Authors

C Barrett¹; J Chiphwanya²; D Matipula²; L Chaponda²; J Turner¹; J Read³; M Taylor¹; L Kelly-Hope⁴;  ¹ Liverpool School of Tropical Medicine, UK;  ² Ministry of Health, Malawi, UK;  ³ Lancaster University, UK;  ⁴ University of Liverpool, UK

Discussion

Background: Lymphatic filariasis (LF) is a major cause of disfiguring and disabling lymphoedema. This study aims to: i) determine the prevalence of and risk factors associated with depression and low quality of life (QOL) in lymphoedema patients; ii) understand if implementation of enhanced self-care (ESC) impacts depression and QOL. Methodology: A prospective cohort of ~300 patients from two regions of Malawi (North/South) was conducted over six months. Lymphoedema patients were surveyed at baseline then trained in ESC; hygiene, deep-breathing, massage and leg exercises. Follow-up surveys at 3- and 6-months assessed depression and QOL using a Likert scale Patient Health Questionnaire (PHQ-9) and a adapted LF Specific QOL Questionnaire (LFSQQ). Data were stratified by the three survey time periods. Associated sociodemographic and clinical conditions (lymphoedema severity, acute dermatolymphangioadenitis (ADLAs; secondary bacteria infections) risk factors were identified using univariable beta regression. Results: Baseline data on 309 patients found that 23% (95%CI, 18%-28%) reported mild/moderate depression and 31% (95%CI, 26%-37%) reported moderately/severely low QOL. A higher number of ADLAs in last 6 months was significantly associated with higher depression and lower QOL scores (pConclusion: Filarial lymphoedema is associated with a high prevalence of depression and lower QOL. ESC is a promising home-based intervention that national LF elimination programmes could readily scale up and help to reduce depression and improve quality of life amongst those affected.