Abstract:
Introduction: Compression therapy is well established standard of care for chronic leg
ulcers from venous disease and lymphedema.
Chronic leg ulcers and lymphedema have a
significant impact on quality of life, driven by
pain, foul odor, and restricted mobility. Provision of layered compression therapy in
resource-limited settings, as in Western Kenya
and other regions of sub-Saharan Africa, is a
major challenge due to several barriers: availability, affordability, and access to healthcare
facilities. When wound care providers from an Academic Model Providing Access to Healthcare
(AMPATH) health center in Western Kenya
noted that a donated, finite supply of two component compression bandages was helping
to heal chronic leg ulcers, they began to explore
the potential of finding a local, sustainable
solution. Dermatology and pharmacy teams
from AMPATH collaborated with health center
providers to address this need.
Methods: Following a literature review and
examination of ingredients in prepackaged
brand-name kits, essential components were
identified: elastic crepe, gauze, and zinc oxide
paste. All of these materials are locally available
and routinely used for wound care. Two-component compression bandages were made by
applying zinc oxide to dry gauze for the inner
layer and using elastic crepe as the outer layer.
Feedback from wound clinic providers was utilized to optimize the compression bandages for
ease of use.
Results: Adjustments to assembly of the paste
bandage included use of zinc oxide paste
instead of zinc oxide ointment for easier gauze
impregnation and cutting the inner layer gauze
in half lengthwise to facilitate easier bandaging
of the leg, such that there were two rolls of zinc impregnated gauze each measuring
5 inches 9 2 m. Adjustments to use of the
compression bandage have included increasing
the frequency of bandage changes from 7 to
3 days during the rainy seasons, when it is difficult to keep the bandage dry. Contiacquisition of all components led to lower price
quotes for bulk materials, driving down the
production cost and enabling a cost to the
patient of 200 KSh (2 USD) per two-component
compression bandage kit. Wound care providers
have provided anecdotal reports of healed
chronic leg ulcers (from venous stasis, trauma),
improved lymphedema, and patient tolerance
of compression.
Conclusions: Low-cost locally sourced two component compression bandages have been
developed for use in Western Kenya. Their use
has been initiated at an AMPATH health center
and is poised to meet the need for affordable
compression therapy options in Western Kenya.
Studies evaluating their efficacy in chronic leg
ulcers and Kaposi sarcoma lymphedema are
ongoing. Future work should address adaptation of compression bandages for optimal use in
Western Kenya and evaluate reproducibility of
these bandages in similar settings, as well as
consider home- or community-based care
delivery models to mitigate transportation costs
associated with accessing healthcare facilities.