Abstract:
Lymphatic filariasis, a mosquito-borne parasitic disease, can lead to lymphoedema and
elephantiasis, is a major contributor to disability in the developing world. Information on the
disability and psychological impact of filarial lymphoedema patients in the community in
Sri Lanka are scarce. Morbidity control practices of the filarial lymphoedema (FL) patients
in a community setting were not assessed after their introduction, other than assessing in the
clinic setting. Therefore, this study was carried out to assess the disease status, health care
seeking behavior, acute adenolymphangitis (ADL) attacks, knowledge and practices related
to morbidity control among patients with filarial lymphoedema in the community and
compared the patients with a matched comparison group from the community for socio
demographic factors, disability, psychological distress and knowledge on filariasis. Study
had three components. Component I translated the World Health Organization Disability
Assessment Schedule II (WHODAS II) in to Sinhala and validated it among 180 patients
with filarial lymphoedema and their comparison group (180) in the Kalutara district before
its application in the main study. Even though, all the cases had ever attended at least one
allopathic doctor and treated with DEC, only 57 percent of cases had ever attended a
filariasis clinic and only 37 percent out of cases had visited the filariasis clinics during last
5 years after the commencement of educating the morbidity control measures in the year
2003. ADL attacks and repeated ADL attacks aggravate the swelling leading to
elephantiasis. About 80 percent of cases reported of ever having ADL attacks, 35.0 percent
had experienced ADL attacks during the last one year, while 17 percent had experienced
ADL attacks during the past three months. A majority had warmed their limbs (80.0 percent
) during ADL attacks, which is an incorrect practice. ADL attacks during last one year, was
significantly higher among those with: lower educational categories, lower income
categories (p =0.007), Grade III and Grade IV lymphoedema (p=O.OOO), not wearing
footwear (p~O.OOO), not practicing washing as a morbidity control measure (p -0.001), and
not attending the filarisis clinic during last 5 years (p-'O.O 15). The study concluded that
WHODAS II is a valid and reliable tool to assess disability among patients with filarial.
Community Home Based Care (CHBC) services should be provided to ensure the patients
practicing morbidity control measures. Measures should be taken to improve the
psychological wellbeing of the FL patients, as it was shown by both qualitative and
quantitative methods that they experience psychological distress. Counseling programmes
should be implemented targeting the clinic attendees and those in the community.
