[show abstract][hide abstract] ABSTRACT: This cross-sectional, descriptive study describes the treatment-seeking behavior of 413 lymphoedema patients attending 2 filariasis clinics in the Colombo district, Sri Lanka. A pretested, interviewer-administered questionnaire obtained information regarding sources and types of treatment taken, time taken for diagnosis, and details regarding diethylcarbamazine citrate (DEC) treatment. There was a mean delay of 2.37 years (SD 1.37) in diagnosing filariasis after the first appearance of limb swelling. General practitioners were the most frequent first-contact health care providers and the most visited source overall, followed by government hospitals and Ayurvedic practitioners. Approximately 95% of patients were on DEC treatment ranging from 10 days to 43 years (mean 2.5 years SD +/- 1.1). Sixty-one percent of patients reported always having taken the recommended DEC course. Nonsteroidal anti-inflammatory drugs, diuretics, and antibiotics were liberally prescribed. Approximately 97% had sought treatment from a medical practitioner for an acute adenolymphangitis attack. Despite the area being endemic for filariasis, there was a delay in treatment and inappropriate use of DEC in patients with chronic filarial lymphoedema.
Asia-Pacific Journal of Public Health 02/2008; 20(2):129-38. · 1.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: The efficacy of a programme of community home-based care (CHBC) for lymphoedematous limbs was evaluated among 163 lymphoedema patients attending two filariasis clinics in Colombo. Each patient was interviewed and examined and his or her lymphoedema was graded during a baseline assessment, before the CHBC programme, and again, during a post-intervention assessment, after the patient had been in the programme for 1 year. The number of patients having entry lesions was 24% lower at the post-intervention assessment than at the baseline (P<0.001), with a reduction in the frequency of each type of entry lesion investigated. In the year the patients were in the CHBC programme, 30% fewer of them experienced at least one attack of adenolymphangitis (ADL; P<0.001), the mean number of ADL attacks/patient was lower (P<0.001), and the mean duration of each ADL attack suffered was slightly shorter (5.70 v. 5.84 days; P>0.05) than in the year before the baseline assessment. The reduction in the incidence of ADL attacks was greatest in the patients with the higher grades of lymphoedema. Approximately 66% of the patients perceived an improvement in their swollen limb post-intervention. Eleven patients had grade-II lymphoedema at baseline but only grade-I lymphoedema after being on the CHBC programme for a year (P=0.012). The programme appeared to increase the frequencies with which patients followed each of the limb-care measures considered and most of the measures for the home management of ADL attacks that were investigated. It is recommended that the CHBC programme be implemented as a national programme in Sri Lanka.
Annals of Tropical Medicine and Parasitology 10/2007; 101(6):487-97. · 1.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: Knowledge of filariasis and perceptions of the disease were explored among 413 lymphoedema cases attending two filariasis clinics in the Colombo district of Sri Lanka. The information was collected in interviews based on a pre-tested, interviewer-administered questionnaire. Only 15% of the patients had initially attributed their limb swelling to filariasis. Most knew that filariasis resulted from mosquito bites (81.1%) and that the disease is transmissible (59.8%) and preventable (74.3%). The majority did not know, or were uncertain, whether filariasis causes swelling of the breasts in females (68.5%), scrotal swelling (60.7%) or dry cough/breathlessness (62.7%). Most (60%) of the interviewees wrongly believed that chronic filarial lymphoedema could be cured, primarily by long-term treatment with diethylcarbamazine. Knowledge of filariasis was significantly associated with level of education (P<0.05). Curiously, compared with the male interviewees, the females interviewed were much less likely to say that filariasis was the cause of their initial swelling (P<0.001). Those who had suffered with the disease for more than 1 year were not significantly more knowledgeable about the disease than the interviewees who had developed symptomatic filariasis more recently. Knowledge about the symptoms of filariasis was generally poor in the study population. In order to dispel several common myths about the disease, health-education programmes, that are targeted both at the community in general and at primary-care providers, are clearly needed.
Annals of Tropical Medicine and Parasitology 05/2007; 101(3):215-23. · 1.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: Information on the physical and psychosocial disability of lymphatic filariasis in Sri Lanka is scarce. Therefore this study was carried out to describe the physical disability and psychosocial impact associated with chronic lymphoedema in patients attending filariasis clinics in the Colombo district, Sri Lanka.
Four hundred and thirteen patients with lymphoedema of limbs attending filariasis clinics in Werahera and Dehiwala in the Colombo district were enrolled in the study after obtaining informed written consent. Data were collected using a pre-tested, interviewer-administered questionnaire and analyzed using SPSS.
Majority (95%) of patients had lower limbs affected and there was a significant association with difficulty in walking (p = 0.023). The swollen limb affected the work of 87 (52%) of employed patients and 26 persons reported loss of job. Approximately 25% and 6% reported having problems interacting with the community and family, respectively and 8.7% felt that they were rejected by society. The swollen limb was perceived as a major problem by 36.8% of patients. Of the married persons, 5.7% and 6.2% reported sexual and marital problems respectively, due to their swollen limb/s. Of those who had marital problems, 77.3% reported sexual problems as well (p < 0.001).
Lymphoedema significantly affects physical, psychological and social functioning in affected individuals. Morbidity control, in addition to control of physical disability, should target the psychosocial consequences.
[show abstract][hide abstract] ABSTRACT: Ipomoea aquatica Forsk is a common green leafy vegetable consumed in many parts of the world. The present study was designed to investigate the oral hypoglycaemic activity of Ipomea aquatica in streptozotocin induced diabetic Wistar rats, and Type II diabetic patients. Experimental diabetes was induced with streptozotocin in Wistar rats. The rats were then divided into test and control groups. In addition to the standard feed given to both groups the test was fed with the shredded leaves of Ipomoea aquatica (3.4 g/kg) for one week. Type II diabetic patients were subjected to a glucose challenge before and after a single dose of blended I. aquatica. Patients acted as their own controls. The results revealed that consumption of the shredded, fresh, edible portion of I. aquatica for one week, effectively reduced the fasting blood sugar level of streptozotocin-induced diabetic rats (p = 0.01). When subjected to a glucose challenge, the Type II diabetic subjects showed a significant reduction (p = 0.001) in the serum glucose concentration 2 h after the glucose load. However, it was not significantly reduced at 1 h (p < 0.09) post glucose load. There was a 29.4% decrease in the serum glucose concentration of the diabetic patients when treated with the plant extract.
Phytotherapy Research 11/2003; 17(9):1098-100. · 2.07 Impact Factor