Effect of a Community-Based Holistic Care Package on Physical and Psychosocial Outcomes in People with Lower Limb Disorder Caused by Lymphatic Filariasis, Podoconiosis, and Leprosy in Ethiopia: Results from the EnDPoINT Pilot Cohort Study

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  • 1 Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom;
  • | 2 Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia;
  • | 3 School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia;
  • | 4 Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom

Lymphatic filariasis (LF), podoconiosis, and leprosy are highly stigmatized neglected tropical diseases that can cause lower limb swelling and deformity. Simple interventions to support self-care can reduce their physical impacts, but little is known about how to address the psychosocial needs of people living with the diseases, and about how to scale-up morbidity reduction programs. EnDPoINT is a multistage implementation study designed to address these knowledge gaps by developing and evaluating a holistic care package that can be integrated into the Ethiopian health system. This article presents the quantitative results from the EnDPoINT pilot, in which the effectiveness of the care package was assessed in 251 participants from one district in northern Ethiopian using a pre-post design. Reductions 12 months after care package initiation were seen in attacks of acute adenolymphangitis (adjusted odds ratio for attack in last month 0.005; 95% CI 0.001, 0.02; P < 0.001), lower limb and foot circumference (mean difference lower limb circumference −2.0 cm; 95% CI −2.3, −1.8; P < 0.001; foot circumference −2.3 cm; 95% CI −2.5, −2.0; P < 0.001), and lymphedema stage (mean reduction in stage −0.27; 95% CI −0.37, −0.19; P < 0.001). Significant improvements were also observed in scores assessing disability, quality-of-life, depression, stigma, discrimination, and social support. This study thus suggests that the EnDPoINT care package is highly effective in reducing morbidity in people living with LF, podoconiosis, and leprosy in northern Ethiopia.

Author Notes

Address correspondence to Maya Semrau, Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Room G19, Medical Research Building, University of Sussex, Falmer Brighton, BN1 9PS, United Kingdom. E-mail: m.semrau@bsms.ac.uk

These authors contributed equally to this work.

Financial support: This research was supported by the National Institute for Health Research Global Health Research Unit on NTDs at Brighton and Sussex Medical School using Official Development Assistance funding.

Authors’ addresses: Rachael Dellar and Maya Semrau, Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom, E-mails: rachael.dellar@gmail.com and m.semrau@bsms.ac.uk. Oumer Ali and Abebaw Fekadu, Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom, and Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia, E-mails: oumeral33@gmail.com and a.fekadu@bsms.ac.uk. Mersha Kinfe and Asrat Mengiste, Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia, E-mails: merhsa35@yahoo.com and asratmengiste@hotmail.com. Gail Davey, Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom, and School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia, E-mail: g.davey@bsms.ac.uk. Stephen Bremner, Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom, E-mail: s.bremner@bsms.ac.uk.

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