Evaluation of Progress of Patients Exposed to Togo's National Lymphoedema Management Programme: A Longitudinal Study Open Access

Abstract

Abstract

Lymphatic Filariasis (LF), a mosquito-borne parasitic disease, can lead to
permanent damage to the lymphatic system, causing lymphoedema. Patients experience
bacterial infections, called acute adenolymphangitis attacks (ADLA), which can speed
progression of disease. Lymphoedema management techniques have been shown to
decrease incidence of ADLA, slowing progression of disease. In 2007, Togo's Ministry
of Health and the Centers for Disease Control & Prevention started the National
Lymphoedema Management Programme (NLMP). This program teaches lymphoedema
patients lymphoedema management techniques in order to change treatment behavior and
improve outcomes among patients. The purpose of this study is to use longitudinal data to
evaluate the extent to which participation in the NLMP was associated with changes in
treatment behavior, ADLA incidence, and quality of life. Data were collected annually
from the same between 2007 and 2010. Paired analyses and longitudinal analyses were
conducted in order to detect changes in responses over time.

Longitudinal analysis showed that use of promoted lymphoedema treatment
methods increased significantly over time, and that patients whose symptoms had begun
most recently (<10 years before 2007) experienced the greatest change in self-reported
treatment behavior. Paired analyses found that use of many ineffective or harmful
treatments also decreased significantly between 2007 and 2010. However, longitudinal
analysis failed to detect a significant change in rate of ADLA over time. Paired analyses
also failed to detect significant changes in most measures of quality of life.
Although patients participating in the NLMP in Togo experienced significant
changes in self-reported lymphoedema management behaviors over time, this change was
not accompanied by a reduction in ADLA incidence. There was also no evidence that
self-sufficiency improved as a result of the program. However, it is not possible to know
how outcomes would have been different in the absence of the NLMP. Studies using
control groups and verification of self-report should be conducted in the future.

Table of Contents

Chapter 1: Background and Literature Review....................................................................1

Lymphatic Filariasis Biology and Physical Effects...........................................................1

Lymphatic Filariaisis Psychosocial Effects ..................................................................... 2

Lymphatic Filaraisis Epidemiology ................................................................................ 3

Global Programme to Eliminate Lymphatic Filariaisis .................................................. 3

Evidence for the Effectiveness of Lymphoedema Morbidity Management .................... 4

Lymphatic Filariaisis in Togo.......................................................................................... 6

Togo's National Lymphoedema Management Programme ............................................ 6

The Purpose of this Study ................................................................................................7

Chapter 2: Manuscript........................................................................................................ 9

Introduction .................................................................................................................... 9

Methods........................................................................................................................ 11

Data Collection Methods ............................................................................................ 11

Survey Questions ........................................................................................................12

Data Analysis ..............................................................................................................12

Longitudinal Analysis.................................................................................................13

Ethics ..........................................................................................................................15

Results ............................................................................................................................15

Demographic Characteristics .....................................................................................15

Frequencies.................................................................................................................16

Paired analyses ...........................................................................................................17

Longitudinal Analysis.................................................................................................19

Discussion ..................................................................................................................... 22

References....................................................................................................................... 26

Tables.............................................................................................................................. 29

Table 1: Lymphoedema stage classification.................................................................. 29

Table 2: Demographic and initial symptoms information............................................ 29

Table 4: Responses to interval and ordinal questions by participants who were surveyed all 4 years ........................................................................................................31

Table 4: Results of MacNemar's Paired analyses for yes-no questions........................ 33

Table 5: Results of Sign-Rank paired analyses for continuous and ordinal variables.. 33

Table 6: Confounding assessment for the relationship between year and proportion of respondents who reported use of at least one appropriate treatment.......................... 34

Table 7: Correlation structure assessment for the final model of the relationship between year and proportion of respondents reporting use of at least one appropriate lymphoedema treatment............................................................................................... 34

Table 8: Results of the final model of the relationship between year and proportion of respondents reporting use of at least one appropriate lymphoedema treatment ........ 34

Table 9: Confounding assessment for relationship between year and rate of ADLA per year ............................................................................................................................... 35

Table 10: Correlation structure assessment for relationship between year and rate of ADLA per year............................................................................................................... 36

Table 11: Results of the final model of the relationship between year and rate of ADLA per year.......................................................................................................................... 36

Figures .............................................................................................................................. 37

Figure1: Log-OR of using a promoted treatment by year (2007 is the reference year) 37

Figure 2: Log-IRR of ADLA per year (2007 is the reference year) ............................... 37

Appendix 1: Statistical Appendix...................................................................................... 38

Appendix 2: Emory Institutional Review Board Approval............................................... 49

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	neglected tropical diseases lymphatic filariasis longitudinal analysis morbidity management Togo
Committee Chair / Thesis Advisor	Kleinbaum, David, Emory University
Committee Members	Mathieu, Els, Centers for Disease Control & Prevention
Partnering Agencies	CDC

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