Epidemiology and Individual, Household and Geographical Risk Factors of Podoconiosis in Ethiopia: Results from the First Nationwide Mapping

Deribe, Kebede; Brooker, Simon; Pullan, Rachel L.; Sime, Heven; Gebretsadik, Abeba; Assefa, Ashenafi; Kebede, Amha; Hailu, Asrat; Rebollo, Maria P.; Shafi, Oumer; Bockarie, Moses J.; Aseffa, Abraham; Reithinger, Richard; Cano, Jorge; Enquselassie, Fikre; Newport, Melanie J.; Davey, Gail

doi:10.4269/ajtmh.14-0446

Cited by 78 publications

(125 citation statements)

References 36 publications

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“…Our model predicted environmental suitability for podoconiosis in many areas in Africa, with the strongest prediction largely in East, West and Central Africa Regions. In agreement with previous work, our model showed podoconiosis environmental suitability is largely influenced by annual precipitation, elevation, clay fraction and pH of the soil 17–19,36,47 . The novelty of this study was in translating suitability to the IU level: aggregated risk at the IU level aids in mapping podoconiosis.…”

Section: Discussionsupporting

confidence: 92%

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Predicting the Environmental Suitability and Population at Risk of Podoconiosis in Africa

Deribe

Simpson

Pullan

et al. 2020

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BackgroundPodoconiosis is a type of tropical lymphedema that causes massive swelling of the lower limbs. The disease is associated with both economic insecurity, due to long-term morbidity-related loss of productivity, and intense social stigma. The geographical distribution and burden of podoconiosis in Africa is uncertain.MethodsWe applied statistical modelling to the most comprehensive database compiled to date to predict the environmental suitability of podoconiosis in the African continent. By combining climate and environmental data and overlaying population figures, we predicted the suitability and human population at risk.ResultsIn Africa, environmental suitability for podoconiosis was predicted in 29 countries. By 2020, the total population in areas suitable for podoconiosis was estimated at 114.5 million people, (95% confidence interval: 109.4-123.9) with 16.9 million in areas suitable for both lymphatic filariasis and podoconiosis. Of the total 5,712 implementation units defined by WHO in Africa, 1,655 (29.0%) were found to be environmentally suitable for podoconiosis. The majority of IUs with high environmental suitability are located in Angola (80 IUs), Cameroon (170 IUs), the DRC (244 IUs), Ethiopia (495 IUs), Kenya (217 IUs), Uganda (116 IUs) and Tanzania (112 IUs). Of the 1,655 environmental suitable IUs, 960 (58.0%) require more detailed community-level mappingConclusionsOur estimates provide key evidence of the population at risk and geographical extent of podoconiosis in Africa, which will help decision-makers to better plan more integrated intervention programmes.

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Section: Discussionsupporting

confidence: 92%

“…silt and clay soil fraction) and 7) soil pH. These climate, topographical, environmental and soil-related factors have been found to be associated with the occurrence of podoconiosis in several studies 18–20,36 .…”

Section: Methodsmentioning

confidence: 98%

Predicting the Environmental Suitability and Population at Risk of Podoconiosis in Africa

Deribe

Simpson

Pullan

et al. 2020

Preprint

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“… *Adjusted effect estimate: Molla et al [38] . *Inverted Log [odds ratio] and standard error (SE) from effect estimate of barefoot exposure: Deribe et al [81] and Molla et al [38] . *Log [odds ratio] and SE calculated from raw data: Price et al [82] , Kloos et al [35] , and Yakob et al [83] .…”

Section: Resultsmentioning

confidence: 99%

Association between Footwear Use and Neglected Tropical Diseases: A Systematic Review and Meta-Analysis

et al. 2014

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BackgroundThe control of neglected tropical diseases (NTDs) has primarily focused on preventive chemotherapy and case management. Less attention has been placed on the role of ensuring access to adequate water, sanitation, and hygiene and personal preventive measures in reducing exposure to infection. Our aim was to assess whether footwear use was associated with a lower risk of selected NTDs.MethodologyWe conducted a systematic review and meta-analysis to assess the association between footwear use and infection or disease for those NTDs for which the route of transmission or occurrence may be through the feet. We included Buruli ulcer, cutaneous larva migrans (CLM), leptospirosis, mycetoma, myiasis, podoconiosis, snakebite, tungiasis, and soil-transmitted helminth (STH) infections, particularly hookworm infection and strongyloidiasis. We searched Medline, Embase, Cochrane, Web of Science, CINAHL Plus, and Popline databases, contacted experts, and hand-searched reference lists for eligible studies. The search was conducted in English without language, publication status, or date restrictions up to January 2014. Studies were eligible for inclusion if they reported a measure of the association between footwear use and the risk of each NTD. Publication bias was assessed using funnel plots. Descriptive study characteristics and methodological quality of the included studies were summarized. For each study outcome, both outcome and exposure data were abstracted and crude and adjusted effect estimates presented. Individual and summary odds ratio (OR) estimates and corresponding 95% confidence intervals (CIs) were calculated as a measure of intervention effect, using random effects meta-analyses.Principal FindingsAmong the 427 studies screened, 53 met our inclusion criteria. Footwear use was significantly associated with a lower odds of infection of Buruli ulcer (OR = 0.15; 95% CI: 0.08–0.29), CLM (OR = 0.24; 95% CI: 0.06–0.96), tungiasis (OR = 0.42; 95% CI: 0.26–0.70), hookworm infection (OR = 0.48; 95% CI: 0.37–0.61), any STH infection (OR = 0.57; 95% CI: 0.39–0.84), strongyloidiasis (OR = 0.56; 95% CI: 0.38–0.83), and leptospirosis (OR = 0.59; 95% CI: 0.37–0.94). No significant association between footwear use and podoconiosis (OR = 0.63; 95% CI: 0.38–1.05) was found and no data were available for mycetoma, myiasis, and snakebite. The main limitations were evidence of heterogeneity and poor study quality inherent to the observational studies included.Conclusions/SignificanceOur results show that footwear use was associated with a lower odds of several different NTDs. Access to footwear should be prioritized alongside existing NTD interventions to ensure a lasting reduction of multiple NTDs and to accelerate their control and elimination.Protocol RegistrationPROSPERO International prospective register of systematic reviews CRD42012003338

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“…The finding is also consistent with the results of the nationwide mapping in Ethiopia which showed higher proportions of men wearing shoes than women at the time of the interview. 24 Level of education was also associated with shoe wearing in both affected and unaffected groups. Although it is difficult to disentangle cause and effect, our earlier qualitative work suggested that shoes have social value and facilitate school attendance.…”

Section: Discussionmentioning

confidence: 95%

“…17,19 Recent evidence indicates that shoe-wearing prevalence is low and inconsistent. 24 In our previous qualitative research, we identified three domains of beliefs about the causes of podoconiosis wrongly held by members of the community. 25 Some participants observed that podoconiosis tended to affect multiple family members and concluded that the disease was entirely inherited, making it inevitable.…”

Section: Introductionmentioning

confidence: 99%

Association Between Causal Beliefs and Shoe Wearing to Prevent Podoconiosis: A Baseline Study

Ayode

Tora

Farrell

et al. 2016

The American Journal of Tropical Medicine and Hygiene

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Abstract. Podoconiosis is a neglected tropical disease caused by long-term barefoot exposure to volcanic clay soil. Our previous qualitative research identified various domains of beliefs about the causes of podoconiosis held by members of the community. This cross-sectional survey, conducted in southern Ethiopia, aimed to quantitatively evaluate the prevalence of these beliefs and to assess their association with observed shoe-wearing behavior. A total of 1,800 adult respondents (600 from affected families and 1,200 from unaffected families of an index child aged between 3 and 6 years) took part in the survey. Two standardized versions of an enumerator-administered survey were created, with "all day, everyday" shoe-wearing status of the index child assessed in parallel for the affected and unaffected household respondents. Associations between measures were assessed using logistic regression. Accuracy of understanding about podoconiosis was significantly lower among respondents from unaffected than affected households (P < 0.001). Among affected respondents, beliefs about heredity were negatively associated with reported shoe wearing of the index child (odds ratio = 0.67, 95% confidence interval = 0.55-0.83). In both groups, associations of causal beliefs with shoe wearing were moderated by risk perceptions. Interventions aimed at preventing podoconiosis and improving shoe wearing should consider family-oriented education on hereditary susceptibility that targets affected and unaffected families in resource-limited settings.

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Epidemiology and Individual, Household and Geographical Risk Factors of Podoconiosis in Ethiopia: Results from the First Nationwide Mapping

Cited by 78 publications

References 36 publications

Predicting the Environmental Suitability and Population at Risk of Podoconiosis in Africa

Predicting the Environmental Suitability and Population at Risk of Podoconiosis in Africa

Association between Footwear Use and Neglected Tropical Diseases: A Systematic Review and Meta-Analysis

Association Between Causal Beliefs and Shoe Wearing to Prevent Podoconiosis: A Baseline Study

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