A Longitudinal Analysis of the Effect of Mass Drug Administration on Acute Inflammatory Episodes and Disease Progression in Lymphedema Patients in Léogane, Haiti

Brittany A. Eddy Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Decatur, Georgia; Children Without Worms, Task Force for Global Health, Decatur, Georgia; Center for Tropical Disease Research and Training, University of Notre Dame, Notre Dame, Indiana; and Lymphatic Filariasis Program, Hôpital Sainte Croix, Léogane, Haiti

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Anna J. Blackstock Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Decatur, Georgia; Children Without Worms, Task Force for Global Health, Decatur, Georgia; Center for Tropical Disease Research and Training, University of Notre Dame, Notre Dame, Indiana; and Lymphatic Filariasis Program, Hôpital Sainte Croix, Léogane, Haiti

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John M. Williamson Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Decatur, Georgia; Children Without Worms, Task Force for Global Health, Decatur, Georgia; Center for Tropical Disease Research and Training, University of Notre Dame, Notre Dame, Indiana; and Lymphatic Filariasis Program, Hôpital Sainte Croix, Léogane, Haiti

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David G. Addiss Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Decatur, Georgia; Children Without Worms, Task Force for Global Health, Decatur, Georgia; Center for Tropical Disease Research and Training, University of Notre Dame, Notre Dame, Indiana; and Lymphatic Filariasis Program, Hôpital Sainte Croix, Léogane, Haiti

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Thomas G. Streit Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Decatur, Georgia; Children Without Worms, Task Force for Global Health, Decatur, Georgia; Center for Tropical Disease Research and Training, University of Notre Dame, Notre Dame, Indiana; and Lymphatic Filariasis Program, Hôpital Sainte Croix, Léogane, Haiti

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Valery M. Beau de Rochars Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Decatur, Georgia; Children Without Worms, Task Force for Global Health, Decatur, Georgia; Center for Tropical Disease Research and Training, University of Notre Dame, Notre Dame, Indiana; and Lymphatic Filariasis Program, Hôpital Sainte Croix, Léogane, Haiti

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LeAnne M. Fox Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Atlanta Research and Education Foundation, Decatur, Georgia; Children Without Worms, Task Force for Global Health, Decatur, Georgia; Center for Tropical Disease Research and Training, University of Notre Dame, Notre Dame, Indiana; and Lymphatic Filariasis Program, Hôpital Sainte Croix, Léogane, Haiti

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We conducted a longitudinal analysis of 117 lymphedema patients in a filariasis-endemic area of Haiti during 1995–2008. No difference in lymphedema progression between those who received or did not receive mass drug administration (MDA) was found on measures of foot (P = 0.24), ankle (P = 0.87), or leg (P = 0.46) circumference; leg volume displacement (P = 0.09), lymphedema stage (P = 0.93), or frequency of adenolymphangitis (ADL) episodes (P = 0.57). Rates of ADL per year were greater after initiation of MDA among both groups (P < 0.01). Nevertheless, patients who received MDA reported improvement in four areas of lymphedema-related quality of life (P ≤ 0.01). Decreases in foot and ankle circumference and ADL episodes were observed during the 1995-1998 lymphedema management study (P ≤ 0.01). This study represents the first longitudinal, quantitative, leg-specific analysis examining the clinical effect of diethylcarbamazine on lymphedema progression and ADL episodes.

Author Notes

* Address correspondence to LeAnne M. Fox, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-06, Atlanta, GA 30333. E-mail: lfox@cdc.gov

Financial support: This study was supported by The University of Notre Dame Haiti Program with funding by the Bill and Melinda Gates Foundation; the Framework in Global Health (grant 5 R25 TW7733) to Emory University from the Fogarty International Center, National Institutes of Health; and the Centers for Disease Control and Prevention.

Authors' addresses: Brittany A. Eddy, c/o Partners in Health, Boston, MA, E-mail: beddy@pih.org, Anna J. Blackstock and LeAnne M. Fox, Centers for Disease Control and Prevention, Atlanta, GA, E-mails: ablackstock@cdc.gov and lfox@cdc.gov. John M. Williamson, Center for Global Health Research, Centers for Disease Control and Prevention, Kenya Medical Research Institute, Kisian Kisumu, Kenya, E-mail: jwilliamson@ke.cdc.gov. David G. Addiss, Children Without Worms, Task Force for Global Health, Decatur, GA, E-mail: daddiss@taskforce.org. Thomas G. Streit, Center for Tropical Disease Research and Training, University of Notre Dame, Notre Dame, IN, E-mail: streit1@nd.edu. Valery M. Beau de Rochars, Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, E-mail: madsenbeau@phhp.ufl.edu.

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