Geographical distribution and prevalence of podoconiosis in Rwanda: a cross-sectional country-wide survey.
Lancet Glob Health
; 7(5): e671-e680, 2019 05.
Article
en En
| MEDLINE
| ID: mdl-30926303
ABSTRACT
BACKGROUND:
Podoconiosis is a type of tropical lymphoedema 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. Reliable and detailed data on the prevalence and distribution of podoconiosis are scarce. We aimed to fill this data gap by doing a nationwide community-based study to estimate the number of cases throughout Rwanda.METHODS:
We did a population-based cross-sectional survey to determine the national prevalence of podoconiosis. A podoconiosis case was defined as a person with bilateral, asymmetrical lymphoedema of the lower limb present for more than 1 year, who tested negative for Wuchereria bancrofti antigen (determined by Filariasis Test Strip) and specific IgG4 (determined by Wb123 test), and had a history of any of the associated clinical signs and symptoms. All adults (aged ≥15 years) who resided in any of the 30 districts of Rwanda for 10 or more years were invited at the household level to participate. Participants were interviewed and given a physical examination before Filariasis Test Strip and Wb123 testing. We fitted a binomial mixed model combining the site-level podoconiosis prevalence with continuous environmental covariates to estimate prevalence at unsampled locations. We report estimates of cases by district combining our mean predicted prevalence and a contemporary gridded map of estimated population density.FINDINGS:
Between June 12, and July 28, 2017, 1â360â612 individuals-719â730 (53%) women and 640â882 (47%) men-were screened from 80 clusters in 30 districts across Rwanda. 1143 individuals with lymphoedema were identified, of whom 914 (80%) had confirmed podoconiosis, based on the standardised diagnostic algorithm. The overall prevalence of podoconiosis was 68·5 per 100â000 people (95% CI 41·0-109·7). Podoconiosis was found to be widespread in Rwanda. District-level prevalence ranged from 28·3 per 100â000 people (16·8-45·5, Nyarugenge, Kigali province) to 119·2 per 100â000 people (59·9-216·2, Nyamasheke, West province). Prevalence was highest in districts in the North and West provinces Nyamasheke, Rusizi, Musanze, Nyabihu, Nyaruguru, Burera, and Rubavu. We estimate that 6429 (95% CI 3938-10â088) people live with podoconiosis across Rwanda.INTERPRETATION:
Despite relatively low prevalence, podoconiosis is widely distributed geographically throughout Rwanda. Many patients are likely to be undiagnosed and morbidity management is scarce. Targeted interventions through a well coordinated health system response are needed to manage those affected. Our findings should inform national level planning, monitoring, and implementation of interventions.FUNDING:
Wellcome Trust.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Elefantiasis
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
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Observational_studies
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Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adolescent
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Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
País/Región como asunto:
Africa
Idioma:
En
Revista:
Lancet Glob Health
Año:
2019
Tipo del documento:
Article