Yahathugoda T C, Wickramasinghe D, Weerasooriya M V, Samarawickrema W A
Filariasis Research Unit, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
Ann Trop Med Parasitol. 2005 Jul;99(5):501-10. doi: 10.1179/136485905X46450.
Using in-depth interviews, information on the current state of lymphoedema management was collected from 101 cases of lymphatic filariasis with lymphoedema in three suburbs of Matara. The interviews were conducted prior to the introduction of a programme of community home-based care (CHBC) that incorporates modern lymphoedema-management strategies. Thirty-two of the interviewees had severe lymphoedema (of grade III or above). The male interviewees had significantly more entry lesions than the female. Most of the subjects had suffered from episodes of limb pain with fever, although the incidence of these episodes appeared unrelated to the severity of the lymphoedema. The frequency of the episodes of limb-pain/fever in the 12 months prior to the interviews appeared unrelated either to the level of daily hygiene, which was generally poor, or to the frequency of bathing. Many (65%) of the subjects paid no attention to limb care when bathing, and 44% did not use footwear. Over 80% made no effort to keep their afflicted limbs elevated, and 95% did not exercise. Most of the female interviewees felt shameful of their condition and were, in consequence, less likely to attend government clinics, for treatment, than the male interviewees. The drug treatment that the interviewees had received was often inadequate, and most had stopped seeking treatment because they had not perceived any significant treatment-attributable improvement in their condition. Modern lymphoedema-management strategies (based on regular washing, careful drying, and treatment, with antifungal, antibiotic or emollient creams, of the affected limbs, limb elevation, exercise, and use of footwear) had not reached the study communities and the local physicians were not aware of them. When dermatology life-quality indexes (DLQI) were calculated for the interviewees, the 26 most impaired subjects gave scores of 5-15 (mean=8.6). The DLQI for these subjects will be regularly re-evaluated, as a measure of the effectiveness of the CHBC programme that has now begun.
通过深入访谈，从马特勒三个郊区的101例患有淋巴水肿的淋巴丝虫病患者中收集了有关淋巴水肿管理现状的信息。这些访谈是在引入一项包含现代淋巴水肿管理策略的社区居家护理（CHBC）计划之前进行的。32名受访者患有严重淋巴水肿（三级或以上）。男性受访者的初始病灶明显多于女性。大多数受试者曾经历过伴有发热的肢体疼痛发作，尽管这些发作的发生率似乎与淋巴水肿的严重程度无关。访谈前12个月内肢体疼痛/发热发作的频率似乎与日常卫生水平（普遍较差）或洗澡频率均无关。许多（65%）受试者在洗澡时不注意肢体护理，44%不穿鞋子。超过80%的人没有努力抬高患肢，95%的人不锻炼。大多数女性受访者对自己的病情感到羞耻，因此，与男性受访者相比，她们去政府诊所治疗的可能性较小。受访者接受的药物治疗往往不足，大多数人已停止寻求治疗，因为他们没有感觉到病情有任何因治疗而带来的明显改善。现代淋巴水肿管理策略（基于定期清洗、仔细擦干、用抗真菌、抗生素或润肤霜治疗患肢、抬高患肢、锻炼和穿鞋子）尚未在研究社区实施，当地医生也不了解这些策略。在为受访者计算皮肤病生活质量指数（DLQI）时，受损最严重的26名受试者的得分在5至15分之间（平均=8.6）。这些受试者的DLQI将定期重新评估，作为现已启动的CHBC计划有效性的一项衡量指标。
