Nodules as a Risk Factor for Acute Attacks in Lymphedema: Evidence from Addis Ababa City Administration, Ethiopia

Background Lymphedema is a chronic condition characterized by fluid accumulation and tissue swelling, often complicated by recurrent acute attacks. Nodules, a common feature of chronic lymphedema, may contribute to the frequency and severity of these episodes. However, nodules as a risk factor for acute attacks remains poorly understood. This study aimed to assess the prevalence of nodules, the frequency of acute attacks, and nodule as risk factor for acute attacks among individuals with lymphedema in Addis Ababa city Administration, Ethiopia.

A cross-sectional study was conducted among individuals with lymphedema in Addis Ababa city Administration. Data were collected using structured interviews and clinical examinations. The prevalence of nodules and acute attacks was determined, and logistic regression was used to assess their association.

Among the participants, 57.5% reported the presence of nodules affecting multiple areas of the lower limbs. Additionally, 41.2% experienced acute attacks, with an average of 5.89 episodes in the past six months. Logistic regression analysis revealed that individuals with nodules were 3.2 times more likely to experience acute attacks compared to those without nodules (p = 0.001). Other demographic and clinical factors, including sex and lymphedema severity, also showed trends associated with acute attack occurrence. Stigma was a significant concern, with 42.6% of participants reporting stigma from their communities (60.9%) and families (36.8%). Additionally, 34.8% of participants faced workplace challenges due to their condition.

The occurrence of nodules was associated with an increased risk of acute attacks. Both nodules and acute attacks were commonly observed. Many patients faced stigma from close family members and the surrounding community. Author Summary Lymphedema is a long-term condition that leads to swelling in the limbs due to fluid accumulation and impaired lymphatic function. People with lymphedema often experience recurrent acute attacks, which cause pain, inflammation, and disability. This study investigated the relationship between nodules—hardened tissue formations commonly found in chronic lymphedema—and the occurrence of acute attacks among individuals with lymphedema in Addis Ababa City Administration, Ethiopia. Our findings revealed that more than half of the participants had nodules, and over 40% experienced acute attacks, with an average of nearly six episodes in the past six months. We found that individuals with nodules were significantly more likely to suffer from acute attacks, suggesting that nodules may serve as reservoirs for bacteria or contribute to lymphatic obstruction. Additionally, many participants reported experiencing stigma from their communities and families, as well as difficulties in the workplace due to their condition. These findings highlight the need for early detection and management of nodules to prevent acute attacks, improve patient quality of life, and reduce the psychosocial and economic burden of lymphedema. Public health interventions should focus on improving self-care practices, providing accessible treatment options, and addressing stigma through education and community awareness programs. Future research should explore long-term strategies for preventing and managing nodules to reduce complications associated with lymphedema. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study did not receive any funding for the research or for article processing charges. While Footwork, the International Podoconiosis Initiative, provided funding to support the initiation of the Addis Ababa Podoconiosis Clinics, this was solely implementation funding. No funds were provided for study design, data collection, analysis, manuscript preparation, or publication. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Ethics Committee of Addis Ababa Health Bureau gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data generated or analyzed during this study are included in this published article.