{
  "abstract": "Background: Lymphatic filariasis (LF) causes chronic lymphoedema requiring long-term self-care, often at personal cost. In post-elimination settings such as Bangladesh, understanding the financial burden of self-care is critical for sustaining morbidity management and disability prevention (MMDP). This study evaluated self-care costs and the impact of an enhanced morbidity management protocol among people affected by filarial lymphoedema in Bangladesh. Methodology: A longitudinal cohort study was conducted in Lalmonirhat and Thakurgaon districts (2020–2021). People affected by mild, moderate, and severe lymphoedema (n = 290) were assessed at baseline, trained in an enhanced self-care protocol, and assessed at a 3-month follow-up and a final follow-up conducted at 6 months in Lalmonirhat and 9 months in Thakurgaon. Data were collected on clinical characteristics (lymphoedema stage, acute attacks, pain), self-care items (soap, cream, pain relief), related costs, and adherence. Results: At baseline, participants with mild (11.2–54.7%), moderate (21.9–39.5%), and severe (23.4–49.3%) lymphoedema were included, reflecting variation across districts. Acute attacks were reported by 62.8–79.6% of participants and severe pain by 40.6–54.6%. Following the intervention, acute attacks decreased to 25.2–35.2% and severe pain to 22.4–28.0% (p < 0.001). Baseline monthly total self-care expenditure ranged from 195.3–215.2 BDT (US$2.29–2.53), with participants with severe lymphoedema incurring significantly higher costs than those with mild disease in both districts (234.3 vs 159.2 BDT in Lalmonirhat and 234.2 vs 172.0 BDT in Thakurgaon; both p < 0.05). Total monthly expenditure remained broadly stable over time, but spending shifted significantly towards soap and cream, while expenditure on pain relief decreased (p < 0.001). Exploratory mixed-effects analyses supported these findings, showing that higher expenditure was independently associated with follow-up time, district and greater baseline lymphoedema severity. Conclusions: Enhanced self-care training was associated with reductions in reported acute attacks and pain and changes in spending towards preventive self-care practices but did not eliminate the ongoing financial burden of lymphoedema, particularly for individuals with severe disease. Exploratory adjusted analyses supported the descriptive findings, indicating that expenditure was influenced by follow-up time, district and disease severity. Sustainable MMDP programmes should prioritise equitable access to essential self-care supplies to reduce out-of-pocket costs and support long-term adherence. Author summary: Lymphatic filariasis is a disabling neglected tropical disease that can cause chronic swelling of the limbs, known as lymphoedema. In many low-income settings, people affected rely on lifelong self-care at home—washing affected limbs, applying creams, and managing pain—often at their own expense. This study followed 290 people living with limb lymphoedema in two rural districts of northern Bangladesh, where access to health services is limited and household resources are constrained. Participants received training in an enhanced self-care protocol and were followed over a period of 6 months in Lalmonirhat and 9 months in Thakurgaon. Changes in clinical outcomes (disease stage, acute attacks, and pain) and monthly spending on key self-care items were recorded.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom",
    "Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh",
    "Centre for Injury Prevention and Research, Dhaka, Bangladesh",
    "Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island, United States of America",
    "Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Tijana Williams"
    },
    {
      "affs": [
        1
      ],
      "name": "Mohammad Jahirul Karim"
    },
    {
      "affs": [
        2
      ],
      "name": "Samid Siddiqui"
    },
    {
      "affs": [
        3
      ],
      "name": "AKM Fazlur Rahman"
    },
    {
      "affs": [
        4
      ],
      "name": "Salim Chowdhury"
    },
    {
      "name": "Sharmin Jahan"
    },
    {
      "name": "Sultan Mahmood AMS"
    },
    {
      "name": "Shaun P. Forbes"
    },
    {
      "name": "Hannah Betts"
    },
    {
      "name": "Mark J. Taylor"
    },
    {
      "name": "Louise A. Kelly-Hope"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6718528919d3w.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pntd.0014812",
  "fulltext_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014812",
  "id": "6718528919d3w",
  "issns": [
    "1935-2735"
  ],
  "landing_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014812",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2725|Parasitic Diseases Research and Treatment"
    ],
    [
      "plos",
      "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Pain"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Health economics"
    ],
    [
      "plos",
      "/Medicine and health sciences/Health care/Health statistics/Morbidity"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Parasitic diseases/Helminth infections/Filariasis/Lymphatic filariasis"
    ],
    [
      "plos",
      "/Medicine and health sciences/Medical conditions/Tropical diseases/Neglected tropical diseases/Lymphatic filariasis"
    ],
    [
      "plos",
      "/Medicine and health sciences/Public and occupational health"
    ],
    [
      "plos",
      "/People and places/Geographical locations/Asia/Bangladesh"
    ],
    [
      "plos",
      "/Physical sciences/Chemistry/Chemical compounds/Salts/Soaps"
    ],
    [
      "plos",
      "/Social sciences/Economics/Finance"
    ],
    [
      "plos",
      "/Social sciences/Economics/Health economics"
    ]
  ],
  "openalex": "W7223148741",
  "pdf_url": "https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0014812&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-21",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/6718528919d3w.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:23Z",
      "native_id": "10.1371/journal.pntd.0014812",
      "source": "plos",
      "url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014812"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "plos:public and occupational health",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Evaluating the cost of self-care: Impact of enhanced morbidity management protocol on people living with lymphatic filariasis in Bangladesh",
  "title_text": "Evaluating the cost of self-care: Impact of enhanced morbidity management protocol on people living with lymphatic filariasis in Bangladesh",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:23Z",
  "url": "https://research.draconitic.com/paper/6718528919d3w",
  "venue": "PLOS Neglected Tropical Diseases",
  "versions": []
}