Yahathugoda Thishan C, Weerasooriya Mirani V, Samarawickrema Wilfred A, Kimura Eisaku, Itoh Makoto
Filariasis Research Training and Service Unit, Department of Parasitology, Faculty of Medicine, University of Ruhuna, Galle, P.O.Box 70, Sri Lanka.
Department of Parasitology, Aichi Medical University School of Medicine, Aichi, 480-1195, Japan.
Parasitol Int. 2018 Apr;67(2):176-183. doi: 10.1016/j.parint.2017.11.005. Epub 2017 Nov 22.
Alleviating morbidity due to lymphatic filariasis (LF)-especially in elderly patients who are rather ignorant-is presently the biggest challenge for the national filariasis campaign. We introduced two follow-up schemes and compared each other to address three key programmatic issues (1) locating patients, (2) educating patients, family members on practice of lymphoedema self-care (3) well sustained daily self-care. Hundred and seven lymphoedema patients were introduced to the new Community Home Based Care (CHBC) programme as a part of MMDP programme at their homes. Twenty seven of 107 patients were selected by purposive sampling and followed-up under two schemes, 14 in Daily follow-up (DFU) scheme and 13 in Monthly follow-up (MFU) scheme. Impact was assessed using a KAP score, number of entry lesions (EL) and number of ADL episodes, limb volume, its appearance, changes in the quality of life and gained benefits. Visiting patients in their homes to introduce lymphoedema care programme was a success. KAP scores of the more important activities on lymphoedema care were significantly higher in DFU scheme. Number of patients (51.9%; 14/27) who had EL/s at baseline reduced significantly to 18.5% (5/27) at one year follow-up. The mean numbers of ADL episodes/year reduced significantly in both schemes. Six photographs of 27 showed obvious improvement in lymphoedema and its grade. Mean volume of lymphoedema reduced significantly in both schemes at one year no significant difference between schemes. Benefit score at one year revealed that the patients in DFU scheme received significantly higher amount of benefits compared to MFU scheme. In conclusion daily instruction has significantly motivated the patient and his/her family bringing a new hope.
减轻淋巴丝虫病（LF）所致的发病率，尤其是在那些相当无知的老年患者中，目前是国家丝虫病防治运动面临的最大挑战。我们引入了两种随访方案并进行相互比较，以解决三个关键的项目问题：（1）确定患者位置；（2）对患者及其家庭成员进行淋巴水肿自我护理实践的教育；（3）持续良好的日常自我护理。107名淋巴水肿患者作为MMDP项目的一部分，在其家中被引入新的社区居家护理（CHBC）项目。通过目的抽样从107名患者中选取27名，按照两种方案进行随访，14名采用每日随访（DFU）方案，13名采用每月随访（MFU）方案。使用知识、态度和实践（KAP）评分、初始病变数量（EL）、日常生活活动（ADL）发作次数、肢体体积、外观、生活质量变化和获得的益处来评估效果。到患者家中介绍淋巴水肿护理项目取得了成功。在DFU方案中，关于淋巴水肿护理的更重要活动的KAP评分显著更高。基线时有EL的患者数量（51.9%；14/27）在一年随访时显著降至18.5%（5/27）。两种方案中每年ADL发作的平均次数均显著减少。27名患者的6张照片显示淋巴水肿及其分级有明显改善。一年时两种方案中淋巴水肿的平均体积均显著减小，方案之间无显著差异。一年时的益处评分显示，与MFU方案相比，DFU方案中的患者获得的益处显著更多。总之，每日指导显著激发了患者及其家人的积极性，带来了新的希望。
