Podoconiosis in Uganda: prevalence, geographical distribution and risk factors.

BACKGROUND: Podoconiosis is a neglected debilitating yet preventable disease. Despite its public health significance, podoconiosis is often misdiagnosed and confused with lymphatic filariasis. No appropriate diagnostic tests exist, contributing to underestimation and the absence of control interventions. METHODS: A population-based cross-sectional survey was conducted in seven districts with suspected or reported cases of podoconiosis or an altitude of 1200 m above sea level. Conducted from 30 January to 19 March 2023, the survey employed multilevel stratified sampling to reach eligible household members. RESULTS: Of the 10 023 participants sampled, 187 (confidence interval 1.25 to 2.78) had clinical features of podoconiosis. The highest prevalence was recorded in Nakapiripirit (7.2% [58/809]) and Sironko (2.8 [44/1564]) and the lowest in Kasese (0.3% [5/1537]), but ranged from 1.1 to 1.8% in Zombo, Rukungiri, Gomba and Hoima districts. The duration of podoconiosis was reported to range from 1 to 57 y. Factors associated with podoconiosis occurrence included advanced age, tungiasis, household cleanliness and personal hygiene. Sleeping on a bed, bathing daily, use of soap and use of footwear in at least moderate condition were protective against podoconiosis. CONCLUSIONS: Podoconiosis occurred in all the sampled districts and was linked to personal hygiene. Long-standing cases suggest an absence of treatment. There is potential for early intervention using a holistic care model in managing this condition. Urgent action and stakeholder engagement are essential for effective podoconiosis management.

Sero-antigen prevalence of lymphatic filariasis and risk factors of podoconiosis in Busiriba sub-county, Kamwenge district, Southwestern Uganda, August-September 2018.

OBJECTIVE: Given the neglected nature of filariasis, especially in Uganda where data are scarce, this cross-sectional study aimed to determine the sero-antigen prevalence of lymphatic filariasis and risk factors associated with non-lymphatic filariasis (podoconiosis) in Busiriba Sub-county, Kamwenge District, Uganda, during August-September 2018, to inform targeted elimination efforts. RESULTS: We enrolled 101 participants, among whom 35 (34.7%) had podoconiosis. The sero-antigen prevalence of lymphatic filariasis was 1.0%. Older age and walking barefoot were associated with increased podoconiosis risk. Specifically, individuals aged 25-49 years with had 7.38 times higher odds of podoconiosis (adjusted odds ratio [aOR] = 7.38, 95% CI: 1.36-40.13) compared to those under 25 years, while those aged ≥ 50 years had even higher odds (aOR = 8.49, 95%CI: 1.44-50.15). Additionally, individuals who reported walking barefoot had 14 times higher odds of podoconiosis (aOR = 14.08; 95% CI: 2.49-79.50).

'We no longer experience the same pain': a cross-sectional study assessing the impact of Heart and Sole Africa's podoconiosis prevention education program.

BACKGROUND: Podoconiosis is a non-infectious neglected tropical disease caused by long-term exposure to irritant volcanic soils. It results in severe physical, psychological and financial consequences. Heart and Sole Africa (HASA) is a non-governmental, community-based organization providing management to podoconiosis patients in Rwanda. We sought to analyze the impact of their program on the lives of patients. METHODS: Quantitative surveys recorded the participants' demographics, adherence to HASA's management recommendations and changes in quality of life (QOL). Qualitative questions were used to gather respondent perspectives on HASA programming. RESULTS: We interviewed 127 patients from HASA's Musanze (n=47) and Burera (n=80) clinics. Almost all participants (98.4%) reported statistically significant (p<0.01) improvements in their QOL, and more than one-half (51.2%) had a favorable adherence score of >80%. Qualitative feedback identified specific challenges to adherence and recognition of program success in symptom management. CONCLUSIONS: Our study demonstrated the value of community-based podoconiosis programming in improving the lives of patients. Practices such as regular feet washing, emollient application, shoe wearing and limb raising can result in a marked reduction of morbidity. Our findings support the argument for scaling up these management practices across Rwanda.

Epidemiology of podoconiosis in sub-Saharan Africa: A systematic review and meta-analysis.

Objective: Podoconiosis, one of the neglected tropical diseases (NTDs), affects barefoot people in impoverished regions and contributes to poverty by having negative impacts on economic output, education, and disability. People who have the disease waste nearly half of all of their productive workdays. There is limited evidence available on prevalence of podoconiosis in sub-Saharan Africa (SSA). Therefore, the aim of this research was to determine the pooled prevalence of podoconiosis in the SSA over the last 10 years. Methods: Studies were retrieved from PubMed, Embase, Web of Science, Scopus, Google Scholar, and Google by using a combination of search terms with Boolean operators. All authors independently assessed each study's quality using the modified Newcastle-Ottawa Scale for cross-sectional studies. STATA Version 14 was used to conduct the statistical analysis. The random-effect approach of meta-analysis was used. To test for heterogeneity, I-Squared (I2) statistics were employed and sensitivity analysis with a leave-one-out was done. Result: In this systematic review and meta-analysis, a total of 16 publications with 2,195,722 individuals were included. The pooled prevalence of podoconiosis was 2.66 (95% confidence interval (CI): 2.24, 3.10) with heterogeneity index (I2) of 99.9%. Walking barefoot adjusted odd ratio (AOR) 5.35 (95% CI: 1.65, 9.05), p = 0.001, not washing feet with soap and water regularly AOR 2.8 (95% CI: 1.16, 4.44, p = 0.001), and an increased age AOR 2.23 (95% CI: 1.25, 5.58) were factors significantly associated with the prevalence of podoconiosis. Conclusion: This study revealed that pooled prevalence of podoconiosis was considerable in SSA. Age, being barefoot, and failing to wash one's feet with soap and water have been identified to be factors that were significantly associated with the prevalence of podoconiosis. Therefore, creating awareness on shoe wearing and providing shoes in communication with supporting organizations in podoconiosis prevalent areas, and early diagnosis based on family history are needed for the prevention of podoconiosis.

Phenotypical characterization, and antibiotics susceptibility patterns of skin bacteria found in podoconiosis patients in the North West Region of Cameroon.

BACKGROUND: Podoconiosis, a non-infectious disease originating from long-term exposure of bare feet to irritant red clay soil is a lifelong, disabling disease with no specific diagnostic tool, classified into 5 stages based on the severity of leg swelling (lymphoedema). Secondary bacterial infections have been suggested to cause acute dermatolymphangioadenitis (ADLA) attacks and drive disease progression. Although the North West Region of Cameroon has a proven history of podoconiosis endemicity, the bacterial composition of lymphoedema due to this condition has not been studied. Thus, this study investigated the leg bacterial diversity of patients who suffered from the lymphoedema and their susceptibility pattern to selected antibiotics. METHODS: A cross-sectional study was carried out in which podoconiosis affected and non-lymphoedema individuals living in the same community were purposively selected. Samples were collected by swabbing the skin between the toes and around the anklebone, then cultured and sub-cultured on nutrient agar to obtain pure isolates. The cultured isolates were then morphologically and biochemically classified using microscopy and analytic profile index test kits, respectively. The disk diffusion technique was used to determine antibiotic susceptibility. RESULTS: Thirty-three participants were recruited, and 249 bacterial isolates were characterized into 29 genera, 60 species; with 30 (50%) being gram positive rods, 19 (31.7%) gram positive cocci, and 11 (18.3%) gram negative rods. Thirteen gram positive rods, fifteen gram positive cocci, and eight gram negative rods of bacterial species were found only in podoconiosis individuals among which Cellulomonas spp / Microbacterium spp. (2.8%), Staphylococcus lentus (3.3%), and Burkholderia cepacia (4.0%) dominated. 90% (90%) of the bacterial isolates were sensitive to doxycycline, whereas ampicillin had a high level of intermediate resistance, and penicillin G had the greatest resistant profile. CONCLUSION: Our findings show that 94 (37.8%) out of 249 described bacterial isolates were exclusively found in the legs of podoconiosis individuals, and their susceptibility pattern to antibiotics was similar to that of others.

From Neglected to Public Health Burden: Factors Associated with Podoconiosis in Resource Limited Setting in Case of Southwest Ethiopia: A Community Based Cross Sectional Study.

Background: Even though podoconiosis can cause physical, financial, and social impairments, it is commonly overlooked by organizations, and one-fourth of the predicted worldwide burden will fall on Ethiopia. In spite of this, there are only a few attempts for prevention and control in certain areas in Ethiopia. Updated statistics on prevalence and contributing factors could make local efforts at prevention, control, and rehabilitation more effective. Thus, this study was aimed to assess the prevalence of podoconiosis and its associated factors among Ilu Aba Bor zone residents, South West Ethiopia. Methods: A community-based cross-sectional study was conducted on 491 participants from March 25 to April 25, 2022. Data were entered into Epi-Data version 4.6.0, then exported to SPSS version 25 for final analysis. In the bi-variable regression, variables with P-values less than 0.25 were included in the multivariable model. Finally, multivariable logistic regression was performed to identify factors associated with podoconiosis at a 5% level of significance. Results: In this study area, podoconiosis prevalence was found to be 5.7% [3.6-7.2]. In multivariable regression model, lower tertile wealth status [AOR=2.09; (95% CI (1.384, 5.343)], no formal education [AOR=2.23; (95% CI; 1.179-3.820)] and average distance to reach water source to home [AOR=2.061; (95% CI: 1.78-7.35)] were significantly associated podoconiosis. Conclusion and Recommendation: According to this study, one in every seventeen individuals had podoconiosis, which is a significant prevalence when compared to earlier studies. Podoconiosis was observed to be associated with factors like wealth status, educational attainment, and distance from water source. To address this public health issue, strong preventive and therapeutic treatments should be used.

Evaluating Rural Ethiopian Youths' Willingness and Competency to Promote Literacy Regarding G × E Influences on Podoconiosis.

INTRODUCTION: Engaging youth as peer educators has yet to be considered to promote literacy concerning conjoint genetic and environmental (G × E) influences on health conditions. Whether youth living in low- and middle-income countries (LMICs) could and would be willing to serve as lay educators of G × E education is unclear. METHODS: A cross-sectional survey of youth living in Southern Ethiopia was conducted from August to September 2017. Trained data collectors administered the survey on 377 randomly selected youth who ranged in age from 15 to 24; 52% were female and 95% reported having some formal education. Self-reported willingness and a constructed competency score were assessed. Bivariate analyses tested for factors associated with willingness and competency to serve as lay G × E literacy builders. RESULTS: Competency and willingness were significantly greater (p < 0.05) for youth who were male, had some formal education, and had civic or leadership experience. Differences in median willingness were significant for youth who scored as more competent versus those who scored as less competent (p < 0.001). There were no characteristics that moderated the association of competency with willingness. CONCLUSION: Youth peer educator programs hold promise for disseminating improved G Χ E literacy and reducing stigma associated with deterministic misunderstandings. Thoughtful recruitment and training strategies will be needed to ensure that the broadest representation of youth in LMIC contexts has the opportunity to serve in this role, particularly girls and those without formal education.

Geostatistical modelling of the distribution, risk and burden of podoconiosis in Kenya.

BACKGROUND: Understanding and accurately predicting the environmental limits, population at risk and burden of podoconiosis are critical for delivering targeted and equitable prevention and treatment services, planning control and elimination programs and implementing tailored case finding and surveillance activities. METHODS: This is secondary analysis of a nationwide podoconiosis mapping survey in Kenya. We combined national representative prevalence survey data of podoconiosis with climate and environmental data, overlayed with population figures in a geostatistical modelling framework, to predict the environmental suitability, population living in at-risk areas and number of cases of podoconiosis in Kenya. RESULTS: In 2020, the number of people living with podoconiosis in Kenya was estimated to be 9344 (95% uncertainty interval 4222 to 17 962). The distribution of podoconiosis varies by geography and three regions (Eastern, Nyanza and Western) represent >90% of the absolute number of cases. High environmental suitability for podoconiosis was predicted in four regions of Kenya (Coastal, Eastern, Nyanza and Western). In total, 2.2 million people live in at-risk areas and 4.2% of the total landmass of Kenya is environmentally predisposed for podoconiosis. CONCLUSIONS: The burden of podoconiosis is relatively low in Kenya and is mostly restricted to certain small geographical areas. Our results will help guide targeted prevention and treatment approaches through local planning, spatial targeting and tailored surveillance activities.

An analysis of social dimensions of podoconiosis and leprosy on affected households in endemic health districts of the North West Region of Cameroon.

Background: Podoconiosis and leprosy are Neglected Tropical Diseases associated with low quality of life, social stigma and isolation of affected people and families. Despite the substantial social burden it imposes, podoconiosis has largely been ignored in the global health literature until recently unlike leprosy. This study assessed and compared the quality of life and social impact of podoconiosis with that of leprosy among affected households and neighborhoods in North West Cameroon. Methods: A comparative cross-sectional design was used. Eighty-six households: 43 podoconiosis and 43 leprosy, plus household neighbours were enrolled from July and August 2015 from three health districts. Podoconiosis patients living in households within Batibo and Ndop health districts were sequentially sampled using a list of confirmed podoconioisis cases from previous studies. Leprosy patients living within communities in Mejang Health Area were sequentially sampled using the Mbingo treatment center register. WHO BREF tool was used to assess quality of life. Franklin Stigma Scale was adapted to assess felt and enacted stigma. Mann-Whitney U test was used to compare differences in stigma and QoL. Results: Physical domain showed a significant difference in the distribution in quality of life between groups (p < 0.05, median:70; U:635, r = 0.2). Overall enacted stigma revealed significant differences with p < 0.05 and r = 0.4. Overall stigma from family members (median:17, U:627 and r = 0.3) and neighbours (median:67, U:336 and r = 0.5) showed significant differences with p < 0.05 in the distribution of scores for both diseases. Sex and age showed significant associations with QoL and stigma. Conclusion: This study reveals the quality of life and stigma associated with podoconiosis on affected households to be comparable to that experienced by households with a leprosy patient. There is need for intensified preventive, management and control schemes to fight podoconiosis in Cameroon, just like leprosy.

Self-Care Practice and Its Associated Factors Among Podoconiosis Patients in East Gojjam Zone, North West Ethiopia.

Introduction: Podoconiosis is endemic non-filarial elephantiasis of the lower legs swelling caused by barefoot exposure to red clay soil. The burden of disability occurs among the poorest populations. Self-care practice is the most cost-effective prevention strategy practiced at home to improve lymphedema, working functionality, and quality of life. Despite this, there is a scarce of knowledge about self-care practices and associated factors among podoconiosis patients in Ethiopia. Objective: To determine self-care practice and its associated factors among podoconiosis patients in East Gojjam zone North West, Ethiopia. Methods: Community-based cross-sectional study design was used among 633 podoconiosis patients. Computer-generated simple random sampling technique was used to recruit participants. All patients who started podoconiosis treatment were the source population. Data were entered using Epidata version 3.1 and exported to SPSS version 25 for cleaning and analysis. Variables with 95% CI corresponding AOR were used to identify statistically significant factors for self-care practice. Results: In this study, the self-care practice of podoconiosis patient was 64%. Females [AOR: 0.38 (95% CI: 0.22, 0.65)], 55-65 years age [AOR: 0.41 (95% CI: 0.22, 0.74)], above 65 years age [AOR: 0.22 (95% CI: 0.11, 0.450)], 4-6 km distance from water source [AOR: 0.06 (95% CI: 0.03, 0.12)], above 6 km distance from water source [AOR: 0.03 (95% CI: 0.01, 0.09)], educational level [AOR: 0.05 (95% CI: 0.01, 0.40)], marital status [AOR: 5.40 (95% CI: 2.30, 12.90)], and distance from health institution [AOR: 0.35 (95% CI: 0.23, 0.54)] were statistically identified associated factors for self-care practice of podoconiosis patient. Conclusion: In this study, the self-care practice of podoconiosis patients was not well practiced. Socio-demographic factors are identified as associated factors for self-care practice. Strengthening health education and behavioral changes are required to improve self-care practice.

Prevalence of podoconiosis and its associated factors in Gamo zone, Southern Ethiopia, 2021.

BACKGROUND: Podoconiosis is a chronic non-infectious preventable disease. Though not fatal, it may cause social, economic and physical disability. Ethiopia is projected to bear one-fourth (25%) of the global burden of podoconiosis. Despite its huge economic impact and chronic morbidity and disability, podoconiosis seems to be neglected. Therefore, the aim of this study was to assess the prevalence of podoconiosis and its associated factors in Gamo zone, Southern Ethiopia. METHODS: A community based cross sectional study was conducted among 683 household members. A multistage sampling method was used to select study participants. Binary logistic regression model was fitted to identify factors associated with podoconiosis. Odds ratio with 95% confidence interval was computed to determine the level of significance; in multivariable analysis, variables with a P value less than 0.05 were considered as statistically significant. RESULTS: The prevalence of podoconiosis was 6.2% (95%CI: 4.3-8%). The significantly contributed factors for the prevalence of podoconiosis were wealth index (AOR = 0.249, 95%CI = 0.073-0.845), number of shoes owned (AOR = 6.199, 95% CI = 1.281-29.98), times when individual do not wear shoes (AOR = 2.448, 95%CI = 1.041-5.754), soap utilization during foot washing (AOR = 2.773, 95%CI = 1.210-6.355) and family history of leg swelling (AOR = 4.69, 95%CI = 2.215-9.935). CONCLUSIONS: This study showed that there was significant burden of podoconiosis in the study area. Wealth index, times when individual do not wear shoes, number of shoes owned, soap utilization during foot washing, and family history of leg swelling were significantly associated with podoconiosis. It is recommended to practice secondary prevention which includes regular foot hygiene and wearing shoes, and the use of antiseptic soaks.

Podoconiosis instruction at nursing schools in Kenya, Rwanda, and Uganda.

BACKGROUND: Podoconiosis is a preventable, progressive, and non-infectious form of elephantiasis that can contribute to significant disability and economic burden when not treated early. Nurses play a critical role in early detection and response in rural Africa, but it is unclear if they receive adequate training on podoconiosis. We aimed to characterize podoconiosis instruction at all government accredited, post-secondary nursing institutions in three African countries. METHODS: Data for this cross-sectional study was collected through a quantitative survey with several open-answer questions. Through a rigorous online search, we identified all post-secondary institutions in Kenya, Rwanda and Uganda accredited to teach human nursing. A total of 289 accredited programs, including 85 certificate, 56 degree and 148 diploma programs were invited to participate. Respondents completed surveys online or by telephone. Measures focused on podoconiosis knowledge, perceptions of quality/quantity of podoconiosis instruction, and barriers to sufficient podoconiosis education. RESULTS: We obtained information about 212 curricula across 149 nursing institutions in the three countries (participation rate: 73.4%). Podoconiosis coverage was limited across programs (certificate-24.1%; diploma-55.6%; degree-30.3%). Most respondents felt that the quality and quantity of instruction were insufficient (60.6%, 62.9%), respectively. Exclusion from government curricula, low priority and faculty lack of knowledge were commonly reported barriers to podoconiosis inclusion. CONCLUSIONS: This study demonstrated clear gaps in podoconiosis training for nurses across the three countries and highlights a serious challenge in eliminating podoconiosis as a public health problem. Interventions to improve nurses' knowledge could include the development and free distribution of podoconiosis teaching materials, designed for integration into pre-existing courses.

Dr E W Price, the discoverer of podoconiosis.

A straightforward biography of Dr E W Price, the discoverer of podoconiosis, a medical missionary who was also the first to elucidate plantar ulcers in leprosy.

Podoconiosis: A Possible Cause of Lymphedema in Micronesia.

Podoconiosis is a type of tropical lymphedema sharing some clinical characteristics with lymphatic filariasis. Also referred to as endemic non-filarial elephantiasis, podoconiosis is a non-infectious disease from barefoot exposure to irritant red clay soil of volcanic origins. Podoconiosis is most common in Ethiopia and has also been reported in many other countries, but not in the Pacific Islands. Lymphatic filariasis is endemic in the Pacific Islands and was historically reported as elephantiasis in Micronesia. It was considered to have been eradicated in Guam and the Northern Mariana Islands following World War II. A small number of patients in Saipan exhibited characteristics of lymphatic filariasis but were seronegative for filariasis. Clinical examination of these patients matched podoconiosis much more closely than filariasis. Moreover, these patients reported a history of chronic barefoot exposure to irritant red clay soil and a prodrome characteristic of podoconiosis. While this study is limited to several cases, the results suggest that podoconiosis could be considered a cause of non-filarial lymphedema in Saipan and perhaps other islands in Micronesia. Preventive patient education is focused on discouraging barefoot exposure to red clay soils, particularly in those with a family history of lymphedema. Early recognition of the possibility of podoconiosis would allow appropriate treatment and prevent progression to later debilitating stages of the disease.

Foot care practice and associated factors among patients with lymphoedema in Boreda district, Gamo zone, southern Ethiopia, 2020. Implications for elimination of podoconiosis and lymphatic filariasis.

BACKGROUND: Lymphatic filariasis is ranked as the second leading cause of disability world-wide. The current global programme to eliminate lymphatic filariasis is based on the interruption of transmission and the alleviation of disability and suffering. OBJECTIVE: to assess foot care practice and associated factors among lymphoedema patients in Boreda district, Gamo zone Southern Ethiopia. METHODS: a community based cross sectional study was employed from December 2020 to June 2021 in Boreda district. Simple random sampling technique was used for selecting participants. Pretested structured interviewer administered questionnaire was prepared in English and translated to local language. FINDINGS: a total of 280 lymphedema patients were involved in this study. More than half 153 (54.6%) had poor practice towards foot care practice with 95% CI (48.7, 60.4%). Patients who fetched 50 l of water or below and wore shoes at the age above 20 years were negatively associated with foot care practice, (AOR = 0.383, 95%CI: 0.155, 0.945) and (AOR = 0.261, 95%CI: 0.107, 0.63), respectively. Patients who owned only one pair and two pairs were negatively associated with foot care practice (AOR = 0.04, 95%CI: 0.009, 0.182) and (AOR = 0.27, 95%CI: 0.087, 0.85), respectively. On the other hand, attending LMMDP service and frequency of adenolymphangitis once and twice or more per month were positively associated with foot care practice (AOR = 3.339, 95%CI: 1.53, 7.285) and (AOR = 8.15, 95% CI: 3.157, 21.058) and (AOR = 9.35, 95% CI: 3.118, 28.059), respectively. CONCLUSION: this study indicated foot care practice among lymphedema patients in Boreda district was poor. Number of litre of water collected per day, age at which footwear first worn, number of shoes owned, attending LMMDP and frequency of adenolymphangitis were significantly associated with foot care practice. Standard foot care practice should be emphasized to control progression of lymphedema. Foot care practices like skin care, exercise and elevation, washing legs, bandaging and massaging are important factors that influence in reduction of lymphedema volume and acute attacks among people who are suffering from the diseases.

Epidemiology and sex differences of podoconiosis in Ethiopia: A systemic review and meta-analysis.

OBJECTIVES: Podoconiosis is a poorly understood neglected tropical disease which results in a high socio-economic burden. In Ethiopia, despite the high prevalence, morbidity, and socio-economic impacts, little information is available about the disease. Thus, this review aimed to assess the effect of sex differences and pooled prevalence of podoconiosis in Ethiopia. STUDY SETTING: Ethiopia is a country located in East Africa. METHODS: Published literature on the prevalence of podoconiosis in Ethiopia was searched through MEDLINE/PubMed, Cochrane Library, Goggle scholar, and Global Health. Studies conducted in humans, open access, and met 50% threshold on the quality assessment checklist score adopted from Joanna Briggs Institute were eligible for inclusion. Data were extracted using first author, year of publication, participants' population, setting (urban/rural), study design, podoconiosis infection among males, the total number of males, podoconiosis infection among females, the total number of females, and context using Microsoft™ Excel. R statistical software version 3.6.1 was utilized to carry out the meta-analysis. The protocol of this review is registered in the PROSPERO international prospective register of systematic reviews and assigned a registration number of CRD 42020154697. RESULTS: We performed heterogeneity, sensitivity, and publication bias analysis for the included articles. We identified 229 records, of which 11 studies met the inclusion criteria. The pooled prevalence of podoconiosis in Ethiopia was 6% [95% CI: 5%; 6%]. Subgroup analysis by setting indicated slightly higher prevalence in rural settings. The odds of podoconiosis infection among female is 1.15 times that of males" The effect of sex on podoconiosis was sub-grouped by study setting and the odds of females were 1.29 times at increased risk of acquiring podoconiosis than males (p < 0.01) in rural settings. CONCLUSIONS: The prevalence of podoconiosis in Ethiopia is high. This review suggested that females are at higher risk of developing podoconiosis than males, particularly in rural communities which has health promotion and awareness implications regarding protective wear.

Knowledge, attitude, practice and associated factors of health professionals towards podoconiosis in Gamo zone, Ethiopia, 2019.

BACKGROUND: Podoconiosis is entirely preventable, non-communicable disease with high potential of elimination. The prevalence of podoconiosis in Ethiopia was 7.45%. One of the pillars for elimination of podoconiosis is morbidity control and management. Therefore, the present study aimed to assess the knowledge, attitude, practices and associated factors of health professionals towards podoconiosis cause, prevention and treatments. METHODS: Facility based cross-sectional study was conducted. The source population was all health professionals currently working in public health facilities. The final estimated sample size was 349. A pretested self-administrated structured questionnaire was used to collect the data. The data were coded, entered, and cleaned by using Epi.info version7, and analyzed by using SPSS version 20. RESULT: A total of 320 health professionals participated in the study. Sixty eight (23.1%) health professionals had poor knowledge towards podoconiosis. Seventy (21.9%) identified podoconiosis as infectious disease. Profession, address of health facility, service year and attitude of participants were significantly associated with knowledge towards podoconiosis. More than half (56%) had favorable attitude towards podoconiosis patients. Knowledge score (95%CI: 1.389, 4.059, p-value = 0.002) was the independent predictor for attitude status. Very few (11.6%) respondents treated podoconiosis patients. Age group 45 years old and above and training on lymphedema morbidity management and disability prevention were significantly associated with clinical experience in treating affected patients, (AOR = 17.345; 95%CI: 4.62, 65.119) and (AOR = 7.385; 95%CI: 2.5, 21.797), respectively. CONCLUSION: Despite, high percent of good knowledge of health professionals towards podoconiosis, clinical experience of health professionals in treating podoconiosis patients was very low. In-service trainings will be given for health professionals to improve treatment. In podoconiosis endemic districts hygiene supplies and other referencing materials should be made available for podoconiosis case management.

Rapid ethical appraisal of stakeholder views on research prior to undertaking immunopathogenesis studies on podoconiosis in northeast Ethiopia during a period of social instability.

BACKGROUND: Undertaking research and attaining informed consent can be challenging when there is political unrest and community mistrust. Rapid ethical appraisal (REA) is a tool that uses qualitative methods to explore sociocultural issues that may affect the ethical conduct of research. METHODS: We used REA in northeast Ethiopia shortly following a period of unrest, during which violence against researchers occurred, to assess stakeholder perceptions of research, researchers and the informed consent process. We held 32 in-depth interviews and 2 focus group discussions. RESULTS: Most community members had little awareness about podoconiosis or healthcare research. Convincing the community to donate blood for research is challenging due to association with HIV testing. The attack on researchers was mainly motivated by the community's mistrust of their intentions against the background of a volatile political situation. Social media contributed to the spread of misinformation. Lack of community engagement was also a key contributing factor. CONCLUSIONS: Using REA, we identified potential barriers to the informed consent process, participant recruitment for data and specimen collection and the smooth conduct of research. Researchers should assess existing conditions in the study area and engage with the community to increase awareness prior to commencing their research activities.

With Bare Feet in the Soil: Podoconiosis, a Neglected Cause of Tropical Lymphoedema.

Podoconiosis is a form of lymphoedema that occurs in tropical highland areas in genetically susceptible individuals who are exposed to irritant volcanic soils. The disease is preventable through consistent use of footwear and attention to foot hygiene; however, in endemic areas there is a strong barefoot tradition, and many cannot afford shoes. Patients with podoconiosis face significant physical disability, psychological comorbidity, reduced quality of life and experience frequent episodes of systemic illness due to acute dermatolymphangioadenitis. This review provides an overview of this important and neglected tropical skin disease and summarizes the latest research findings.