Lymphoedema management in podoconiosis – Authors reply
Authors: Meseret Molla, Moses Ngari, James A Berkley, Patricia Njuguna, Greg Fegan, Trudie Lang, Melanie J Newport, Fikre Enquoselassie, Gail Davey
Journal: The Lancet Global Health (2018)

We thank Jill Brooks and colleagues for their comments on how their trial was referred to in our article.1Negussie H Molla M Ngari M et al.Lymphoedema management to prevent acute dermatolymphangioadenitis in podoconiosis in northern Ethiopia (GoLBeT): a pragmatic randomised controlled trial.Lancet Glob Health. 2018; 6: e795-e803Summary Full Text Full Text PDF PubMed Scopus (41) Google Scholar We used the adjective “small” to provide context for readers of The Lancet Global Health. Given that the average number of individuals in the nine non-stepped-wedge trials reported so far in this journal in 2018 was over 3600, both the Brooks trial2Brooks J Ersser SJ Cowdell F Gardiner E Mengistu A Matts PJ A randomised controlled trial to evaluate the effect of a new skin care regimen on skin barrier function in those with podoconiosis in Ethiopia.Br J Dermatol. 2017; 177: 1422-1431Crossref PubMed Scopus (12) Google Scholar and GoLBeT1Negussie H Molla M Ngari M et al.Lymphoedema management to prevent acute dermatolymphangioadenitis in podoconiosis in northern Ethiopia (GoLBeT): a pragmatic randomised controlled trial.Lancet Glob Health. 2018; 6: e795-e803Summary Full Text Full Text PDF PubMed Scopus (41) Google Scholar are small by comparison. Small trials can be highly efficient, and the term is not used pejoratively. The point we were trying to make in the introduction was around the type of question GoLBeT was designed to answer, and how this differed from earlier studies. One earlier study was uncontrolled,3Sikorski C Ashine M Zeleke Z Davey G Effectiveness of a simple lymphoedema treatment regimen in podoconiosis management in southern Ethiopia: one year follow-up.PLoS Negl Trop Dis. 2010; 4: e902Crossref PubMed Scopus (62) Google Scholar while the Brooks and colleagues2Brooks J Ersser SJ Cowdell F Gardiner E Mengistu A Matts PJ A randomised controlled trial to evaluate the effect of a new skin care regimen on skin barrier function in those with podoconiosis in Ethiopia.Br J Dermatol. 2017; 177: 1422-1431Crossref PubMed Scopus (12) Google Scholar trial compared different approaches to foot hygiene, rather than foot hygiene versus no foot hygiene. Brooks and colleagues2Brooks J Ersser SJ Cowdell F Gardiner E Mengistu A Matts PJ A randomised controlled trial to evaluate the effect of a new skin care regimen on skin barrier function in those with podoconiosis in Ethiopia.Br J Dermatol. 2017; 177: 1422-1431Crossref PubMed Scopus (12) Google Scholar showed less transepidermal water loss and greater stratum corneum hydration with glycerol than with water alone, whereas GoLBeT tested a composite package versus no package. The question GoLBeT was designed to answer came from a public health perspective within the Ethiopian Federal Ministry of Health, who asked for evidence of the effectiveness of the most basic package of treatment, compared with none, under pragmatic field circumstances. This research aimed to assist decisions on the value, or absence of value, of scale-up of provision of lymphoedema care through the state health system of Ethiopia. Lastly, we recognise that Brooks and colleagues investigated days of work lost to acute adenolymphangitis, a secondary outcome of GoLBeT, which differs from acute dermatolymphangioadenitis incidence. We applaud the Brooks team for measuring transepidermal water loss and stratum corneum hydration, which we agree are important in the pathogenesis of podoconiosis and its sequelae. Our primary outcome was selected from a public health perspective, following consultation with patients, carers, and service providers who identified acute dermatolymphangioadenitis incidence as the most debilitating consequence of the disease. We declare no competing interests. Lymphoedema management to prevent acute dermatolymphangioadenitis in podoconiosis in northern Ethiopia (GoLBeT): a pragmatic randomised controlled trialA simple, inexpensive package of lymphoedema self-care is effective in reducing the frequency and duration of acute dermatolymphangioadenitis. We recommend its implementation by the governments of endemic countries. Full-Text PDF Open AccessLymphoedema management in podoconiosisAs researchers in the skin treatment of podoconiosis, we were interested to read the Article by Henok Negussie and colleagues on lymphoedema management to prevent acute dermatolymphangioadenitis in podoconiosis (July, 2018).1 Full-Text PDF Open Access