Implementation of basic package of care improved socio-economic conditions of lymphedema patients in rural Mali after two years follow-up

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Research shows that a local hygiene package washing, wound care, and exercise improves lymphedema (LE) patients' quality of life by reducing ADLA, costs, stigma, and boosting work capacity. The 'LEdoxy' study, a 24-month, multicountry, double-blind, randomized controlled trial of doxycycline plus hygiene, investigated the efficacy of daily doxycycline versus a placebo for lymphatic filariasis in Mali, India, and Sri Lanka. All 'LEdoxy' participants consistently followed a standardized hygiene program. This study, embedded within the previous 'LEdoxy' study, assessed cost reductions in ADLA management and evaluated the social impact of the regular local care based on the HP among LE patients in Mali. We conducted a cross-sectional study embedded in "LEdoxy" study participants in the health districts of Kolondieba and Kolokani from September to December 2021. Questionnaire was used to collect retrospective data on pre-trial conditions and prospective data on post-trial conditions. Data were collected using a digital questionnaire and qualitative methods, including in-depth interviews and focus group discussions with interview guide, without recycling 'LEDoxy' data. These quantitative data were analysed using SPSS version 25.0. We performed a thematic analysis approach using Quirkos version 2. We investigated 196 LE patients with a median age of 56 years [range: 25-70 years]. We observed a reduction in the monthly frequency of acute ADLA from 90.8% (178/196) before the trial to 43.9%, (86/196) after the trial (p<0.05). Importantly, in term of economic evaluation the average ADLA attack management cost decreased significantly from US$20.01(± US $18.56) before the trial to US$5.7(± US $4.78), after the trial (p< 0.001). Patients reported that the hygiene program reduced social isolation and stigma and improved their ability to work. Using a basic care package improved LE patients' quality of life by lowering ADLA costs. To sustain this, community-based programs that include income-generating activities are essential.

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