{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:38:47Z","timestamp":1792802327436,"version":"4.5.0"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"USTTB","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"https:\/\/ror.org\/023rbaw78","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Research shows that a local hygiene package washing, wound care, and exercise improves lymphedema (LE) patients\u2019 quality of life by reducing ADLA, costs, stigma, and boosting work capacity. The \u2018LEdoxy\u2019 study, a 24-month, multicountry, double-blind, randomized controlled trial of doxycycline plus hygiene, investigated the efficacy of daily doxycycline versus a placebo for lymphatic filariasis in Mali, India, and Sri Lanka. All \u2018LEdoxy\u2019 participants consistently followed a standardized hygiene program. This study, embedded within the previous \u2018LEdoxy\u2019 study, assessed cost reductions in ADLA management and evaluated the social impact of the regular local care based on the HP among LE patients in Mali. We conducted a cross-sectional study embedded in \u201cLEdoxy\u201d study participants in the health districts of Kolondieba and Kolokani from September to December 2021. Questionnaire was used to collect retrospective data on pre-trial conditions and prospective data on post-trial conditions. Data were collected using a digital questionnaire and qualitative methods, including in-depth interviews and focus group discussions with interview guide, without recycling \u2018LEDoxy\u2019 data. These quantitative data were analysed using SPSS version 25.0. We performed a thematic analysis approach using Quirkos version 2. We investigated 196 LE patients with a median age of 56 years [range: 25-70 years]. We observed a reduction in the monthly frequency of acute ADLA from 90.8% (178\/196) before the trial to 43.9%, (86\/196) after the trial (p&lt;0.05). Importantly, in term of economic evaluation the average ADLA attack management cost decreased significantly from US$20.01(\u00b1 US $18.56) before the trial to US$5.7(\u00b1 US $4.78), after the trial (p&lt; 0.001). Patients reported that the hygiene program reduced social isolation and stigma and improved their ability to work. Using a basic care package improved LE patients\u2019 quality of life by lowering ADLA costs. To sustain this, community-based programs that include income-generating activities are essential.<\/jats:p>","DOI":"10.1371\/journal.pgph.0005454","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T18:26:42Z","timestamp":1762885602000},"page":"e0005454","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Implementation of basic package of care improved socio-economic conditions of lymphedema patients in rural Mali after two years follow-up"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4234-3488","authenticated-orcid":true,"given":"Housseini","family":"Dolo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diadje","family":"Tanapo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3860-5203","authenticated-orcid":true,"given":"Sekou Oumarou","family":"Thera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moussa","family":"Sangar\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdoul Fatao","family":"Diabat\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0042-7019","authenticated-orcid":true,"given":"Lamine","family":"Diarra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salif S\u00e9riba","family":"Doumbia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siaka Yamoussa","family":"Coulibaly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6532-4925","authenticated-orcid":true,"given":"Ilo","family":"Dicko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oumar","family":"Coulibaly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ousmane","family":"Faye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamadoun","family":"Sangho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seydou","family":"Doumbia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaya Ibrahim","family":"Coulibaly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas B.","family":"Nutman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"issue":"7","key":"pgph.0005454.ref001","doi-asserted-by":"crossref","first-page":"3907","DOI":"10.3390\/ijms25073907","article-title":"The Role of Inflammation in Lymphedema: A Narrative Review of Pathogenesis and Opportunities for Therapeutic Intervention","volume":"25","author":"C Bowman","year":"2024","journal-title":"Int J Mol Sci"},{"issue":"11","key":"pgph.0005454.ref002","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0008839","article-title":"Morbidity management and surveillance of lymphatic filariasis disease and acute dermatolymphangioadenitis attacks using a mobile phone-based tool by community health volunteers in Ghana","volume":"14","author":"LB Debrah","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"key":"pgph.0005454.ref003","doi-asserted-by":"crossref","first-page":"22","DOI":"10.4269\/ajtmh.23-0908","article-title":"Effect of Adding a Six-Week Course of Doxycycline to Intensive Hygiene-Based Care for Improving Lymphedema in a Rural Setting of Mali: A Double-Blind, Randomized Controlled 24-Month Trial","volume":"111","author":"YI Coulibaly","year":"2024","journal-title":"Am J Trop Med Hyg"},{"issue":"12","key":"pgph.0005454.ref004","doi-asserted-by":"crossref","first-page":"2003","DOI":"10.1161\/CIRCRESAHA.121.318307","article-title":"Advances in Lymphedema","volume":"128","author":"SG Rockson","year":"2021","journal-title":"Circ Res"},{"key":"pgph.0005454.ref005","article-title":"Aspects \u00e9pid\u00e9miologiques et cliniques du lymph\u0153d\u00e8me dans le service de dermatologie du CHU Gabriel Tour\u00e9 (Bamako)","author":"M Gassama","year":"2018","journal-title":"Health Sciences and Diseases"},{"issue":"1","key":"pgph.0005454.ref006","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s13561-022-00388-6","article-title":"Cost of a lymphedema treatment mandate - 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