MGHD 2021

Background: Podoconiosis is a non-infectious chronic lymphedema that occurs in genetically susceptible individuals, upon long-term feet exposure to irritant volcanic soil. It is a debilitating disease with profound psychological, social, and economic consequences. Nearly 4 million subsistence farmers and impoverished populations are affected worldwide, with more than 6,000 podoconiosis patients residing in Rwanda. Established cases of podoconiosis are often irreversible. Community-based lymphedema management is currently recommended for the management of the morbidity caused by podoconiosis. Only one organization (HASA) currently provides lymphedema management services in Rwanda. This study evaluated the adherence characteristics, the changes in clinical condition and quality of life of podoconiosis patients enrolled in HASA’s community-based lymphedema management program. Methods: A cross-sectional study was conducted using in-person surveys and physical examinations between May and June 2021. We included all HASA participants who joined the program within the past 5 years, residing in Musanze and Burera Districts. Data was collected at the two HASA clinics in Musanze City and Kinoni Village. The survey measured quality of life, adherence to podoconiosis management guidelines, patients’ perceptions of the HASA PEP, and clinical staging. Quantitative analysis was conducted using SPSS (IBM, V.26). Pearson’s Chi square, Mann Whitney U, Kruskal Wallis, and Wilcoxon’s signed-rank tests were used to test for association between variables and statistical significance was considered at p <0.05. Qualitative thematic analysis was used to assess the open-ended questions. Results: A total of 127 participants (18 male, 109 female) were enrolled in the study. Twenty-five participants had pre-HASA photographs for clinical staging. The mean age of our participants was 56.8 years (SD=17.9). Half (50.4%) of participants belonged to the lowest Ubudehe (category 1). Nearly half (44.1%) of the participants were farmers. More than two-thirds (69.3%) of participants washed their feet at least twice a day, while 45.7% raised their legs overnight. The majority (78.7%) of participants regularly wore shoes. Few (6.3%) participants experienced frequent ADLA episodes post-HASA when compared to pre-HASA intervention (89.8%). Almost all (98.4%) participants experienced an improvement in their QoL. The median QoL score decreased from 14 to 7 (p<0.01). There was no significant change in the clinical stage of participants (p>0.99). Participants reported improvements in mobility, self-esteem, and productivity. The disruption caused by Covid-19 and financial constraints were cited as major drivers for reduced adherence to the HASA PEP guidelines. Conclusion: Community-based lymphedema management is an important tool for the reduction of morbidity caused by podoconiosis. Its benefits are not only limited to improvements in clinical condition but also the overall psychosocial wellbeing of patients. Programs should follow a holistic approach to improve adherence to programs and ensure optimal benefits.