Excess mortality among people with podoconiosis: secondary analysis of two Ethiopian cohorts.

BACKGROUND: While morbidity attributable to podoconiosis is relatively well studied, its pattern of mortality has not been established. METHODS: We compared the age-standardised mortality ratios (SMRs) of two datasets from northern Ethiopia: podoconiosis patients enrolled in a 1-y trial and a Health and Demographic Surveillance System cohort. RESULTS: The annual crude mortality rate per 1000 population for podoconiosis patients was 28.7 (95% confidence interval [CI] 17.3 to 44.8; n=663) while that of the general population was 2.8 (95% CI 2.3 to 3.4; n=44 095). The overall SMR for the study period was 6.0 (95% CI 3.6 to 9.4). CONCLUSIONS: Podoconiosis patients experience elevated mortality compared with the general population and further research is required to understand the reasons.

Measuring elimination of podoconiosis, endemicity classifications, case definition and targets: an international Delphi exercise.

BACKGROUND: Podoconiosis is one of the major causes of lymphoedema in the tropics. Nonetheless, currently there are no endemicity classifications or elimination targets to monitor the effects of interventions. This study aimed at establishing case definitions and indicators that can be used to assess endemicity, elimination and clinical outcomes of podoconiosis. METHODS: This paper describes the result of a Delphi technique used among 28 experts. A questionnaire outlining possible case definitions, endemicity classifications, elimination targets and clinical outcomes was developed. The questionnaire was distributed to experts working on podoconiosis and other neglected tropical diseases in two rounds. The experts rated the importance of case definitions, endemic classifications, elimination targets and the clinical outcome measures. Median and mode were used to describe the central tendency of expert responses. The coefficient of variation was used to describe the dispersals of expert responses. RESULTS: Consensus on definitions and indicators for assessing endemicity, elimination and clinical outcomes of podoconiosis directed at policy makers and health workers was achieved following the two rounds of Delphi approach among the experts. CONCLUSIONS: Based on the two Delphi rounds we discuss potential indicators and endemicity classification of this disabling disease, and the ongoing challenges to its elimination in countries with the highest prevalence. Consensus will help to increase effectiveness of podoconiosis elimination efforts and ensure comparability of outcome data.

Community-based survey of podoconiosis in Bedele Zuria woreda, west Ethiopia.

BACKGROUND: Podoconiosis is a neglected tropical disease resulting in progressive bilateral swelling of the lower legs in barefoot individuals exposed to red-clay soil derived from volcanic rocks. It is a considerable public health problem in countries across tropical Africa, Central America and northern India. The present study aimed to assess the prevalence and clinical features of podoconiosis, and patients' experience of disease prevention and treatment, in Bedele Zuria woreda (district), west Ethiopia. METHODS: The study was conducted during 2011 and involved a house-to-house survey in all 2285 households of five randomly selected rural kebeles (villages). RESULTS: The prevalence of podoconiosis was 5.6% (379/6710) (95% CI 5.1-6.2%) and was significantly greater among women than men (6.6% vs 4.7%; p = 0.001). A total of 311 (16.9%) households had at least one member with podoconiosis, and 128 (33.8%) study participants reported having a blood relative with podoconiosis. Two hundred and forty-three (76.4%) podoconiosis patients were in the economically productive age group of 15-64 years. On average, a patient experienced at least six episodes of adenolymphangitis per year resulting in a loss of 25 working days per year. CONCLUSION: This study has revealed a high burden of podoconiosis in west Ethiopia, and suggests that disease prevention and treatment programmes are needed.