Abstract
Although podoconiosis is one of the major causes of tropical lymphoedema and is endemic in Ethiopia its epidemiology and risk factors are poorly understood. Individual-level data for 129,959 individuals from 1,315 communities in 659 woreda (districts) were collected for a nationwide integrated survey of lymphatic filariasis and podoconiosis. Blood samples were tested for circulating Wuchereria bancrofti antigen using immunochromatographic card tests. A clinical algorithm was used to reach a diagnosis of podoconiosis by excluding other potential causes of lymphoedema of the lower limb. Bayesian multilevel models were used to identify individual and environmental risk factors. Overall, 8,110 of 129,959 (6.2%, 95% confidence interval [CI] 6.1–6.4%) surveyed individuals were identified with lymphoedema of the lower limb, of whom 5,253 (4.0%, 95% CI 3.9–4.1%) were confirmed to be podoconiosis cases. In multivariable analysis, being female, older, unmarried, washing the feet less frequently than daily, and being semiskilled or unemployed were significantly associated with increased risk of podoconiosis. Attending formal education and living in a house with a covered floor were associated with decreased risk of podoconiosis. Podoconiosis exhibits marked geographical variation across Ethiopia, with variation in risk associated with variation in rainfall, enhanced vegetation index, and altitude.
Highlights
Podoconiosis is a noninfectious disease arising in barefoot individuals who are in long-term contact with irritant red clay soil of volcanic origin.[1,2]
Thirty-three (4.8%) woreda were excluded or were inaccessible during the survey: 6 in Addis Ababa were excluded because of an exclusively urban population and almost universal shoe wearing practice, 23 in Somali were inaccessible as a result of conflict, and 1 in Oromia and 3 in Amhara had been merged or double counted
Understanding the epidemiology of a disease is the first step in designing control and prevention strategies
Summary
Podoconiosis (endemic non-filarial elephantiasis) is a noninfectious disease arising in barefoot individuals who are in long-term contact with irritant red clay soil of volcanic origin.[1,2] The disease causes progressive bilateral swelling of the lowerlegs.[2,3] the etiology is not fully understood, current evidence suggests that both genetic susceptibility and mineral particles from irritant volcanic soils play a role.[2,4,5] Podoconiosis is the second most common cause of tropical lymphoedema after lymphatic filariasis (LF).[6] Globally, it is estimated that there are 4 million people with podoconiosis, mainly in tropical Africa, Central and South America, and Southeast Asia.[3,4] Previous studies have documented the adverse consequences of the disease,[7,8,9,10,11] including reduced productivity.[7] Other studies have documented that on average, most patients have five or more episodes of recurrent inflammatory swelling of their lymphedematous legs (“acute attacks”) and lose productive days.[12,13,14] Severe stigma and discrimination are experienced by patients.[8,9,10,15] The country with the presumed greatest burden of podoconiosis is Ethiopia, with an estimated one million people living with the disease.[4]
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