title: Impact of a community-based lymphedema management program on episodes of Adenolymphangitis (ADLA) and lymphedema progression--Odisha State, India.
abstract: BACKGROUND
  Lymphedema management programs have been shown to decrease episodes of adenolymphangitis (ADLA), but the impact on lymphedema progression and of program compliance have not been thoroughly explored. Our objectives were to determine the rate of ADLA episodes and lymphedema progression over time for patients enrolled in a community-based lymphedema management program. We explored the association between program compliance and ADLA episodes as well as lymphedema progression.
  
  
  RESULTS
  A lymphedema management program was implemented in Odisha State, India from 2007-2010 by the non-governmental organization, Church's Auxiliary for Social Action, in consultation with the Centers for Disease Control and Prevention. A cohort of patients was followed over 24 months. The crude 30-day rate of ADLA episodes decreased from 0.35 episodes per person-month at baseline to 0.23 at 24 months. Over the study period, the percentage of patients who progressed to more severe lymphedema decreased (P-value  = 0.0004), while those whose lymphedema regressed increased over time (P-value<0.0001). Overall compliance to lymphedema management, lagged one time point, appeared to have little to no association with the frequency of ADLA episodes among those without entry lesions (RR = 0.87 (0.69, 1.10)) and was associated with an increased rate (RR = 1.44 (1.11, 1.86)) among those with entry lesions. Lagging compliance two time points, it was associated with a decrease in the rate of ADLA episodes among those with entry lesions (RR = 0.77 (95% CI: 0.59, 0.99)) and was somewhat associated among those without entry lesions (RR = 0.83 (95% CI: 0.64, 1.06)). Compliance to soap was associated with a decreased rate of ADLA episodes among those without inter-digital entry lesions.
  
  
  CONCLUSIONS
  These results indicate that a community-based lymphedema management program is beneficial for lymphedema patients for both ADLA episodes and lymphedema. It is one of the first studies to demonstrate an association between program compliance and rate of ADLA episodes.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health and Laney Graduate School, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Mues
authors.affiliation: Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Deming
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: David G
authors.initials: DG
authors.lastname: Kleinbaum
authors.affiliation: Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Budge
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Mitch
authors.initials: M
authors.lastname: Klein
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Juan S
authors.initials: JS
authors.lastname: Leon
authors.affiliation: Church's Auxiliary for Social Action, Odisha, India.
authors.forename: Aishya
authors.initials: A
authors.lastname: Prakash
authors.affiliation: Church's Auxiliary for Social Action, Odisha, India.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rout
authors.affiliation: Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: LeAnne M
authors.initials: LM
authors.lastname: Fox
mesh_terms: D000328:Adult; D000368:Aged; D003153:Community Health Services; D018450:Disease Progression; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008205:Lymphangitis / Q000453:epidemiology* / Q000628:therapy*; D008209:Lymphedema / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance