0.000. All patients had reduced bacterial entry points. There was an overall improvement in quality of life in all domains of LF specific quality of life questionnaire p < 0.000. Conclusions: Self care and integrative treatment is possible in resource poor Indian village settings. Further work is needed to explore factors leading to better compliance by randomizing the interventions such as washing and emollient compression vs Ayurvedic and yoga interventions before integrative treatment is considered for national health programmes in developing countries.",
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Narahari, SR, Bose, KS, Aggithaya, MG, Kumara Swamy, G, Ryan, TJ, Unnikrishnan, B, Washington, RG, Sreenivasa Rao, BP, Rajagopala, S, Manjula, K, Vandana, U, Sreemol, TA, Rojith, M, Salimani, SY & Shefuvan, M 2013, 'Community level morbidity control of lymphoedema using self care and integrative treatment in two lymphatic filariasis endemic districts of South India: A non randomized interventional study', Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 107, no. 9, trt054, pp. 566-577. https://doi.org/10.1093/trstmh/trt054

Community level morbidity control of lymphoedema using self care and integrative treatment in two lymphatic filariasis endemic districts of South India : A non randomized interventional study. / Narahari, Saravu R.; Bose, Kuthaje S.; Aggithaya, Madhur G.; Kumara Swamy, Gaddam; Ryan, Terence J.; Unnikrishnan, Bhaskaran; Washington, Reynold G.; Sreenivasa Rao, Balu Palicheralu; Rajagopala, Shrikrishna; Manjula, Kadengodlu; Vandana, Usha; Sreemol, Thaivalath Anandan; Rojith, Mathew; Salimani, Shanappa Y.; Shefuvan, Mohammed.

In: Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol. 107, No. 9, trt054, 01.09.2013, p. 566-577.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Community level morbidity control of lymphoedema using self care and integrative treatment in two lymphatic filariasis endemic districts of South India

T2 - A non randomized interventional study

AU - Narahari, Saravu R.

AU - Bose, Kuthaje S.

AU - Aggithaya, Madhur G.

AU - Kumara Swamy, Gaddam

AU - Ryan, Terence J.

AU - Unnikrishnan, Bhaskaran

AU - Washington, Reynold G.

AU - Sreenivasa Rao, Balu Palicheralu

AU - Rajagopala, Shrikrishna

AU - Manjula, Kadengodlu

AU - Vandana, Usha

AU - Sreemol, Thaivalath Anandan

AU - Rojith, Mathew

AU - Salimani, Shanappa Y.

AU - Shefuvan, Mohammed

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Background: Currently there is no global program to manage lymphoedema as a result of lymphatic filariasis (LF). The primary aim of this study was to determine the efficacy of a previously proposed integrative treatment protocol, using locally available resources to address the morbidity, in a community village setting. Methods: Two LF endemic districts of south India, Gulbarga in Karnataka (GK) and Alleppey in Kerala (AK), were selected for the study. All known patients were invited to an LF camp. Patients with grade two late or three lymphoedema were enrolled. All patients were given training in the integrative procedure which involved patient education and the domiciliary protocol. Results: A total of 730 patients (851 limbs) completed the three and half month follow up. There was a statistically significant (1%) reduction up to mid thigh level volume measurement for both small (0.7-1.1 liters) and large (1.8-5.0 liters) limbs, p < 0.000. In AK inflammatory episodes at the three months interval reduced from 37.5% (127 patients) to 28.3% (96 patients) and in GK from 37.6% (147 patients) to 10.2% (40 patients), p < 0.000. All patients had reduced bacterial entry points. There was an overall improvement in quality of life in all domains of LF specific quality of life questionnaire p < 0.000. Conclusions: Self care and integrative treatment is possible in resource poor Indian village settings. Further work is needed to explore factors leading to better compliance by randomizing the interventions such as washing and emollient compression vs Ayurvedic and yoga interventions before integrative treatment is considered for national health programmes in developing countries.

AB - Background: Currently there is no global program to manage lymphoedema as a result of lymphatic filariasis (LF). The primary aim of this study was to determine the efficacy of a previously proposed integrative treatment protocol, using locally available resources to address the morbidity, in a community village setting. Methods: Two LF endemic districts of south India, Gulbarga in Karnataka (GK) and Alleppey in Kerala (AK), were selected for the study. All known patients were invited to an LF camp. Patients with grade two late or three lymphoedema were enrolled. All patients were given training in the integrative procedure which involved patient education and the domiciliary protocol. Results: A total of 730 patients (851 limbs) completed the three and half month follow up. There was a statistically significant (1%) reduction up to mid thigh level volume measurement for both small (0.7-1.1 liters) and large (1.8-5.0 liters) limbs, p < 0.000. In AK inflammatory episodes at the three months interval reduced from 37.5% (127 patients) to 28.3% (96 patients) and in GK from 37.6% (147 patients) to 10.2% (40 patients), p < 0.000. All patients had reduced bacterial entry points. There was an overall improvement in quality of life in all domains of LF specific quality of life questionnaire p < 0.000. Conclusions: Self care and integrative treatment is possible in resource poor Indian village settings. Further work is needed to explore factors leading to better compliance by randomizing the interventions such as washing and emollient compression vs Ayurvedic and yoga interventions before integrative treatment is considered for national health programmes in developing countries.

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U2 - 10.1093/trstmh/trt054

DO - 10.1093/trstmh/trt054

M3 - Article

VL - 107

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JO - Transactions of the Royal Society of Tropical Medicine and Hygiene

JF - Transactions of the Royal Society of Tropical Medicine and Hygiene

SN - 0035-9203

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