Lymphoedema Evidence Library › Topics › Services in South Africa
Services in South Africa
Services and the South African context
40 sources
Evidence in one minute
- LAOSA (founded 2012) certifies therapists with ≥135 hours of training and keeps a national practice register; its 2018 position statement defines lymphoedema, staging, diagnosis, CDT, compression classes, contraindications and surgery for SA use and argues for Prescribed Minimum Benefit status. Davey 2018
- Workforce (2014): ~67 certified therapists, <10% in the public sector; no official BCRL guideline; garments and bandages rarely available in public hospitals; medical aids pay little. Proposed pathway: every newly diagnosed breast cancer patient measured before treatment; symptomatic patients at clinics to trained staff and home-based carers. Marco 2014
- Burden: no SA prevalence data; 530 000–1.06 million is an extrapolation of an uncited “WHO 2014” 1–2% figure — do not quote as data (revised 2026-10-09). Davey 2014
- Practice realities: OT-made garments of unknown pressure, long custom lead times, adherence problems, cellulitis admissions. Vivian 2019
- Service models: Lymphoedema Framework service template (UK), Dutch expert-centre chronic-care model inside the ILF surgery document, Canadian Lymphedema Framework with accredited online training. Lymphoedema Framework 2007 · International Lymphoedema Framework 2012 · Canadian Lymphedema Framework 2023
- Historic SA surgical literature (lymphangiography 1966–1971, secondary lymphoedema 1970) — citation only. Abramowitz 1970
- Mayrovitz/Davey research programme (Florida, 2005–2014): Suzi (Humen) Davey — later a member of the LAOSA position-statement panel, based in Hillcrest, KwaZulu-Natal — co-authored the tissue dielectric constant and pneumatic compression studies. Mayrovitz 2014 · Fife 2012
Update 2026-10-08 — downloaded evidence
- LMIC burden: after breast cancer treatment, arm lymphoedema prevalence ~27%; no South African cohort in the meta-analysis. Torgbenu 2020
- Self-care training is effective and suits limited therapist capacity. Douglass 2016
- Rural residence increased chronic BCRL in PREVENT — relevant to SA access. Boyages 2023
- LVA economics: not cost-effective from a health-service perspective in the Netherlands. Kleeven 2026
Appraisal update 2026-10-09
- SA opinion pieces appraised (JBI text and opinion): Marco 2014 4/6 (workforce figure from LAOSA, not a survey; staging non-standard); Davey 2014 3/6 (author founded LAOSA, which the article promotes). Marco 2014 · Davey 2014
- Ebrahim 2009 now read (free on SciELO SA): HIV-associated Kaposi lymphoedema with popliteal HIV thrombosis and gangrene in a 34-year-old Durban man — a local differential diagnosis. Ebrahim 2009
- Swedish practice (Nikolaidis 2013): early education and measurement after node surgery, compression first, MLD only as a self-massage trial — a model for scarce therapist time. Nikolaidis 2013
Gaps
No SA epidemiology, cost or outcome data; no SA guideline on surgery; LAOSA's planned consensus document (2018) not held.
Update 2026-10-09 — open-access batch 1 (2020–2026 trials and reviews)
- Low-cost compression model: AMPATH (Kenya) makes two-layer zinc-paste bandages locally for ~US$2 per leg per week v US$7–20 imported; patients preferred home or group bandaging to weekly clinic travel. Effect unproven (pilot). Chang 2022
Update 2026-10-09 — open-access batch 2
- Garment-first for early BCRL (UK practice) is not shown inferior to intensive therapist-delivered DLT — relevant where therapist capacity is scarce, as in the SA public sector (very low). Jeffs 2024
Update 2026-10-09 — South African papers supplied by Dr Weir (Sabinet)
- Workforce: about 67 trained lymphoedema therapists in 2014, fewer than 10% in the public sector (Marco 2014). In 2023 only 38% of 402 responding physiotherapists treated lymphoedema, 16% of those had certified training, and 31% offered full decongestive therapy; most saw 0–5 patients a month (Rhodes 2023, self-selected 5% sample). Marco 2014 · Rhodes 2023
- Frequency in hospital clinics: lymphoedema was 0.05% of Baragwanath (1970) and 0.14% of Ga-Rankuwa (1982) dermatology referrals — no SA population prevalence study exists. Dogliotti 1970 · Schulz 1982
- History: CDT was introduced to SA physiotherapy by 1986 (Goodenough) and promoted to doctors in 1992 with benzopyrones (Casley-Smith — benzopyrone claims since disproved). Goodenough 1986 · Casley-Smith 1992
Update 2026-10-09 — open-access batch 4
- Teaching self-CDT may stretch scarce therapist time: equal results to therapist CDT in a small Turkish RCT (low). Gultekin 2025
- Gynae-oncology units: a nurse-taught self-care package with light hosiery halved first-year leg lymphoedema (low). Wang 2020
Update 2026-10-09 — open-access batch 5
- African trial (Egypt): VR and PNF exercise equally effective alongside MLD and IPC (very low). Atef 2020
Update 2026-10-09 — open-access batch 6
- Phone-based support: an Iranian self-management app improved QoL and arm circumference over 3 months (Hemati 2025, 180 women, prospectively registered) — low; Telegram-channel education showed little effect (Omidi 2020). Relevant where clinic visits are hard. Hemati 2025 · Omidi 2020
- Rural residence is a risk factor for BCRL (PREVENT). Koelmeyer 2022
Update 2026-10-09 — open-access batch 7
- A good leaflet is enough: web multimedia teaching added nothing over a pamphlet (Ridner 2020). Head and neck self-management teaching looked effective (Deng 2025). Ridner 2020 · Deng 2025
Update 2026-10-09 — open-access batch 8 (reviews)
- Telemedicine triage: Spanish Lymphology Group criteria for remote v face-to-face care (COVID-19) — a usable template for outreach. Forner Cordero I 2020
Update 2026-10-09 — open-access batch 9 (reviews)
- Guidelines are weak: only four lymphoedema CPGs qualified and all scored low on AGREE II (CREST best, 67%) — supports writing an evidence-based local guideline. Patient education: no best format; keep it brief, repeated, with a named contact. O'Donnell TF Jr 2020 · O'Donnell TF Jr 2020 · Perdomo 2023
Update 2026-10-09 — open-access batch 12 (reviews; final)
- Online information is poor (median EQIP 22/36; 75% omit risks) — keep patient pages clear on options, risks and numbers (Kok 2026). Psychosocial support is barely studied; hybrid clinic-plus-remote looks best (Stolker 2026). Kok 2026 · Stolker 2026
How the evidence points
| High | Mod. | Low | V. low | None | |
|---|---|---|---|---|---|
| Positive | 0 | 0 | 4 | 0 | 0 |
| Null or negative | 0 | 1 | 2 | 3 | 0 |
Sources on this page with a comparison, by the result of their primary outcome and the GRADE certainty of their main finding (Mod. = Moderate, V. low = Very low, None = not graded). Context sources are not counted. How direction is decided.
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