title: Quantifying the physical and socio-economic burden of filarial lymphoedema in Chikwawa District, Malawi.
abstract: BACKGROUND
  Lymphatic filariasis (LF) is a disfiguring parasitic disease and one of the leading causes of disability in the world. This study aimed to assess the severity of lymphoedema, the physical restrictions and socio-economic impact on affected individuals living in an endemic community in Malawi.
  
  
  METHODS
  In a single health centre catchment area, a follow-up survey was conducted to assess 69 lymphoedema cases, and the impact of their condition in eight different areas of their lives. Differences were examined by sex, age and severity of disease. The overall level of disability was quantified and the impact of acute dermatolymphangioadenitis (ADLA) attacks was examined.
  
  
  RESULTS
  Lymphoedema cases were most affected by pain/discomfort and anxiety/depression, which also had an economic impact. Male and older (>60 years) individuals reported more problems. Higher disability levels based on a quantified score were significantly associated with decreased walking distance and working hours. ADLA significantly increased pain/discomfort and reduced cognition, and also affected the individuals' self-care, social participation and ability to work.
  
  
  CONCLUSIONS
  Filarial lymphoedema causes significant hardship, particularly in relation to ADLAs, and the scale of the problem needs to be better defined with new specific tools so that the best support and care can be provided to those in greatest need.
authors.affiliation: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Martindale
authors.affiliation: National Lymphatic Filariasis Elimination Programme, Ministry of Health, Lilongwe, Malawi.
authors.forename: Square Z
authors.initials: SZ
authors.lastname: Mkwanda
authors.affiliation: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Smith
authors.affiliation: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, UK.
authors.forename: David
authors.initials: D
authors.lastname: Molyneux
authors.affiliation: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, UK.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Stanton
authors.affiliation: Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, UK Louise.Kelly-Hope@lstmed.ac.uk.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Kelly-Hope
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders; D017281:Cost of Illness; D003863:Depression; D006233:Persons with Disabilities / Q000145:classification*; D004605:Elephantiasis, Filarial / Q000150:complications / Q000191:economics / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008209:Lymphedema / Q000150:complications / Q000191:economics / Q000453:epidemiology; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058069:Neglected Diseases; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Dreyer staging; Lymphatic filariasis; Lymphoedema; Malawi