Detecting and staging podoconiosis cases in North West Cameroon: positive predictive value of clinical screening of patients by community health workers and researchers

Abstract

BackgroundThe suitability of using clinical assessment to identify patients with podoconiosis in endemic communities has previously been demonstrated. In this study, we explored the feasibility and accuracy of using Community Health Implementers (CHIs) for the large scale clinical screening of the population for podoconiosis in North-west Cameroon.MethodsBefore a regional podoconiosis mapping, 193 CHIs and 50 health personnel selected from 6 health districts were trained in the clinical diagnosis of the disease. After training, CHIs undertook community screening for podoconiosis patients under health personnel supervision. Identified cases were later re-examined by a research team with experience in the clinical identification of podoconiosis.ResultsCases were identified by CHIs with an overall positive predictive value (PPV) of 48.5% [34.1–70%]. They were more accurate in detecting advanced stages of the disease compared to early stages; OR 2.07, 95% CI = 1.15–3.73, p = 0.015 for all advanced stages). Accuracy of detecting cases showed statistically significant differences among health districts (χ2 = 25.30, p = 0.0001).ConclusionPodoconiosis being a stigmatized disease, the use of CHIs who are familiar to the community appears appropriate for identifying cases through clinical diagnosis. However, to improve their effectiveness and accuracy, more training, supervision and support are required. More emphasis must be given in identifying early clinical stages and in health districts with relatively lower PPVs.

Community based cross sectional study of podoconiosis and associated factors in Dano district, Central Ethiopia

“…The questionnaire includes socio-demographic factors, behavioral factors, genetic factor and housing conditions. A questionnaire was adapted and prepared from related literature with modification to local context [10,12,18–20,24–26] (S2 Text). Six diploma nurses for data collection, three laboratory technologists for blood collection and two Public Health officers for supervision were recruited from Dano health center (nearby health center) and trained in data collection.…”

Predicted distribution and burden of podoconiosis in Cameroon

“…Preliminary community screening was carried out by trained community health implementers, and final confirmation of podoconiosis was done by expert research assistants and health personnel following a standardised clinical diagnosis algorithm. 21 23 Overall, in the 19 Health Districts of the North West region of Cameroon, 204 551 individuals from 672 communities were investigated for podoconiosis. The second study was a nationwide cross-sectional survey conducted in 40 Health Districts from all 10 regions of Cameroon.…”

Global epidemiology of podoconiosis: A systematic review

“…Only two countries (Ethiopia and Rwanda) report podoconiosis within their routine health management information systems [ 12 ]. In other well-known or suspected endemic countries, the existence of podoconiosis is based on cross-sectional surveys, case reports and presence reports intended to ascertain the disease presence and burden in specific areas [ 13 , 14 ].Therefore, to understand the global distribution of podoconiosis, compiling the existing evidence is of utmost importance. Keeping these repositories of epidemiological data up-to-date will be relevant for further monitoring and evaluation of interventions put in place, as similar experiences have come to demonstrate [ 15 , 16 ].…”