Evaluating the cost of self-care: Impact of enhanced morbidity management protocol on people living with lymphatic filariasis in Bangladesh
5 affiliations
- 1Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- 2Filariasis Elimination and STH Control Programme, Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
- 3Centre for Injury Prevention and Research, Dhaka, Bangladesh
- 4Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island, United States of America
- 5Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
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.
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BibTeX
@article{williams2026evaluating,
title = {{Evaluating the cost of self-care: Impact of enhanced morbidity management protocol on people living with lymphatic filariasis in Bangladesh}},
author = {Tijana Williams and Mohammad Jahirul Karim and Samid Siddiqui and AKM Fazlur Rahman and Salim Chowdhury and Sharmin Jahan and Sultan Mahmood AMS and Shaun P. Forbes and Hannah Betts and Mark J. Taylor and Louise A. Kelly-Hope},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = oct,
doi = {10.1371/journal.pntd.0014812},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014812},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Evaluating the cost of self-care: Impact of enhanced morbidity management protocol on people living with lymphatic filariasis in Bangladesh
AU - Tijana Williams
AU - Mohammad Jahirul Karim
AU - Samid Siddiqui
AU - AKM Fazlur Rahman
AU - Salim Chowdhury
AU - Sharmin Jahan
AU - Sultan Mahmood AMS
AU - Shaun P. Forbes
AU - Hannah Betts
AU - Mark J. Taylor
AU - Louise A. Kelly-Hope
PY - 2026
DA - 2026/10/21
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014812
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014812
AB - 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.
SN - 1935-2735
ER -