Lymphatic filariasis (LF) causes disfiguring and disabling lymphoedema, which can lead to mental distress and requires life-long self-care treatment. This study applies syndemic theory to understand the biosocial relationship between LF and mental distress in Malawi. Using in-depth qualitative methods, we critically evaluate experiences of mental distress and LF through 21 life-history interviews, to narrate experiences from the perspective of persons affected by LF, and to understand how enhanced self-care (ESC) for lymphoedema management disrupts the syndemic relationship. Complementary key informant interviews with Ministry of Health LF programme staff were conducted to further understand intervention and health system delivery. All interviews were recorded, transcribed, and translated, and then subject to thematic analysis. Our findings suggest that for persons affected by LF in Malawi, before being trained in ESC, absent referral pathways, inequalities in healthcare provision or available treatment, and limited knowledge of the condition (LF) drove the syndemic of LF and mental distress. Distress was often exacerbated by stigma and social exclusion, and shaped by intersections of gender, generation, poverty, and extreme climate conditions. We argue that addressing the syndemic suffering associated with LF and mental distress through interventions which center the needs of persons affected is critical in effective and equitable LF care delivery.

UNASSIGNED: Poor access to lymphoedema specialists and communication between them and patients prevents appropriate lymphoedema management. Therefore, development and dissemination of remote systems is necessary to improve care in rural areas with limited medical personnel or access to medical coordination.
UNASSIGNED: The authors evaluated the elements required for providing patient education on conservative therapy for lymphoedema, to determine the feasibility of remote management.
UNASSIGNED: The study involved connecting a health professional in a local clinic (point A) treating a patient with lymphoedema, who was present alongside the clinician, with a specialist certified lymphoedema therapist (CLT) located remotely in a university (point B).
UNASSIGNED: The CLT was able to greet, interview and provide guidance to the patient on conservative therapy. Direct contact with the patient was not possible, which limited visualisation, palpation, leg circumference measurement, and lymphatic drainage management.
UNASSIGNED: The findings suggest that remote a lymphoedema management approach involving conservative therapy benefits both patients and health professionals, particularly in rural regions. Future studies are needed to confirm the effectiveness of this approach to confirm adequate treatment.

BACKGROUND: Many clinicians recognise the importance of the patient\'s role in treating and managing lymphoedema and that optimal outcomes depend on patients\' compliance to treatment, or a prescribed daily lymphoedema care regimen. Such a widespread belief can be called a \'compliance paradigm\'.
OBJECTIVE: To ascertain whether breast cancer survivors with lymphoedema have the same concept of compliance as clinicians to characterise their experiences.
METHODS: Using a descriptive phenomenological method, 34 participants were recruited and 102 interviews completed.
RESULTS: The findings of the study reveal that, from the perspective of breast cancer survivors, managing lymphoedema is broader than compliance to treatment. The women actively structured their lives to make lymphoedema management feasible by incorporating it into a daily routine. The study offers an alternative insight into the compliance approach to lymphoedema management and it is important for researchers and clinicians to be aware that breast cancer survivors do not consider compliance to treatment as part of their daily lymphoedema care.
CONCLUSIONS: In research and practice, it may be more appropriate to assess the presence or absence of breast cancer survivors\' intentions, effective and ineffective strategies, and barriers to effective strategies.