Lymphoedema in Rural Ethiopia

The study I am involved with through #CNTD on enhanced #self_care for people affected by moderate to severe #LymphaticFilariasis and #Podoconiosis related #lymphoedema has started in Ethiopia. We recruited our participants in November and then did a four-week follow-up in early December. The study methods are the same as in Bangladesh (see the post Lymphoedema in Rural Bangladesh), but the two countries and the patients are worlds apart.

Information sessions for potential participants are done in small groups

Access issues in Bangladesh were mainly due to roads and water, in Ethiopia the biggest challenge was the distances. Simada Woreda is mountainous, open and dry and some participants had to walk one or two hours over rocky, dusty roads to get to the health post.

Health Posts (HP) are managed by Health Extension Workers (HEW) who have basic education in health monitoring, delivering vaccinations, maternal health etc. These local women bear a large part of the health delivery burden in rural areas so we're grateful to them for allowing us to take over their HP for the day.

Each of our research teams had two self-care trainers and two data collectors. One team with the two HEW at a HP in Simada Woreda - and our driver Dereje

Ethiopia is endemic for podoconiosis as well as lymphatic filariasis (LF). Podoconiosis is caused by extended exposure to irritant volcanic soils through barefoot farming. Clearing this chronic inflammatory load ultimately damages the lymph vessel system and causes lymphoedema. Since the irritation is firstly concentrated in the feet podoconiosis can present with more advanced skin changes and less swelling than LF. Both diseases progress to develop key features of lymphoedema and the recommended treatment is essentially the same. As our study was aimed at more advanced cases we did not try differentiate about causes and its possible that some of our participants will be affected by both.

The same self-treatment protocols were taught in both countries and is centred around the daily hygiene routine

Both groups of patients will continue on their allocated daily self-care program for 24 weeks. I was at the 4 week follow-up in Ethiopia and got some great verbal reports from patients who said they could see their leg swelling had reduced.

This woman proudly showed me how much her ankles had reduced and you can see the wrinkles appearing over the skin along the front. I asked her if she did the program every day and she replied, "Of course I do, it is for my own health"

This man reported that his joints are moving more easily. He is noticing a change at his toes also. I hope that 24 weeks is enough to make a valuable difference in these very advanced cases

This lady talked about how soft her skin was, and I could see it for myself. So happy people are noticing a benefit