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

Abstract 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. Methods 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. Results 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. Conclusions 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.