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Geta ET, Guteta TO, Tiruneh G. Impairment of health-related quality of life and its determinants among patients with podoconiosis in East Wollega Zone, Oromia Regional State, Ethiopia: institutional-based cross-sectional study. BMJ Open 2024; 14:e077268. [PMID: 38553080 PMCID: PMC10982751 DOI: 10.1136/bmjopen-2023-077268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE This study aimed to assess the impairment of health-related quality of life (HRQoL) and its determinants among patients diagnosed with podoconiosis in East Wollega Zone, Oromia Regional State, Ethiopia. METHODS An institutional-based cross-sectional study design was used in the setting of primary healthcare facilities to assess impaired HRQoL among patients with podoconiosis in the East Wollega Zone from 1 March 2023 to 30 April 2023, using the Dermatologic Life Quality Index (DLQI). Data was collected from 494 patients with podoconiosis, and a multistage sampling technique was employed. The data was entered into EpiData V.4.6 and exported to SPSS V.27 for analysis. A linear regression model with a 95% cofidence interval (CI) was used to estimate level of HRQoL and to identify its determinants estimating beta (β) coefficient declaring the significance level at p<0.05. RESULTS The quality of life among patients was impaired on average by 9.6±6.1 with the lowest DLQI Score in the domain of treatment (0.8±0.97) and the highest in the domain of daily activity (2.3±1.72). The identified significant determinants of impairment of HRQoL associated with DLQI scores were duration of disease (95% CI, β=0.11 (0.08 to 0.15)), acute dermato-lymphangio-adenitis (ADLA) (95% CI, β=0.08 (0.01 to 0.16)), comorbidity (95% CI, β=1.26 (0.37 to 2.16)), consistently wearing shoes (95% CI, β=-0.06 (-0.09 to -0.03)), feeling of stigmatised (95% CI, β=0.21 (0.16 to 0.25)) and psychological distress (95% CI, β=0.17 (0.14 to 0.21)) and being female (95% CI, β=1.16 (0.19 to 2.12)). CONCLUSION Overall, HRQoL among patients with podoconiosis was moderately impaired. The duration of disease, ADLA, comorbidity, stigma, psychological distress and being female in sex significantly impaired HRQoL, whereas consistently wearing shoes significantly improved HRQoL among the patients with podoconiosis. Therefore, healthcare providers and public health experts should work on educating communities and counselling patients to avoid stigma and psychological distress, wearing shoes consistently and treating podoconiosis and other comorbidities among these patients.
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Affiliation(s)
- Edosa Tesfaye Geta
- School of Public Health, Wollega University, Nekemte, Oromia Regional State, Ethiopia
| | | | - Gemechu Tiruneh
- School of Public Health, Wollega University, Nekemte, Oromia Regional State, Ethiopia
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Celone M, Beeman S, Han BA, Potter AM, Pecor DB, Okech B, Pollett S. Understanding transmission risk and predicting environmental suitability for Mayaro Virus in Central and South America. PLoS Negl Trop Dis 2024; 18:e0011859. [PMID: 38194417 PMCID: PMC10775973 DOI: 10.1371/journal.pntd.0011859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024] Open
Abstract
Mayaro virus (MAYV) is a mosquito-borne Alphavirus that is widespread in South America. MAYV infection often presents with non-specific febrile symptoms but may progress to debilitating chronic arthritis or arthralgia. Despite the pandemic threat of MAYV, its true distribution remains unknown. The objective of this study was to clarify the geographic distribution of MAYV using an established risk mapping framework. This consisted of generating evidence consensus scores for MAYV presence, modeling the potential distribution of MAYV in select countries across Central and South America, and estimating the population residing in areas suitable for MAYV transmission. We compiled a georeferenced compendium of MAYV occurrence in humans, animals, and arthropods. Based on an established evidence consensus framework, we integrated multiple information sources to assess the total evidence supporting ongoing transmission of MAYV within each country in our study region. We then developed high resolution maps of the disease's estimated distribution using a boosted regression tree approach. Models were developed using nine climatic and environmental covariates that are related to the MAYV transmission cycle. Using the output of our boosted regression tree models, we estimated the total population living in regions suitable for MAYV transmission. The evidence consensus scores revealed high or very high evidence of MAYV transmission in several countries including Brazil (especially the states of Mato Grosso and Goiás), Venezuela, Peru, Trinidad and Tobago, and French Guiana. According to the boosted regression tree models, a substantial region of South America is suitable for MAYV transmission, including north and central Brazil, French Guiana, and Suriname. Some regions (e.g., Guyana) with only moderate evidence of known transmission were identified as highly suitable for MAYV. We estimate that approximately 58.9 million people (95% CI: 21.4-100.4) in Central and South America live in areas that may be suitable for MAYV transmission, including 46.2 million people (95% CI: 17.6-68.9) in Brazil. Our results may assist in prioritizing high-risk areas for vector control, human disease surveillance and ecological studies.
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Affiliation(s)
- Michael Celone
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, Maryland, United States of America
| | - Sean Beeman
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, Maryland, United States of America
| | - Barbara A. Han
- Cary Institute of Ecosystem Studies, Millbrook, New York, United States of America
| | - Alexander M. Potter
- One Health Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Walter Reed Biosystematics Unit, Smithsonian Museum Support Center, Suitland, Maryland, United States of America
- Department of Entomology, Smithsonian Institution—National Museum of Natural History (NMNH), Washington, DC, United States of America
| | - David B. Pecor
- One Health Branch, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America
- Walter Reed Biosystematics Unit, Smithsonian Museum Support Center, Suitland, Maryland, United States of America
- Department of Entomology, Smithsonian Institution—National Museum of Natural History (NMNH), Washington, DC, United States of America
| | - Bernard Okech
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Bethesda, Maryland, United States of America
| | - Simon Pollett
- Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, United States of America
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Abiso TL, Abebe Kerbo A, Wolka Woticha E. Epidemiology of podoconiosis in sub-Saharan Africa: A systematic review and meta-analysis. SAGE Open Med 2023; 11:20503121231193602. [PMID: 37719165 PMCID: PMC10504841 DOI: 10.1177/20503121231193602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/24/2023] [Indexed: 09/19/2023] Open
Abstract
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.
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Affiliation(s)
- Temesgen Lera Abiso
- School of Public Health, College of Health sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Amene Abebe Kerbo
- School of Public Health, College of Health sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Eskinder Wolka Woticha
- School of Public Health, College of Health sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Semahegn A, Manyazewal T, Getachew E, Fekadu B, Assefa E, Kassa M, Davey G, Hopkins M, Araya M, Woldehanna T, Hanlon C, Fekadu A. Burden of neglected tropical diseases and access to medicine and diagnostics in Ethiopia: a scoping review. Syst Rev 2023; 12:140. [PMID: 37580784 PMCID: PMC10424375 DOI: 10.1186/s13643-023-02302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 07/28/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND More than 1.7 billion people are affected by neglected tropical diseases (NTDs) worldwide. Forty percent of the NTD-affected people live in Africa with the poorest, most vulnerable, and hard to reach geographical areas. The NTDs cause significant social and economic burden and deepen marginalization and stigmatization. The World Health Organization's current roadmap for NTD aims to prevent, control, eliminate, or eradicate 20 tropical diseases. Ethiopia experiences a high burden of these diseases, but current access to diagnostics, medicine, and/or care has been little explored to inform the country's NTD strategic plan. The overall purpose of the scoping review was to map and characterize the burden of NTDs and challenges in access to diagnostics, medicine, and/or care in Ethiopia. METHODS A systematic search of evidence was conducted in PubMed, Cochrane Library, and Google Scholar from January 2000 until May 2022, without restrictions of language or study design. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review was followed for screening of studies. Key findings were extracted and narrated qualitatively. RESULTS The search resulted in 4532 articles, of which 105 met the inclusion criteria and were included in the scoping review under three themes: burden of NTDs, access to diagnostics, medicine and/or care, and key barriers. Although gains have been made in the prevention and control of NTDs in Ethiopia, the burden remains high, and progress in access to diagnostics, medicine/drugs, and/or care is very slow. Poverty, poor quality of life, and underfunding of NTD programs decelerate the process of NTD elimination program in the country. CONCLUSIONS The scoping review identified a considerable number of studies on the burden of NTDs in Ethiopia and strategies for diagnosis, treatment, and/or care; however, there is a paucity of evidence on the suitability and potential benefits of novel diagnostic technologies and medicines in the country. A regular review and analysis of such country-level evidence is important to inform the country NTDs roadmap and local implementation strategies.
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Affiliation(s)
- Agumasie Semahegn
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
- Department of Population, Family and Reproductive Health, School of Public Health, Unversity of Ghana, Accra, Ghana.
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eyerusalem Getachew
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bethelhem Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Esubalew Assefa
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
- Department of Economics, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | - Munir Kassa
- Ministry of Health of Ethiopia, Addis Ababa, Ethiopia
| | - Gail Davey
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Michael Hopkins
- Science Policy Research Unit, University of Sussex, Brighton, UK
| | - Mesele Araya
- College of Business and Economics, Addis Ababa University, Addis Ababa, Ethiopia
- Policy Studies Institute, Addis Ababa, Ethiopia
| | - Tassew Woldehanna
- College of Business and Economics, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health & Infection Department, Brighton and Sussex Medical School, Brighton, UK
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Hailu M, Chea N, Ali MM, Hailu M. Determinants of Podoconiosis in Bensa District, Sidama Region, Ethiopia: A case control study. PLoS Negl Trop Dis 2023; 17:e0011502. [PMID: 37643189 PMCID: PMC10464951 DOI: 10.1371/journal.pntd.0011502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 07/05/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Podoconiosis is one of the neglected tropical diseases (NTD) with the greatest potential for elimination. Despite its public health importance, podoconiosis is a poorly understood disease which led to a widespread misconception about its cause, prevention, and treatment. Even though the exact global burden is still to be measured, it is estimated that at least 4 million people are affected with podoconiosis worldwide, of which more than 1.5 million people are in Ethiopia. The objective of this study was to identify the determinants of podoconiosis in Bensa District, Sidama Regional State, Ethiopia. METHODOLOGY/PRINCIPAL FINDINGS A community-based unmatched case-control study was used to identify the determinants of podoconiosis. The sample size was estimated using the double population proportion formula. An interviewer-administered structured questionnaire was used for data collection. Blood specimens collected from cases were tested by Filariasis Test Strip to exclude lymphatic filariasis. Data were checked for completeness, coded and entered into Epi-data Version 4.6, and exported to the SPSS version 22 software. Variables with a p<0.2 in the bivariate analysis were further analyzed using multivariable binary logistic regression. Multivariable logistic regression analysis was used to examine determinants that could be associated with podoconiosis with a 95% confidence interval. A total of 459 (153 cases and 306 controls) participants were included with a response rate of 100%. Factors such as the age of participant [AOR = 0.34, 95% CI (0.13-0.87)], being female [AOR = 2.90, 95% CI (1.40-6.10)], age at which shoe wearing started [AOR = 0.7, 95% CI (0.03-0.16)], not wearing shoe daily [AOR = 2.26, 95% CI (1.05-4.86)], wearing hard plastic shoe [AOR = 3.38, 95% CI (1.31-10.89)], and family history with a similar disease (leg swelling) [AOR = 10.2, 95% CI (3.97-26.37)] were significantly associated with the occurrence of podoconiosis. CONCLUSIONS/SIGNIFICANCE The age of the participants, gender, the age at which shoe wearing started, type of shoe the participants' wear, frequency of shoe wearing, traveling barefoot, and family history with similar disease (leg swelling) were significantly associated with the occurrence of podoconiosis. Sidama regional health bureau along with non-governmental organizations working on the neglected tropical disease should plan modalities on awareness creation and comprehensive health education on shoe wearing and foot hygiene.
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Affiliation(s)
| | - Nana Chea
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Musa Mohammed Ali
- School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Mesay Hailu
- Ethiopian Public Health institute, Addis Ababa, Ethiopia
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Ayode D, Engdawork K, Moore R, Tadele G, Davey G, McBride CM. Evaluating Rural Ethiopian Youths' Willingness and Competency to Promote Literacy Regarding G × E Influences on Podoconiosis. Public Health Genomics 2023; 26:68-76. [PMID: 37231974 DOI: 10.1159/000530889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
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.
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Affiliation(s)
- Desta Ayode
- Department of Sociology, College of Social Sciences, Addis Ababa University, Addis Ababa, Ethiopia,
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA,
| | - Kibur Engdawork
- Department of Sociology, College of Social Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Renee Moore
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Getnet Tadele
- Department of Sociology, College of Social Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Brighton and Sussex Medical School, University of Sussex, Brighton, Falmer, UK
| | - Colleen M McBride
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Deribe K, Sultani HM, Okoyo C, Omondi WP, Ngere I, Newport MJ, Cano J. Geostatistical modelling of the distribution, risk and burden of podoconiosis in Kenya. Trans R Soc Trop Med Hyg 2023; 117:72-82. [PMID: 36130407 PMCID: PMC9890307 DOI: 10.1093/trstmh/trac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/27/2022] [Accepted: 09/02/2022] [Indexed: 02/04/2023] Open
Abstract
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.
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Affiliation(s)
- Kebede Deribe
- Children's Investment Fund Foundation, Addis Ababa, Ethiopia.,Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK.,School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Collins Okoyo
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | - Wyckliff P Omondi
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya
| | - Isaac Ngere
- Global Health Program, Washington State University, Nairobi, Kenya
| | - Melanie J Newport
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Jorge Cano
- Expanded Special Project for Elimination of Neglected Tropical Diseases, World Health Organization Regional Office for Africa, Brazzaville, Republic of the Congo
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Row JR, Holloran MJ, Fedy BC. Quantifying the temporal stability in seasonal habitat for sage‐grouse using regression and ensemble tree approaches. Ecosphere 2022. [DOI: 10.1002/ecs2.4034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Jeffrey R. Row
- School of Environment, Resources and Sustainability University of Waterloo Waterloo Ontario Canada
| | | | - Bradley C. Fedy
- School of Environment, Resources and Sustainability University of Waterloo Waterloo Ontario Canada
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Leveraging Machine Learning and Geo-Tagged Citizen Science Data to Disentangle the Factors of Avian Mortality Events at the Species Level. REMOTE SENSING 2022. [DOI: 10.3390/rs14102369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Abrupt environmental changes can affect the population structures of living species and cause habitat loss and fragmentations in the ecosystem. During August–October 2020, remarkably high mortality events of avian species were reported across the western and central United States, likely resulting from winter storms and wildfires. However, the differences of mortality events among various species responding to the abrupt environmental changes remain poorly understood. In this study, we focused on three species, Wilson’s Warbler, Barn Owl, and Common Murre, with the highest mortality events that had been recorded by citizen scientists. We leveraged the citizen science data and multiple remotely sensed earth observations and employed the ensemble random forest models to disentangle the species responses to winter storm and wildfire. We found that the mortality events of Wilson’s Warbler were primarily impacted by early winter storms, with more deaths identified in areas with a higher average daily snow cover. The Barn Owl’s mortalities were more identified in places with severe wildfire-induced air pollution. Both winter storms and wildfire had relatively mild effects on the mortality of Common Murre, which might be more related to anomalously warm water. Our findings highlight the species-specific responses to environmental changes, which can provide significant insights into the resilience of ecosystems to environmental change and avian conservations. Additionally, the study emphasized the efficiency and effectiveness of monitoring large-scale abrupt environmental changes and conservation using remotely sensed and citizen science data.
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van 't Noordende AT, Aycheh MW, Moges NA, Tadesse T, Schippers AP. Family-based intervention for prevention and self-management of disabilities due to leprosy, podoconiosis and lymphatic filariasis versus usual care in Ethiopia: study protocol for a cluster-randomised controlled trial. BMJ Open 2022; 12:e056620. [PMID: 35354636 PMCID: PMC8968636 DOI: 10.1136/bmjopen-2021-056620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Leprosy, podoconiosis and lymphatic filariasis (LF) are three skin-related neglected tropical diseases. All three conditions can lead to temporary and permanent impairments. These impairments progressively worsen and are major determinants of stigma, discrimination and participation restrictions. Self-care is essential to prevent disabilities and chronic disease complications. Many persons with leprosy-related, LF-related and podoconiosis-related disabilities need to practice self-management routines their entire life. This is difficult without support and encouragement of others. The objective of this study was to assess the effectiveness of a family-based intervention in terms of physical outcomes related to prevention and self-management of disabilities due to leprosy, podoconiosis and LF and family quality of life and well-being compared with usual practice and care. METHODS AND ANALYSIS The study will use a cluster-randomised controlled trial design with two study arms. The project will be carried out in endemic districts in East and West Gojjam zones in the Amhara region in Ethiopia. Clusters consist of kebeles (lower administrative structures in the district) that have been merged, based on their geographical proximity and the number of cases in each kebele. A total of 630 participants will be included in the study. The intervention group will consist of 105 persons affected by leprosy, 105 persons affected by LF or podoconiosis, and 210 family members. The control group will consist of 105 persons affected by leprosy and 105 persons affected by LF or podoconiosis. The family-based intervention comprises an essential care package that consists of the following three main components: (1) self-management of disabilities, (2) economic empowerment and (3) psychosocial support. Participants in the control areas will receive usual practice and care. Data analysis includes, but is not limited to, calculating the percentage of change and corresponding 95% CI of physical impairment outcomes in each group, before and after the intervention is implemented, effect sizes, intention to treat and difference in difference analysis. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Debre Markos University Health Sciences Institutional Research Ethics Review Committee. Results will be disseminated through peer-reviewed publications, conference presentations and workshops. TRIAL REGISTRATION NUMBER PACTR202108907851342.
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Affiliation(s)
- Anna Tiny van 't Noordende
- Disability Studies in the Netherlands, Utrecht, The Netherlands
- Technical Department, NLR, Amsterdam, The Netherlands
- Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Moges Wubie Aycheh
- Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Nurilign Abebe Moges
- Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Tesfaye Tadesse
- Programme, Ethiopian National Association of Persons Affected by Leprosy (ENAPAL), Addis Ababa, Ethiopia
| | - Alice P Schippers
- Disability Studies in the Netherlands, Utrecht, The Netherlands
- Care ethics, University of Humanistic Studies, Utrecht, The Netherlands
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Davies B, Kinfe M, Ali O, Mengiste A, Tesfaye A, Wondimeneh MT, Davey G, Semrau M. Stakeholder perspectives on an integrated package of care for lower limb disorders caused by podoconiosis, lymphatic filariasis or leprosy: A qualitative study. PLoS Negl Trop Dis 2022; 16:e0010132. [PMID: 35061673 PMCID: PMC8809619 DOI: 10.1371/journal.pntd.0010132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/02/2022] [Accepted: 01/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Lower limb disorders including lymphoedema create a huge burden for affected persons in their physical and mental health, as well as socioeconomic and psychosocial consequences for them, their families and communities. As routine health services for the integrated management and prevention of lower limb disorders are still lacking, the ‘Excellence in Disability Prevention Integrated across Neglected Tropical Diseases’ (EnDPoINT) study was implemented to assess the development and delivery of an integrated package of holistic care–including physical health, mental health and psychosocial care–within routine health services for persons with lower limb disorders caused by podoconiosis, lymphatic filariasis and leprosy. Methodology/Principal findings This study was part of the first of three phases within EnDPoINT, involving the development of the integrated care package. Focus group discussions and key informant interviews were undertaken with 34 participants between January–February 2019 in Awi zone, Ethiopia, in order to assess the draft care package’s feasibility, acceptability and appropriateness. Persons affected by lower limb disorders such as lymphoedema experience stigma, exclusion from families, communities and work as well as physical and financial hardship. Beliefs in disease causation inhibit affected persons from accessing care. Ignorance was a barrier for health care providers as well as affected persons. Training and education of affected persons, communities and caregivers is important in improving care access. It also requires time, space, materials and financial resources. Both top-down and grass roots input into service development are key, as well as collaboration across stakeholders including charities, community leaders and “expert patients”. Conclusions/Significance This study highlighted the need for the EnDPoINT integrated care package and provided suggestions for solutions according to its three aspects of integrated care (integration into routine care; integration of mental health and psychosocial care; and integration of care across the three diseases), thereby giving support for its feasibility, acceptability and appropriateness. Lower limb disorders including lymphoedema are prevalent in Ethiopia as a common endpoint of varying causes such as podoconiosis, leprosy and lymphatic filariasis. This study involved the development of a comprehensive integrated and holistic care package for lower limb disorders into routine health care services. It used interviews and focus groups to assess feasibility, acceptability and appropriateness of the draft care package. We found that persons affected by lower limb disorders had many negative experiences due to their condition, especially related to stigma, that included physical, financial and psychological sequelae. Neglect was paramount, with financial neglect in central budgets, a lack of knowledge by care givers and a lack of awareness among affected persons and their communities, all contributing to inadequate care provision and access. Affected persons, communities and caregivers may benefit from provision of learning opportunities about the prevention and treatment of lower limb disorders; and resources are crucial in engendering change, including material goods, time to provide care, and collaborative work to create a culture shift and address stigma.
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Affiliation(s)
- Bethany Davies
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- * E-mail: (BD); (MS)
| | - Mersha Kinfe
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Oumer Ali
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Asrat Mengiste
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraham Tesfaye
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Gail Davey
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maya Semrau
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- * E-mail: (BD); (MS)
| | - EnDPoINT Research Team and Consortium
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Tora A, Tadele G, Davey G, McBride CM. The extent of protective footwear use among school-age rural children at high risk for podoconiosis and socio-economic correlates: A household cross-sectional survey in Southern Ethiopia. PLoS Negl Trop Dis 2021; 15:e0009791. [PMID: 34606499 PMCID: PMC8489712 DOI: 10.1371/journal.pntd.0009791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Podoconiosis is preventable if genetically susceptible people wear shoes starting from an early age and do so consistently. However, lack of routine use of footwear is one of the major risk factors for podoconiosis and several other foot-related Neglected Tropical Diseases (NTDs). This study is aimed at describing the extent of footwear use among school-age rural children susceptible to the disease and investigating associated socioeconomic factors. METHODS Cross sectional surveys were conducted in 330 randomly selected households in Wolaita zone, southern Ethiopia. A household head and a child aged between 9 and 15 years were recruited from each household. Household heads provided socioeconomic data while children were asked about their footwear ownership and footwear use. RESULTS Nearly half (49.5%) of the children reported either walking barefoot or wearing under-protective footwear in a range of situations. Girls, older children, those in higher school grades, who belonged to families with higher socio-economic status, and those who owned a larger number of pairs of footwear reported more protective use of footwear. The linear regression model constituting the adequacy of footwear ownership and interaction term (i.e. family socioeconomic status by adequacy of footwear ownership) variables explained 30% of variance in the protective use of footwear (AR2 = 0.307). The interaction effect of adequate ownership of footwear and family socioeconomic status consistently predicted the protective use of footwear among children (β = -0.175, p<0.01) though the main effect of adequacy of footwear ownership was stronger (β = 0.507, p<0.001). CONCLUSION Increased adoption of protective footwear is needed to effectively prevent school-age children living in endemic areas from developing podoconiosis and other neglected tropical diseases. Interventions aimed to improve the protective footwear use should consider approaches that also increase the socio-economic capacity of families in podoconiosis endemic communities.
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Affiliation(s)
- Abebayehu Tora
- Department of Sociology, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getnet Tadele
- Department of Sociology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Colleen M. McBride
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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Mersha TT, Mekonnen Wolde B, Shumuye NA, Hailu AB, Mohammed AH, Redda YT, Abera BH, Menghistu HT. Prioritization of neglected tropical zoonotic diseases: A one health perspective from Tigray region, Northern Ethiopia. PLoS One 2021; 16:e0254071. [PMID: 34292951 PMCID: PMC8297755 DOI: 10.1371/journal.pone.0254071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 06/21/2021] [Indexed: 11/26/2022] Open
Abstract
Neglected tropical zoonotic diseases (NTZDs) continue to have a major effect on the health of humans and animals. In this study, a one health approach was used to prioritize and rank neglected tropical zoonotic diseases at the regional and zonal levels in Tigray National Regional State, Ethiopia. For prioritization of NTZDs a cross-sectional study through a structured questionnaire was administered to 313 health experts from human and animal health sectors. In addition, focus group discussions (FGD) were held with purposively selected key informants. Descriptive, and Multivariable analysis was applied to report the results and a ranked list of diseases was developed at the zonal and regional level. In the region, 8 of the 12 World Health Organization listed NTZDs were considered major diseases including anthrax, brucellosis, bovine tuberculosis, taeniasis, leishmaniasis, rabies, schistosomiasis, and soil-transmitted helminths. Considering the zoonotic and socioeconomic importance of the diseases at the regional level, rabies ranked 1stwhereas anthrax, bovine tuberculosis, leishmaniasis, and brucellosis were ranked from 2nd to 5th, respectively. The FGD result also supported the prioritization result. The Multivariable analysis showed a statistically significant difference in the zonal distribution of anthrax (р = 0.009, OR = 1.16), taeniasis (p<0.001, OR = 0.82), leishmaniasis (p<0.001, OR = 1.91), rabies (p = 0.020, OR = 0.79) and soil-transmitted helminths (p = 0.007, OR = 0.87) but not for brucellosis (p = 0.585), bovine tuberculosis (p = 0.505), and schistosomiasis (p = 0.421). Anthrax (p<0.001, OR = 26.68), brucellosis (p<0.001, OR = 13.18), and taeniasis (p<0.001, OR = 6.17) were considered as the major zoonotic diseases by veterinary practitioners than human health practitioners whereas, leishmaniasis was recognized as a major health challenge by human health professionals. Understanding the priority diseases in the region is supportive for informed decision-making and prioritizes the limited resources to use. Furthermore, strengthening the collaboration between human and animal health professions is important to control the diseases.
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Affiliation(s)
- Tadesse Teferi Mersha
- Department of Veterinary Clinical Medicine and Epidemiology, College of Veterinary Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Biruk Mekonnen Wolde
- Department of Basic and Diagnostic Sciences, College of Veterinary Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
- * E-mail: ,
| | - Nigus Abebe Shumuye
- Department of Veterinary Clinical Medicine and Epidemiology, College of Veterinary Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
- Lanzihou Veterinary Research Institute, CAAS, Lanzhou, China
| | - Abrha Bsrat Hailu
- Department of Basic and Diagnostic Sciences, College of Veterinary Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Abrahim Hassen Mohammed
- Health Bureau, Research, Projects, and International Relations, National Regional State of Tigray, Mekelle, Ethiopia
| | - Yisehak Tsegaye Redda
- Department of Basic and Diagnostic Sciences, College of Veterinary Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Birhanu Hadush Abera
- Department of Veterinary Clinical Medicine and Epidemiology, College of Veterinary Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Habtamu Taddele Menghistu
- Department of Basic and Diagnostic Sciences, College of Veterinary Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
- Institute of Climate and Society, Mekelle University, Mekelle, Tigray, Ethiopia
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Menghistu HT, Mersha TT, Shumuye NA, Woldie BM, Redda YT, Hadush B, Mohammed AH. Neglected tropical zoonotic diseases in Tigray region, northern Ethiopia: Spatial distribution and trend analysis of rabies, tuberculosis, schistosomiasis, and visceral leishmaniasis in humans. Zoonoses Public Health 2021; 68:823-833. [PMID: 34263554 DOI: 10.1111/zph.12874] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 06/14/2021] [Indexed: 12/01/2022]
Abstract
Neglected tropical zoonotic diseases (NTZDs) continue to affect the health and livelihoods of humans particularly the poor and marginalized populations in developing countries. Mapping the distribution and burden of these diseases will support making an informed decision. A retrospective study was conducted to map the spatial distribution and analyse trend of NTZDs in Tigray region, Northern Ethiopia. A health management information system (HMIS) data between 2012/13 and 2016/17 was obtained from Tigray National Regional State Health Bureau. The Quantum-GIS software was used to map the spatial distribution and burden of selected NTZDs at zonal level. Only four of the NTZDs namely rabies, tuberculosis (TB), schistosomiasis and visceral leishmaniasis (VL) from the records of HMIS data were considered. A high incidence rate (IR) at least for one of the NTZDs was reported in males above 15 years old. In the 5-year period, of the 60,099 reported NTZD cases, 30.3% (18,220), 26.6% (16,005), 23.3% (14,001), 14.4% (8,661), and 5.3% (3,212) were, respectively, schistosomiasis, extra-pulmonary TB, rabies, pulmonary TB, and visceral leishmaniasis. The year-wise analysis showed an irregular trend for the NTZDs where both the decreasing and increasing trends didn't show statistically significant variation. However, the overall regional number of TB cases showed a decreasing trend, where the decrease for extra-pulmonary TB (1.8 cases per 100,000 population) was higher than pulmonary TB (0.5 cases per 100,000 population). Similarly, the annual number of rabies and VL cases showed a decreasing trend. On the other hand, the number of schistosomiasis cases showed an increasing trend (8.2 cases per 100,000 population). The annual average number of TB (171 cases per 100,000 population), schistosomiasis (354 cases per 100,000 population), and VL (63 cases per 100,000 population) cases were much higher in Western zone compared to the rest of the zones. The incidence rate of rabies was higher in Mekelle and Southeastern (100 cases per 100,000 population) and Northwestern (97 cases per 100,000 population) zones. Intervention strategies applied in the region should take into account the zonal distribution and burden of NTZDs.
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Affiliation(s)
- Habtamu Taddele Menghistu
- Department of Basic and Diagnostic Sciences, College of Veterinary Sciences, Mekelle University, Mekelle, Ethiopia.,Institute of Climate and Society, Mekelle University, Mekelle, Ethiopia
| | - Tadesse Teferi Mersha
- Department of Veterinary Clinical Medicine and Epidemiology, College of Veterinary Sciences, Mekelle University, Mekelle, Ethiopia
| | - Nigus Abebe Shumuye
- Department of Veterinary Clinical Medicine and Epidemiology, College of Veterinary Sciences, Mekelle University, Mekelle, Ethiopia.,Lanzihou Veterinary Research Institute, CAAS, Beijing, China
| | - Biruk Mekonnen Woldie
- Department of Basic and Diagnostic Sciences, College of Veterinary Sciences, Mekelle University, Mekelle, Ethiopia
| | - Yisehak Tsegaye Redda
- Department of Basic and Diagnostic Sciences, College of Veterinary Sciences, Mekelle University, Mekelle, Ethiopia
| | - Birhanu Hadush
- Department of Veterinary Clinical Medicine and Epidemiology, College of Veterinary Sciences, Mekelle University, Mekelle, Ethiopia
| | - Abrahim Hassen Mohammed
- Research, Project and International Relations, Tigray National Regional State Health Bureau, Mekelle, Ethiopia
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Wanji S, Deribe K, Minich J, Debrah AY, Kalinga A, Kroidl I, Luguet A, Hoerauf A, Ritter M. Podoconiosis - From known to unknown: Obstacles to tackle. Acta Trop 2021; 219:105918. [PMID: 33839086 DOI: 10.1016/j.actatropica.2021.105918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 12/17/2022]
Abstract
Podoconiosis is a non-filarial and non-communicable disease leading to lymphedema of the lower limbs. Worldwide, 4 million individuals live with podoconiosis, which is accompanied by disability and painful intermittent acute inflammatory episodes that attribute to significant disability adjusted life years (DALYs). Different risk factors like contact with volcanic red clay soil, high altitude (above 1000 m), high seasonal rainfall (above 1000 mm/year) and occupation (e.g., subsistence farmer) are associated with the risk of podoconiosis. Although podoconiosis was described to be endemic in 32 countries in Africa, parts of Latin America and South East Asia, knowledge about related genetics, pathophysiology, immunology and especially the causing molecule(s) in the soil remain uncertain. Thus, podoconiosis can be considered as one of the most neglected diseases. This review provides an overview about this non-filarial related geochemical disease and aim to present perspectives and future directions that might be important for better understanding of the disease, prospect for point-of-care diagnosis, achieving protection and developing novel treatment strategies.
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Deribe K, Mackenzie CD, Newport MJ, Argaw D, Molyneux DH, Davey G. Podoconiosis: key priorities for research and implementation. Trans R Soc Trop Med Hyg 2021; 114:889-895. [PMID: 33169167 PMCID: PMC7738650 DOI: 10.1093/trstmh/traa094] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/31/2020] [Accepted: 08/27/2020] [Indexed: 12/14/2022] Open
Abstract
Podoconiosis is a non-infectious tropical lymphoedema causing swelling of the lower legs. Podoconiosis is associated with stigma, depression and reduced productivity, resulting in significant socio-economic impacts for affected individuals, families and communities. It is caused by barefoot exposure to soils and affects disadvantaged populations. Evidence from the past 5 y suggests that podoconiosis is amenable to public health interventions, e.g. footwear and hygiene-based morbidity management, which reduce acute clinical episodes. Although much has been learned in recent years, advances in care for these patients and worldwide control requires further reliable and relevant research. To develop a comprehensive global control strategy, the following key research priorities are important: better understanding of the global burden of podoconiosis through extended worldwide mapping, development of new point-of-care diagnostic methods and approaches to define the presence of the environmental characteristics that contribute to the development of the condition, improving treatment through an increased understanding of the pathogenesis of dermal changes over time, improved understanding of optimal ways of providing patient care at the national level, including research to optimize behavioural change strategies, determine the optimum package of care and integrate approaches to deliver robust surveillance, monitoring and evaluation of control programmes.
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Affiliation(s)
- Kebede Deribe
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton BN1 9PX, UK.,School of Public Health, College of Health Sciences, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia
| | | | - Melanie J Newport
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton BN1 9PX, UK
| | - Daniel Argaw
- World Health Organization, Control of Neglected Tropical Diseases, Geneva 1211, Switzerland
| | | | - Gail Davey
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton BN1 9PX, UK.,School of Public Health, College of Health Sciences, Addis Ababa University, PO Box 9086, Addis Ababa, Ethiopia
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Deribe K, Florence L, Kelemework A, Getaneh T, Tsegay G, Cano J, Giorgi E, Newport MJ, Davey G. Developing and validating a clinical algorithm for the diagnosis of podoconiosis. Trans R Soc Trop Med Hyg 2021; 114:916-925. [PMID: 33174588 PMCID: PMC7738664 DOI: 10.1093/trstmh/traa074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/06/2020] [Accepted: 08/04/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Difficulties in reliably diagnosing podoconiosis have severely limited the scale-up and uptake of the World Health Organization-recommended morbidity management and disability prevention interventions for affected people. We aimed to identify a set of clinical features that, combined into an algorithm, allow for diagnosis of podoconiosis. METHODS We identified 372 people with lymphoedema and administered a structured questionnaire on signs and symptoms associated with podoconiosis and other potential causes of lymphoedema in northern Ethiopia. All individuals were tested for Wuchereria bancrofti-specific immunoglobulin G4 in the field using Wb123. RESULTS Based on expert diagnosis, 344 (92.5%) of the 372 participants had podoconiosis. The rest had lymphoedema due to other aetiologies. The best-performing set of symptoms and signs was the presence of moss on the lower legs and a family history of leg swelling, plus the absence of current or previous leprosy, plus the absence of swelling in the groin, plus the absence of chronic illness (such as diabetes mellitus or heart or kidney diseases). The overall sensitivity of the algorithm was 91% (95% confidence interval [CI] 87.6 to 94.4) and specificity was 95% (95% CI 85.45 to 100). CONCLUSIONS We developed a clinical algorithm of clinical history and physical examination that could be used in areas suspected or endemic for podoconiosis. Use of this algorithm should enable earlier identification of podoconiosis cases and scale-up of interventions.
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Affiliation(s)
- Kebede Deribe
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.,School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, PO Box 9086, Ethiopia
| | - Lyndsey Florence
- King's College Hospital NHS Foundation Trust, Denmark Hill SE5 9RS, London, UK
| | - Abebe Kelemework
- International Orthodox Christian Charities, PO Box 495 Bahir Dar, Ethiopia
| | - Tigist Getaneh
- International Orthodox Christian Charities, PO Box 495 Bahir Dar, Ethiopia
| | - Girmay Tsegay
- College of Medicine and Health Sciences, Debre Markos University, PO Box 269, Debre Markos, Ethiopia
| | - Jorge Cano
- Department of Disease Control, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK
| | - Emanuele Giorgi
- CHICAS Research Group, Lancaster Medical School, Lancaster University, Bailrigg, LA1 4YW, Lancaster, UK
| | - Melanie J Newport
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - Gail Davey
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.,School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, PO Box 9086, Ethiopia
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Deribe K, Negussu N, Newport MJ, Davey G, Turner HC. The health and economic burden of podoconiosis in Ethiopia. Trans R Soc Trop Med Hyg 2021; 114:284-292. [PMID: 32055853 PMCID: PMC7139123 DOI: 10.1093/trstmh/traa003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/31/2019] [Accepted: 01/10/2019] [Indexed: 12/11/2022] Open
Abstract
Background Podoconiosis is one of the leading causes of lymphoedema-related morbidity in low-income settings, but little is known about the scale of its health and economic impact. This information is required to inform control programme planning and policy. In this study, we estimated the health and economic burden of podoconiosis in Ethiopia. Methods We developed a model to estimate the health burden attributed to podoconiosis in terms of the number of disability-adjusted life years (DALYs) and the economic burden. We estimated the economic burden by quantifying the treatment and morbidity-management costs incurred by the healthcare system in managing clinical cases, patients' out-of-pocket costs and their productivity costs. Results In 2017, there were 1.5 million cases of podoconiosis in Ethiopia, which corresponds to 172 073 DALYs or 182 per 100 000 people. The total economic burden of podoconiosis in Ethiopia is estimated to be US$213.2 million annually and 91.1% of this resulted from productivity costs. The average economic burden per podoconiosis case was US$136.9. Conclusions The national cost of podoconiosis is formidable. If control measures are scaled up and the morbidity burden reduced, this will lead to Ethiopia saving millions of dollars. Our estimates provide important benchmark economic costs to programme planners, policymakers and donors for resource allocation and priority setting.
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Affiliation(s)
- Kebede Deribe
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.,School of Public Health, College of Health Sciences, Addis Ababa University, P.O.Box 9086, Addis Ababa, Ethiopia
| | - Nebiyu Negussu
- Federal Ministry of Health, P.O.Box 1234, Addis Ababa, Ethiopia
| | - Melanie J Newport
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - Gail Davey
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.,School of Public Health, College of Health Sciences, Addis Ababa University, P.O.Box 9086, Addis Ababa, Ethiopia
| | - Hugo C Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, OX3 7LG, Oxford, UK.,Oxford University Clinical Research Unit, Wellcome Africa Asia Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
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Tesfaye A, Semrau M, Ali O, Kinfe M, Tamiru M, Fekadu A, Davey G. Development of an integrated, holistic care package for people with lymphoedema for use at the level of the Primary Health Care Unit in Ethiopia. PLoS Negl Trop Dis 2021; 15:e0009332. [PMID: 33878110 PMCID: PMC8086999 DOI: 10.1371/journal.pntd.0009332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/30/2021] [Accepted: 03/25/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Neglected Tropical Diseases (NTDs) are a group of several communicable and non-communicable diseases prevalent in tropical and subtropical areas. The co-endemicity of these diseases, the similarity of their clinical signs, and the need to maximize limited financial and human resources suggest the importance of adoptingan integratedapproach to their prevention and treatment. AIMS This study describes the development of a comprehensive package of physical, mental health and psychosocial care for people with lower-limb lymphoedema caused bypodoconiosis, lymphatic filariasis (LF)or leprosy as part of the EnDPoINT program in Ethiopia. METHOD The care package was developed using a mixed-methods approach, consisting of a literature review, situational analysis, Theory of Change (ToC) workshops, qualitative research, and additional workshops to fine-tune the draft care package. The care package was developed between March 2018 and January 2020 in Addis Ababa and the implementation research site, Awi zone in the North-West of Ethiopia. RESULTS The holistic care package includes components implemented at three levels of the health care system:health organization, facility, and community. Sections of the care package are directed at strengthening capacity building, program management, community engagement, awareness-raising, stigma-reduction, morbidity management, disability prevention, follow-up visits, referral linkage, community-based rehabilitation, and monitoring and evaluation. CONCLUSIONS The study developed a holistic integrated care package for lower limb disorder and co-morbid mental health problems caused by podoconiosis, LF or leprosy. The approach has the potential to significantly reduce lower limb disorder-associated morbidity, disability, and psychosocial problems. It also standardizes a scalable approach appropriate for the Ethiopian setting and, most likely, other countries where these NTDs are present.
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Affiliation(s)
- Abraham Tesfaye
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Maya Semrau
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Oumer Ali
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Mersha Kinfe
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Abebaw Fekadu
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Gebresilase T, Finan C, Suveges D, Tessema TS, Aseffa A, Davey G, Hatzikotoulas K, Zeggini E, Newport MJ, Tekola-Ayele F. Replication of HLA class II locus association with susceptibility to podoconiosis in three Ethiopian ethnic groups. Sci Rep 2021; 11:3285. [PMID: 33558538 PMCID: PMC7870958 DOI: 10.1038/s41598-021-81836-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/29/2020] [Indexed: 11/25/2022] Open
Abstract
Podoconiosis, a debilitating lymphoedema of the leg, results from barefoot exposure to volcanic clay soil in genetically susceptible individuals. A previous genome-wide association study (GWAS) conducted in the Wolaita ethnic group from Ethiopia showed association between single nucleotide polymorphisms (SNPs) in the HLA class II region and podoconiosis. We aimed to conduct a second GWAS in a new sample (N = 1892) collected from the Wolaita and two other Ethiopian populations, the Amhara and the Oromo, also affected by podoconiosis. Fourteen SNPs in the HLA class II region showed significant genome-wide association (P < 5.0 × 10−8) with podoconiosis. The lead SNP was rs9270911 (P = 5.51 × 10−10; OR 1.53; 95% CI 1.34–1.74), located near HLA-DRB1. Inclusion of data from the first GWAS (combined N = 2289) identified 47 SNPs in the class II HLA region that were significantly associated with podoconiosis (lead SNP also rs9270911 (P = 2.25 × 10−12). No new loci outside of the HLA class II region were identified in this more highly-powered second GWAS. Our findings confirm the HLA class II association with podoconiosis suggesting HLA-mediated abnormal induction and regulation of immune responses may have a direct role in its pathogenesis.
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Affiliation(s)
- Tewodros Gebresilase
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia.,Unit of Health Biotechnology, Institute of Biotechnology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Chris Finan
- Institute of Cardiovascular Science, Faculty of Population Health, University College London, London, UK
| | - Daniel Suveges
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK.,European Bioinformatics Institute, Hinxton, Cambridge, UK
| | - Tesfaye Sisay Tessema
- Unit of Health Biotechnology, Institute of Biotechnology, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Gail Davey
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | - Konstantinos Hatzikotoulas
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK.,Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,TUM School of Medicine, Technical University of Munich and Klinikum Rechts Der Isar, Munich, Germany
| | - Eleftheria Zeggini
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK.,Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,TUM School of Medicine, Technical University of Munich and Klinikum Rechts Der Isar, Munich, Germany
| | - Melanie J Newport
- Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK.
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Van't Noordende AT, Aycheh MW, Schippers AP. An exploration of family quality of life in persons with leprosy-, lymphatic filariasis- and podoconiosis-related disabilities and their family members in Ethiopia. Trans R Soc Trop Med Hyg 2020; 114:1003-1012. [PMID: 33169139 PMCID: PMC7738662 DOI: 10.1093/trstmh/traa090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 12/03/2022] Open
Abstract
Background Leprosy, podoconiosis and lymphatic filariasis (LF) may adversely affect the social, economic and psychological well-being of persons affected and their families. The objectives of this study were to assess and compare family quality of life of persons affected and their family members, explore the relationship between family quality of life and perceived stigma and activity limitations and explore what factors influence family quality of life. Methods A cross-sectional quantitative study was conducted in the Awi zone in Ethiopia. Persons affected and their family members were selected using purposive sampling. Three questionnaires were used: the Beach Center Family Quality of Life (FQOL) scale (range 25–125, with higher scores denoting higher family quality of life), the SARI Stigma Scale (range 0–63, with higher scores denoting higher levels of stigma) and the Screening of Activity Limitation and Safety Awareness (SALSA) scale (range 0–80, with higher scores denoting more activity limitations). Data analysis consisted of simple descriptive analysis and regression analysis. Results A total of 95 persons affected and 117 family members were included. The overall mean of the family quality of life score was 71.7. Persons affected had significantly higher mean family quality of life scores than family members on all domains. Female gender, a smaller family size and occupation were associated with lower family quality of life. We found a mean SARI Stigma score of 22.3 and a mean SALSA score of 37.6. There was no association between the FQOL and SARI scores or between the FQOL and SALSA scores. Conclusions Family quality of life is an important area to address because neglected tropical diseases often affect the whole family. It is therefore important in order to provide appropriate support for persons affected and their family members. Efforts to improve the quality of life of families in which a family member is affected by leprosy, podoconiosis or LF should give priority to women and families with a smaller family size.
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Affiliation(s)
- Anna T Van't Noordende
- Programme Department, Stichting Disability Studies in Nederland, p/a Marelaan 61, 3454 GB De Meern, The Netherlands.,Technical Department, NLR, Wibautstraat 137K, 1097 DN Amsterdam, The Netherlands.,Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Moges Wubie Aycheh
- Department of Public Health, Debre Markos University, A3, Debre Markos, Ethiopia
| | - Alice P Schippers
- Programme Department, Stichting Disability Studies in Nederland, p/a Marelaan 61, 3454 GB De Meern, The Netherlands.,Amsterdam University Medical Centre, VU Medical Center, De Boelelaan 1117-1118, 1081 HV Amsterdam, The Netherlands
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22
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Simpson H, Panicker KN, George LS, Cano J, Newport MJ, Davey G, Deribe K. Developing consensus of evidence to target case finding surveys for podoconiosis: a potentially forgotten disease in India. Trans R Soc Trop Med Hyg 2020; 114:908-915. [PMID: 33169156 PMCID: PMC7738658 DOI: 10.1093/trstmh/traa064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/17/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Podoconiosis is a non-infectious geochemical lymphoedema of the lower legs associated with a significant burden of morbidity. There are historical reports of podoconiosis in India, but its current endemicity status is uncertain. In this investigation we aimed to prioritise the selection of districts for pilot mapping of podoconiosis in India. METHODS Through a consultative workshop bringing together expert opinion on podoconiosis with public health and NTDs in India, we developed a framework for the prioritisation of pilot areas. The four criteria for prioritisation were predicted environmental suitability for podoconiosis, higher relative poverty, occurrence of lymphoedema cases detected by the state health authorities and absence of morbidity management and disability prevention (MMDP) services provided by the National Programme for Elimination of Lymphatic Filariasis. RESULTS Environmental suitability for podoconiosis in India was predicted to be widespread, particularly in the mountainous east and hilly southwest of the country. Most of the districts with higher levels of poverty were in the central east and central west. Of 286 districts delineated by state representatives, lymphoedema was known to the health system in 189 districts and not recorded in 80. Information on MMDP services was unavailable for many districts, but 169 were known not to provide such services. We identified 35 districts across the country as high priority for mapping based on these criteria. CONCLUSIONS Our results indicate widespread presence of conditions associated with podoconiosis in India, including areas with known lymphoedema cases and without MMDP services. This work is intended to support a rational approach to surveying for an unrecognised, geographically focal, chronic disease in India, with a view to scaling up to inform a national strategy if required.
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Affiliation(s)
- Hope Simpson
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - K N Panicker
- Deptartment of Community Medicine, Amrita Institute of Medical Sciences and Research Centre, Edappally, Kochi, Kerala, 682031, India
| | - Leyanna Susan George
- Deptartment of Community Medicine, Amrita Institute of Medical Sciences and Research Centre, Edappally, Kochi, Kerala, 682031, India
| | - Jorge Cano
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Melanie J Newport
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - Gail Davey
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, PO Box 9086, Ethiopia
| | - Kebede Deribe
- Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, PO Box 9086, Ethiopia
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23
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Gislam H, Burnside NG, Brolly M, Deribe K, Davey G, Wanji S, Suh CE, Kemp SJ, Watts MJ, Le Blond JS. Linking soils and human health: geospatial analysis of ground-sampled soil data in relation to community-level podoconiosis data in North West Cameroon. Trans R Soc Trop Med Hyg 2020; 114:937-946. [PMID: 33216129 PMCID: PMC7738663 DOI: 10.1093/trstmh/traa138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background Podoconiosis is a form of leg swelling, which arises when individuals are exposed over time to red clay soil formed from alkaline volcanic rock. The exact causal agent of the disease is unknown. This study investigates associations between podoconiosis disease data and ground-sampled soil data from North West Cameroon. Methods The mineralogy and elemental concentrations were measured in the soil samples and the data were spatially interpolated. Mean soil values were calculated from a 3 km buffer region around the prevalence data points to perform statistical analysis. Analysis included Spearman's rho correlation, binary logistic regression and principal component analysis (PCA). Results Six elements, barium, beryllium, potassium, rubidium, strontium and thallium, as well as two minerals, potassium feldspar and quartz, were identified as statistically related to podoconiosis. PCA did not show distinct separation between the spatial locations with or without recorded cases of podoconiosis, indicating that other factors such as shoe-wearing behaviour and genetics may significantly influence podoconiosis occurrence and prevalence in North West Cameroon. Conclusion Several soil variables were statistically significantly related to podoconiosis. To further the current study, future investigations will look at the inflammatory pathway response of cells after exposure to these variables.
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Affiliation(s)
- H Gislam
- School of Environment & Technology, University of Brighton, Brighton, UK
| | - N G Burnside
- School of Environment & Technology, University of Brighton, Brighton, UK
| | - M Brolly
- School of Environment & Technology, University of Brighton, Brighton, UK
| | - K Deribe
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK.,Centre for Environmental and Developmental Studies and School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - G Davey
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK.,Centre for Environmental and Developmental Studies and School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - S Wanji
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - C E Suh
- Department of Geology, Environmental Science and Mining, University of Bamenda, Bamenda, Cameroon
| | - S J Kemp
- British Geological Survey, Environmental Science Centre, Keyworth, Nottingham, NG12 5GG, UK
| | - M J Watts
- British Geological Survey, Environmental Science Centre, Keyworth, Nottingham, NG12 5GG, UK
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24
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Deribe K, Simpson H, Pullan RL, Bosco MJ, Wanji S, Weaver ND, Murray CJL, Newport MJ, Hay SI, Davey G, Cano J. Predicting the environmental suitability and population at risk of podoconiosis in Africa. PLoS Negl Trop Dis 2020; 14:e0008616. [PMID: 32853202 PMCID: PMC7480865 DOI: 10.1371/journal.pntd.0008616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 09/09/2020] [Accepted: 07/20/2020] [Indexed: 01/17/2023] Open
Abstract
Podoconiosis 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 are uncertain. We 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 environmental suitability and human population at risk of podoconiosis in Africa. Environmental suitability for podoconiosis was predicted in 29 African countries. In the year 2020, the total population in areas suitable for podoconiosis is estimated at 114.5 million people, (95% uncertainty 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 (typically second administrative-level units, such as districts) defined by the World Health Organization in Africa, 1,655 (29.0%) were found to be environmentally suitable for podoconiosis. The majority of implementation units with high environmental suitability are located in Angola (80, 4.8%), Cameroon (170, 10.3%), the DRC (244, 14.7%), Ethiopia (495, 29.9%), Kenya (217, 13.1%), Uganda (116, 7.0%) and Tanzania (112, 6.8%). Of the 1,655 environmentally suitable implementation units, 960 (58.0%) require more detailed community-level mapping. Our 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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Affiliation(s)
- Kebede Deribe
- Department of Global Heath and Infection, Brighton and Sussex Medical School, Falmer, Brighton, BN1 9PX, United Kingdom
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Hope Simpson
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel L. Pullan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mbonigaba Jean Bosco
- Malaria and Other Parasitic Disease Division, Rwanda Biomedical Center–Ministry of Health, Kigali, Rwanda
| | - Samuel Wanji
- Parasites and Vector Biology Research Unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Nicole Davis Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Christopher J. L. Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, United States of America
| | - Melanie J. Newport
- Department of Global Heath and Infection, Brighton and Sussex Medical School, Falmer, Brighton, BN1 9PX, United Kingdom
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
- Department of Health Metrics Sciences, University of Washington, Seattle, Washington, United States of America
| | - Gail Davey
- Department of Global Heath and Infection, Brighton and Sussex Medical School, Falmer, Brighton, BN1 9PX, United Kingdom
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jorge Cano
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
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25
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Caprioli T, Martindale S, Mengiste A, Assefa D, H/Kiros F, Tamiru M, Negussu N, Taylor M, Betts H, Kelly-Hope LA. Quantifying the socio-economic impact of leg lymphoedema on patient caregivers in a lymphatic filariasis and podoconiosis co-endemic district of Ethiopia. PLoS Negl Trop Dis 2020; 14:e0008058. [PMID: 32126081 PMCID: PMC7069637 DOI: 10.1371/journal.pntd.0008058] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 03/13/2020] [Accepted: 01/14/2020] [Indexed: 12/11/2022] Open
Abstract
Background Lymphoedema caused by lymphatic filariasis (LF) or podoconiosis can result in physical disability and social exclusion, which is exacerbated by painful acute dermatolymphangioadenitis (ADLA) episodes. These conditions have a significant impact on patients, however, little is known about the indirect effects on their caregivers. This study, therefore, aimed to determine the impact on caregivers for patients with leg lymphoedema in a co-endemic district of Ethiopia. Methodology/Principal findings A cross-sectional survey of lymphoedema patients and their caregivers was conducted using semi-structured questionnaires in the Southern Nation Nationalities Peoples Region (SNNPR) of Ethiopia. Lymphoedema patient information on clinical severity (mild, moderate, severe), frequency of ADLAs, their socio-demographic characteristics and the identity of main caregiver(s) was collected. Caregiver information on socio-demographic characteristics, types of care provided, their quality of life (QoL) measured across nine domains, and productivity was collected, with key indicators compared in the presence and absence of patients’ ADLAs. A total of 73 patients and 76 caregivers were included. Patients were grouped by mild/moderate (n = 42, 57.5%) or severe (n = 31, 42.5%) lymphoedema, and reported an average of 6.1 (CI± 2.18) and 9.8 (CI± 3.17) ADLAs respectively in the last six months. A total of 48 (65.8%) female and 25 (34.2%) male patients were interviewed. Caregivers were predominately male (n = 45, 59.2%), and spouses formed the largest caregiving group for both female and male patients. In the absence of an ADLA, most caregivers (n = 42, 55.2%) did not provide care, but only one caregiver did not provide care during an ADLA. In the absence of an ADLA, the average time (hour:minute) spent by mild/moderate (00:17, CI: ± 00:08) and severe (00:10, CI: ± 00:07) patient caregiver per task was minimal. The time mild/moderate (00:47, CI: ± 00:11) and severe (00:51, CI: ± 00:16) patient caregivers spent per task significantly increased in the presence of an ADLA. In addition, caregivers’ QoL was negatively impacted when patients experienced an ALDA, and they had to forfeit an average of 6 to 7 work/school days per month. Conclusion/Significance Lymphoedema and ADLAs impact negatively on patients’ and their caregivers’ lives. This emphasises the importance of increasing access to effective morbidity management and disability prevention services to reduce the burden and help to address the Sustainable Development Goal (SDG) 5, target 5.4, which seeks to recognise and value unpaid care and domestic work. Lymphatic filariasis and podoconiosis can result in chronic severe lymphoedema of the limbs, which is aggravated by frequent painful episodes of acute bacterial infection known as ‘acute attacks’. The debilitating impact of these conditions on patients are well documented, however, the extent to which the hardship extends to their caregivers is unknown. To address this knowledge gap, a survey of 73 lymphoedema patients and their caregivers was conducted in an endemic region of Ethiopia. Patients were found to be predominately female and caregivers predominately male, mostly spouses. Caregivers provided a wide range of care, and the type, frequency and time spent on tasks significantly increased when patients experienced an acute attack. Caregivers reported a negative impact on their quality of life and provided care for an average of 15 days and forfeited an average of 7 days of work or school per month. This study has revealed a previously hidden burden of lymphoedema that not only affects patients, but their caregivers who are mostly family members. This emphasises the importance of increasing access to effective morbidity management and disability prevention programmes to reduce the burden and help to address the Sustainable Development Goal (SDG) 5, target 5.4, which seeks to recognise and value unpaid and domestic work.
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Affiliation(s)
- Thais Caprioli
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sarah Martindale
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Asrat Mengiste
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | - Dereje Assefa
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | - Fikre H/Kiros
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | | | | | - Mark Taylor
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hannah Betts
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Louise A. Kelly-Hope
- Department of Tropical Disease Biology, Centre for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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26
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Chandler DJ, Grijsen ML, Fuller LC. With Bare Feet in the Soil: Podoconiosis, a Neglected Cause of Tropical Lymphoedema. Dermatology 2020; 237:236-247. [PMID: 32101870 DOI: 10.1159/000506045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/19/2020] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- David J Chandler
- Dermatology Department, Brighton General Hospital, Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom,
| | - Marlous L Grijsen
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Lucinda C Fuller
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.,International Foundation for Dermatology, London, United Kingdom
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27
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Coates SJ, Enbiale W, Davis MDP, Andersen LK. The effects of climate change on human health in Africa, a dermatologic perspective: a report from the International Society of Dermatology Climate Change Committee. Int J Dermatol 2020; 59:265-278. [PMID: 31970754 DOI: 10.1111/ijd.14759] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 12/14/2022]
Abstract
Throughout much of the African continent, healthcare systems are already strained in their efforts to meet the needs of a growing population using limited resources. Climate change threatens to undermine many of the public health gains that have been made in this region in the last several decades via multiple mechanisms, including malnutrition secondary to drought-induced food insecurity, mass human displacement from newly uninhabitable areas, exacerbation of environmentally sensitive chronic diseases, and enhanced viability of pathogenic microbes and their vectors. We reviewed the literature describing the various direct and indirect effects of climate change on diseases with cutaneous manifestations in Africa. We included non-communicable diseases such as malignancies (non-melanoma skin cancers), inflammatory dermatoses (i.e. photosensitive dermatoses, atopic dermatitis), and trauma (skin injury), as well as communicable diseases and neglected tropical diseases. Physicians should be aware of the ways in which climate change threatens human health in low- and middle-income countries in general, and particularly in countries throughout Africa, the world's lowest-income and second most populous continent.
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Affiliation(s)
- Sarah J Coates
- Department of Dermatology, The University of California San Francisco, San Francisco, CA, USA
| | | | - Mark D P Davis
- Division of Clinical Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Louise K Andersen
- Department of Dermato-Venereology, Aarhus University Hospital, Aarhus, Denmark
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28
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Eneanya OA, Fronterre C, Anagbogu I, Okoronkwo C, Garske T, Cano J, Donnelly CA. Mapping the baseline prevalence of lymphatic filariasis across Nigeria. Parasit Vectors 2019; 12:440. [PMID: 31522689 PMCID: PMC6745770 DOI: 10.1186/s13071-019-3682-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/22/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction The baseline endemicity profile of lymphatic filariasis (LF) is a key benchmark for planning control programmes, monitoring their impact on transmission and assessing the feasibility of achieving elimination. Presented in this work is the modelled serological and parasitological prevalence of LF prior to the scale-up of mass drug administration (MDA) in Nigeria using a machine learning based approach. Methods LF prevalence data generated by the Nigeria Lymphatic Filariasis Control Programme during country-wide mapping surveys conducted between 2000 and 2013 were used to build the models. The dataset comprised of 1103 community-level surveys based on the detection of filarial antigenemia using rapid immunochromatographic card tests (ICT) and 184 prevalence surveys testing for the presence of microfilaria (Mf) in blood. Using a suite of climate and environmental continuous gridded variables and compiled site-level prevalence data, a quantile regression forest (QRF) model was fitted for both antigenemia and microfilaraemia LF prevalence. Model predictions were projected across a continuous 5 × 5 km gridded map of Nigeria. The number of individuals potentially infected by LF prior to MDA interventions was subsequently estimated. Results Maps presented predict a heterogeneous distribution of LF antigenemia and microfilaraemia in Nigeria. The North-Central, North-West, and South-East regions displayed the highest predicted LF seroprevalence, whereas predicted Mf prevalence was highest in the southern regions. Overall, 8.7 million and 3.3 million infections were predicted for ICT and Mf, respectively. Conclusions QRF is a machine learning-based algorithm capable of handling high-dimensional data and fitting complex relationships between response and predictor variables. Our models provide a benchmark through which the progress of ongoing LF control efforts can be monitored.
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Affiliation(s)
- Obiora A Eneanya
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Claudio Fronterre
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Tini Garske
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Jorge Cano
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Christl A Donnelly
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Department of Statistics, University of Oxford, Oxford, UK
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Deribe K, Mbituyumuremyi A, Cano J, Jean Bosco M, Giorgi E, Ruberanziza E, Bayisenge U, Leonard U, Bikorimana JP, Rucogoza A, Turate I, Rusanganwa A, Pigott DM, Pullan RL, Noor AM, Enquselassie F, Condo JU, Murray CJL, Brooker SJ, Hay SI, Newport MJ, Davey G. Geographical distribution and prevalence of podoconiosis in Rwanda: a cross-sectional country-wide survey. Lancet Glob Health 2019; 7:e671-e680. [PMID: 30926303 PMCID: PMC6465958 DOI: 10.1016/s2214-109x(19)30072-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/10/2019] [Accepted: 02/12/2019] [Indexed: 02/06/2023]
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, 1 360 612 individuals-719 730 (53%) women and 640 882 (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 100 000 people (95% CI 41·0-109·7). Podoconiosis was found to be widespread in Rwanda. District-level prevalence ranged from 28·3 per 100 000 people (16·8-45·5, Nyarugenge, Kigali province) to 119·2 per 100 000 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 3938-10 088) 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.
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Affiliation(s)
- Kebede Deribe
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK; School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Aimable Mbituyumuremyi
- Malaria and Other Parasitic Disease Division, Rwanda Biomedical Center-Ministry of Health, Kigali, Rwanda
| | - Jorge Cano
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Mbonigaba Jean Bosco
- Malaria and Other Parasitic Disease Division, Rwanda Biomedical Center-Ministry of Health, Kigali, Rwanda
| | - Emanuele Giorgi
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK; Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Eugene Ruberanziza
- Malaria and Other Parasitic Disease Division, Rwanda Biomedical Center-Ministry of Health, Kigali, Rwanda
| | - Ursin Bayisenge
- Malaria and Other Parasitic Disease Division, Rwanda Biomedical Center-Ministry of Health, Kigali, Rwanda
| | | | | | - Aniceth Rucogoza
- National Reference Laboratory, Rwanda Biomedical Center, Kigali, Rwanda
| | - Innocent Turate
- Institute of HIV/AIDS, Disease Control and Prevention Department, Rwanda Biomedical Center, Kigali, Rwanda
| | - Andre Rusanganwa
- World Health Organization, Rwanda Country Office, Kigali, Rwanda
| | - David M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Rachel L Pullan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Abdisalan M Noor
- Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Nairobi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, UK
| | | | - Jeanine U Condo
- Malaria and Other Parasitic Disease Division, Rwanda Biomedical Center-Ministry of Health, Kigali, Rwanda
| | | | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Melanie J Newport
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | - Gail Davey
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK; School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Cooper JN, Cooper AM, Clausen BL, Nick KE. Regional bedrock geochemistry associated with podoconiosis evaluated by multivariate analysis. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2019; 41:649-665. [PMID: 30187152 PMCID: PMC6510837 DOI: 10.1007/s10653-018-0158-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
Podoconiosis is a disease whose etiology remains murky. Currently, the disease is attributed to particles that are believed to move through the skin and into the lymphatic system causing swelling of the lower legs. Identity of these particles or their composition remains unclear, though the presence of silicon and/or aluminum is often noted and frequently cited as causal agents. We applied multivariate analyses to the bedrock compositions of a large set of cases from an online database in an effort to identify underlying patterns or combinations of relative element abundances associated with podoconiosis-endemic regions. Using a combination of principal component analysis, discriminant function analysis, and ANOVA, we analyzed ten oxides from five regions on the African continent known to be associated with podoconiosis. The Hawaiian Islands were included as a control group since they are not known to have cases of podoconiosis despite similarity in geology and agricultural practices. Our analyses suggest that a unique alkaline- and silicon-rich geochemistry underlies regions associated with podoconiosis. Our results also imply that minerals enriched in incompatible elements, such as Ca, K, Mg, and Na, may be stronger predictors of the presence of the disease than either silicon or aluminum.
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Affiliation(s)
- Jamey N Cooper
- Department of Earth and Biological Sciences, Loma Linda University, Loma Linda, CA, 92350, USA.
| | - Allen M Cooper
- Department of Earth and Biological Sciences, Loma Linda University, Loma Linda, CA, 92350, USA
| | - Benjamin L Clausen
- Department of Earth and Biological Sciences, Loma Linda University, Loma Linda, CA, 92350, USA
- Geoscience Research Institute, Loma Linda, CA, 92350, USA
| | - Kevin E Nick
- Department of Earth and Biological Sciences, Loma Linda University, Loma Linda, CA, 92350, USA
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Marks M, Mitja O. Prevalence surveys for podoconiosis and other neglected skin diseases: time for an integrated approach. LANCET GLOBAL HEALTH 2019; 7:e554-e555. [PMID: 30926302 DOI: 10.1016/s2214-109x(19)30158-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/13/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London UK; Hospital for Tropical Diseases, London, UK
| | - Oriol Mitja
- Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona 08916, Spain; Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain.
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32
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Wanji S, Kengne-Ouafo JA, Deribe K, Tembei AM, Njouendou AJ, Tayong DB, Sofeu-Feugaing DD, Datchoua-Poutcheu FR, Cano J, Giorgi E, Longang-Tchounkeu YF, Enyong PA, Newport MJ, Davey G. Study of lymphoedema of non-filarial origin in the northwest region of Cameroon: spatial distribution, profiling of cases and socio-economic aspects of podoconiosis. Int Health 2019; 10:285-293. [PMID: 29771349 DOI: 10.1093/inthealth/ihy028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/05/2018] [Indexed: 11/14/2022] Open
Abstract
Background Although podoconiosis is endemic in Cameroon, little is known about its epidemiology and spatial distribution. Methods This cross-sectional, population-based study enrolled all adults (≥15 y) residing in the districts of the northwest region of Cameroon for 10 or more years. Participants were interviewed and had a physical examination. The study outcomes were prevalence estimates of lymphoedema and podoconiosis. House-to-house screening was conducted by Community Health Implementers (CHIs). CHIs registered all individuals with lymphoedema and collected additional individual and household-related information. A panel of experts re-examined and validated all lymphoedema cases registered by CHIs. Results Of the 439 781 individuals registered, 214 195 were adults (≥15 y old) and had lived in the districts of the region for more than 10 y. A total of 2143 lymphoedema cases were identified by CHIs, giving a prevalence of lymphoedema of 1.0% (2143/214 195; 95% CI, 0.96-1.04). After review by experts, podoconiosis prevalence in the study area was 0.48% (1049/214 195; 95% CI, 0.46-0.52). The prevalence of podoconiosis varied by health district, from 0.16% in Oku to 1.92% in Bafut (p<0.05). A total of 374 patients were recruited by stratified random sampling from the validated CHIs' register to assess the clinical features and socio-economic aspects of the disease. Patients reportedly were said to have first noticed swelling at an average age of 41.9±19.1 (range: 6-90 y). Most patients (86.1%; 315/366) complained of their legs suddenly becoming hot, red and painful. The majority (96.5%; 361/374) of the interviewees said they had worn shoes occasionally at some point in their life. The reported mean age at first shoe wearing was 14.2±10.1 (±SD,range 1-77 y). A high proportion (82.8%; 309/374) of the participants wore shoes at the time of interview. Of those wearing shoes, only 21.7% (67/309) were wearing protective shoes. Conclusion This study provides an insight into the geographical distribution and epidemiology of podoconiosis in the North West region of Cameroon, yet management is limited. Evidence-informed targeted interventions are needed to manage people with lymphoedema.
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Affiliation(s)
- Samuel Wanji
- Epidemiology and Control of Infectious Diseases (ECID), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.,Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Jonas A Kengne-Ouafo
- Epidemiology and Control of Infectious Diseases (ECID), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.,Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Kebede Deribe
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK.,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ayok M Tembei
- Epidemiology and Control of Infectious Diseases (ECID), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.,Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Abdel Jelil Njouendou
- Epidemiology and Control of Infectious Diseases (ECID), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.,Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Dizzel Bita Tayong
- Epidemiology and Control of Infectious Diseases (ECID), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.,Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | | | | | - Jorge Cano
- London School of Hygiene & Tropical Medicine, London
| | - Emanuele Giorgi
- London School of Hygiene & Tropical Medicine, London.,Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Peter A Enyong
- Epidemiology and Control of Infectious Diseases (ECID), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon.,Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Melanie J Newport
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | - Gail Davey
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
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Mapping the epidemiological distribution and incidence of major zoonotic diseases in South Tigray, North Wollo and Ab'ala (Afar), Ethiopia. PLoS One 2018; 13:e0209974. [PMID: 30596744 PMCID: PMC6312287 DOI: 10.1371/journal.pone.0209974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 12/14/2018] [Indexed: 10/31/2022] Open
Abstract
Zoonotic diseases continue to affect the health and livelihood of resource limited communities. In Ethiopia, despite the presence of a national master plan for prevention, control and elimination of some common zoonotic diseases, well-organized epidemiological data regarding incidence and distribution are lacking. A retrospective cross-sectional study based on a patient medical data recorded from 2012-2016 in selected districts of Southern Tigray, North Wollo zone of Amhara region and Ab'Ala district of Afar region was conducted to map the distribution and Incidence proportion of major zoonotic diseases. The incidence proportion of four major zoonotic diseases (helminthiasis, tuberculosis (TB), rabies and schistosomiasis) was mapped using qGIS software based on the Health Management Information System (HMIS) data collected from district health facilities. The result indicated that, out of a total 1,273,145 observed human disease cases, 53,614 (4.2%) of them were potential zoonotic diseases that include: helminthiasis (51,192), TB (2,085), rabies (227), schistosomiasis (105) and visceral leishmaniasis (7). The highest incidence proportion of TB (262.8 cases per 100,000 population) and rabies (33.2 cases per 100,000 population) were recorded in Gubalafto and Weldya followed by Raya Alamata (253.4 cases per 100,000 population %), and Ab'Ala and Raya Azebo (29 cases each per 100,000 population) for TB and rabies, respectively. The highest incidence proportion for schistosomiasis was reported in Raya Alamata (50.1 cases per 100,000 population) followed by Gubalafto and Weldya (10.8 cases per 100,000 population). The incidence proportion of visceral leishmaniasis per 100,000 population was 4.1, 1.3 and 1.2 cases for Ab'Ala, Gubalafto and Weldiya, and Raya Azebo districts, respectively. Except rabies, which showed high incidence proportion (p<0.0001) in 5-14 age groups, the other zoonotic diseases showed higher incidence proportion (p<0.0001) in age groups above 15 years. Rabies, helminthiasis and schistosomiasis showed statistically significant variation (p<0.0001) among seasons. Rabies and TB showed decreasing trend within the data recorded years. In animals, only 31 rabies cases and 15 anthrax cases were recorded from 2012 to 2016. This finding highlighted the distribution and incidence of some major zoonotic diseases in the study areas. Systematic and detailed research should be conducted in the future to map the distribution of major zoonotic diseases at regional and country level so as to initiate integrated effort from human and animal health authorities and professionals.
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Eneanya OA, Cano J, Dorigatti I, Anagbogu I, Okoronkwo C, Garske T, Donnelly CA. Environmental suitability for lymphatic filariasis in Nigeria. Parasit Vectors 2018; 11:513. [PMID: 30223860 PMCID: PMC6142334 DOI: 10.1186/s13071-018-3097-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/04/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Lymphatic filariasis (LF) is a mosquito-borne parasitic disease and a major cause of disability worldwide. It is one of the neglected tropical diseases identified by the World Health Organization for elimination as a public health problem by 2020. Maps displaying disease distribution are helpful tools to identify high-risk areas and target scarce control resources. METHODS We used pre-intervention site-level occurrence data from 1192 survey sites collected during extensive mapping surveys by the Nigeria Ministry of Health. Using an ensemble of machine learning modelling algorithms (generalised boosted models and random forest), we mapped the ecological niche of LF at a spatial resolution of 1 km2. By overlaying gridded estimates of population density, we estimated the human population living in LF risk areas on a 100 × 100 m scale. RESULTS Our maps demonstrate that there is a heterogeneous distribution of LF risk areas across Nigeria, with large portions of northern Nigeria having more environmentally suitable conditions for the occurrence of LF. Here we estimated that approximately 110 million individuals live in areas at risk of LF transmission. CONCLUSIONS Machine learning and ensemble modelling are powerful tools to map disease risk and are known to yield more accurate predictive models with less uncertainty than single models. The resulting map provides a geographical framework to target control efforts and assess its potential impacts.
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Affiliation(s)
- Obiora A. Eneanya
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Jorge Cano
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Ilaria Dorigatti
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | | | | | - Tini Garske
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Christl A. Donnelly
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Department of Statistics, University of Oxford, Oxford, UK
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Deribe K, Negussu N, Bosco MJ, Davey G. Podoconiosis research to implementation: a call for global action. Lancet Glob Health 2018; 6:e950-e951. [PMID: 30103988 PMCID: PMC6103428 DOI: 10.1016/s2214-109x(18)30298-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/08/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Kebede Deribe
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK; School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
| | | | - Mbonigaba Jean Bosco
- Malaria and Other Parasitic Diseases Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Gail Davey
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK; School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Kebede B, Martindale S, Mengistu B, Kebede B, Mengiste A, H/Kiros F, Tamiru A, Davey G, Kelly-Hope LA, Mackenzie CD. Integrated morbidity mapping of lymphatic filariasis and podoconiosis cases in 20 co-endemic districts of Ethiopia. PLoS Negl Trop Dis 2018; 12:e0006491. [PMID: 29965963 PMCID: PMC6044548 DOI: 10.1371/journal.pntd.0006491] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 07/13/2018] [Accepted: 05/02/2018] [Indexed: 11/24/2022] Open
Abstract
Background Lymphatic filariasis (LF) and podoconiosis are neglected tropical diseases (NTDs) that pose a significant physical, social and economic burden to endemic communities. Patients affected by the clinical conditions of LF (lymphoedema and hydrocoele) and podoconiosis (lymphoedema) need access to morbidity management and disability prevention (MMDP) services. Clear estimates of the number and location of these patients are essential to the efficient and equitable implementation of MMDP services for both diseases. Methodology/Principle findings A community-based cross-sectional study was conducted in Ethiopia using the Health Extension Worker (HEW) network to identify all cases of lymphoedema and hydrocoele in 20 woredas (districts) co-endemic for LF and podoconiosis. A total of 612 trained HEWs and 40 supervisors from 20 districts identified 26,123 cases of clinical morbidity. Of these, 24,908 (95.3%) reported cases had leg lymphoedema only, 751 (2.9%) had hydrocoele, 387 (1.5%) had both leg lymphoedema and hydrocoele, and 77 (0.3%) cases had breast lymphoedema. Of those reporting leg lymphoedema, 89.3% reported bilateral lymphoedema. Older age groups were more likely to have a severe stage of disease, have bilateral lymphoedema and to have experienced an acute attack in the last six months. Conclusions/Significance This study represents the first community-wide, integrated clinical case mapping of both LF and podoconiosis in Ethiopia. It highlights the high number of cases, particularly of leg lymphoedema that could be attributed to either of these diseases. This key clinical information will assist and guide the allocation of resources to where they are needed most. Patients affected by the clinical conditions of lymphatic filariasis (lymphoedema and hydrocoele) and podoconiosis (lymphoedema) require access to a minimum package of care to prevent progression of the disease, and to improve their quality of life. Clear estimates of the number and location of these patients is essential for the delivery of this care. To address this, a community-based cross-sectional study was conducted in Ethiopia using the Health Extension Worker (HEW) network to identify all cases of lymphoedema and hydrocoele in 20 co-endemic woredas (districts). A total of 26,123 cases of clinical morbidity were identified. Of these, 24,908 (95.3%) had leg lymphoedema, of which 89.3% were bilateral. The results of this study will help assist the Neglected Tropical Disease (NTD) programme at the Federal Ministry of Health (FMOH) in Ethiopia to effectively and equitably plan the delivery of a basic package of care to those suffering from the clinical manifestations of both diseases.
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Affiliation(s)
- Biruk Kebede
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | - Sarah Martindale
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail: (SM); (LAKH)
| | | | | | - Asrat Mengiste
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | - Fikre H/Kiros
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | - Abraham Tamiru
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | - Gail Davey
- Wellcome Trust Centre for Global Health Research, Brighton & Sussex Medical School, Brighton, United Kingdom
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail: (SM); (LAKH)
| | - Charles D. Mackenzie
- Centre for Neglected Tropical Diseases, Department of Parasitology, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Michigan State University, East Lansing, Michigan, United States of America
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Negussie H, Molla M, Ngari M, Berkley JA, Kivaya E, Njuguna P, Fegan G, Tamiru A, Kelemework A, Lang T, Newport MJ, McKay A, Enquoselassie F, Davey G. Lymphoedema management to prevent acute dermatolymphangioadenitis in podoconiosis in northern Ethiopia (GoLBeT): a pragmatic randomised controlled trial. Lancet Glob Health 2018; 6:e795-e803. [PMID: 29773516 PMCID: PMC6562300 DOI: 10.1016/s2214-109x(18)30124-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Podoconiosis (also known as endemic, non-filarial elephantiasis) affects about 4 million subsistence farmers in tropical Africa. Poor awareness of the condition and inadequate evidence for the efficacy of treatment mean that no government in an endemic country yet offers lymphoedema management for patients with podoconiosis. Among patients with filarial lymphoedema, trials suggest that limb care is effective in reducing the most disabling sequelae: episodes of acute dermatolymphangioadenitis. We aimed to test the hypothesis that a simple, inexpensive lymphoedema management package would reduce the incidence of acute dermatolymphangioadenitis in adult patients with podoconiosis in northern Ethiopia. METHODS We did a pragmatic randomised controlled trial at health posts and health centres in 18 sub-districts of Aneded woreda (district) in Amhara, northern Ethiopia. Participants were adults aged 18 years and older, had a diagnosis of at least stage 2 podoconiosis (persistent lymphoedema) and a negative antigen test for filariasis, and intended to remain within Aneded woreda for the duration of the trial. Patients were randomly assigned (1:1) to either receive a package containing instructions for foot hygiene, skin care, bandaging, exercises, and use of socks and shoes, with support by lay Community Podoconiosis Agents at monthly meetings (intervention group) or to receive no intervention (control group). Participants were aware of their group assignment, but researchers doing all analyses were masked to treatment group. The primary outcome was incidence of acute dermatolymphangioadenitis episodes in the total period of observation of each participant, measured by use of validated patient self-reported pictorial diaries. This trial was registered with the International Standard Randomised Controlled Trials Number Register, number ISRCTN67805210. FINDINGS Between Dec 1, 2014, and June 30, 2015, 1339 patients were screened, and 696 patients were enrolled and randomly allocated to treatment groups. We allocated 350 patients to the intervention group and 346 patients to the control group. 321 (92%) patients from the intervention group and 329 (95%) patients from the control group provided follow-up results at 12 months. During the 12 months of follow-up, 16 550 new episodes of acute dermatolymphangioadenitis occurred during 765·2 person-years. The incidence of acute dermatolymphangioadenitis was 19·4 episodes per person-year (95% CI 18·9-19·9) in the intervention group and 23·9 episodes per person-year (23·4-24·4) in the control group. The ratio of incidence rate in the intervention group to that of the control group was 0·81 (0·74 to 0·89; p<0·0001), with a rate difference of -4·5 (-5·1 to -3·8) episodes per person-year. No serious adverse events related to the intervention were reported. INTERPRETATION A simple, inexpensive package of lymphoedema self-care is effective in reducing the frequency and duration of acute dermatolymphangioadenitis. We recommend its implementation by the governments of endemic countries. FUNDING Joint Global Health Trials scheme (from the Wellcome Trust, the UK Medical Research Council, and UK Aid).
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Affiliation(s)
- Henok Negussie
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | - Meseret Molla
- Centre for Environmental and Developmental Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - James A Berkley
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Esther Kivaya
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Greg Fegan
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya; Swansea University Medical School, Swansea, UK
| | - Abreham Tamiru
- International Orthodox Christian Charities, Debre Markos, Ethiopia
| | - Abebe Kelemework
- International Orthodox Christian Charities, Debre Markos, Ethiopia
| | - Trudie Lang
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Melanie J Newport
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | - Andy McKay
- Department of Economics, University of Sussex, Brighton, UK
| | | | - Gail Davey
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK; School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
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Deribe K, Cano J, Njouendou AJ, Eyong ME, Beng AA, Giorgi E, Pigott DM, Pullan RL, Noor AM, Enquselassie F, Murray CJL, Hay SI, Newport MJ, Davey G, Wanji S. Predicted distribution and burden of podoconiosis in Cameroon. BMJ Glob Health 2018; 3:e000730. [PMID: 29946487 PMCID: PMC6014185 DOI: 10.1136/bmjgh-2018-000730] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/19/2018] [Accepted: 05/24/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Understanding the number of cases of podoconiosis, its geographical distribution and the population at risk are crucial to estimating the burden of this disease in endemic countries. We assessed each of these using nationwide data on podoconiosis prevalence in Cameroon. METHODS We analysed data arising from two cross-sectional surveys in Cameroon. The dataset was combined with a suite of environmental and climate data and analysed within a robust statistical framework, which included machine learning-based approaches and geostatistical modelling. The environmental limits, spatial variation of predicted prevalence, population at risk and number of cases of podoconiosis were each estimated. RESULTS A total of 214 729 records of individuals screened for podoconiosis were gathered from 748 communities in all 10 regions of Cameroon. Of these screened individuals, 882 (0.41%; 95% CI 0.38 to 0.44) were living with podoconiosis. High environmental suitability for podoconiosis was predicted in three regions of Cameroon (Adamawa, North West and North). The national population living in areas environmentally suitable for podoconiosis was estimated at 5.2 (95% CI 4.7 to 5.8) million, which corresponds to 22.3% of Cameroon's population in 2015. Countrywide, in 2015, the number of adults estimated to be suffering from podoconiosis was 41 556 (95% CI, 1170 to 240 993). Four regions (Central, Littoral, North and North West) contributed 61.2% of the cases. CONCLUSION In Cameroon, podoconiosis is more widely distributed geographically than was initially expected. The number of cases and the population at risk are considerable. Expanding morbidity management and follow-up of cases is of utmost necessity. Promotion of footwear use and regular foot hygiene should be at the forefront of any intervention plan.
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Affiliation(s)
- Kebede Deribe
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Jorge Cano
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Abdel Jelil Njouendou
- Parasites and Vector Biology Research Unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Mathias Esum Eyong
- Parasites and Vector Biology Research Unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Amuam Andrew Beng
- Parasites and Vector Biology Research Unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Emanuele Giorgi
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - David M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Rachel L Pullan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Abdisalan M Noor
- Kenya Medical Research Institute–Wellcome Trust Collaborative Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Melanie J Newport
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | - Gail Davey
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | - Samuel Wanji
- Parasites and Vector Biology Research Unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
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Deribe K, Cano J, Newport MJ, Pullan RL, Noor AM, Enquselassie F, Murray CJL, Hay SI, Brooker SJ, Davey G. The global atlas of podoconiosis. LANCET GLOBAL HEALTH 2018; 5:e477-e479. [PMID: 28395836 DOI: 10.1016/s2214-109x(17)30140-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Kebede Deribe
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK; School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Jorge Cano
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Melanie J Newport
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - Rachel L Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Abdisalan M Noor
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | | | - Gail Davey
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
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Famakinde DO, Adenusi AA. Involvement of Hookworm Co-Infection in the Pathogenesis and Progression of Podoconiosis: Possible Immunological Mechanism. Trop Med Infect Dis 2018; 3:E37. [PMID: 30274434 PMCID: PMC6073219 DOI: 10.3390/tropicalmed3020037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 12/19/2022] Open
Abstract
Podoconiosis is an endemic, non-infectious, geochemical and non-filarial inflammatory cause of tropical elephantiasis. The immunology of podoconiosis is not yet expressly understood. In spite of this, co-infection and co-morbidity with the infectious, soil-transmitted hookworm disease that causes iron deficiency anemia has been found to be predominant among affected individuals living in co-endemic settings, thus creating a more complex immunological interplay that still has not been investigated. Although deworming and iron-rich nutrient supplementation have been suggested in podoconiosis patients living under resource-poor conditions, and it is thought that hookworm infection may help to suppress inflammatory responses, the undisputed link that exists between a non-infectious and an infectious disease may create a scenario whereby during a co-infection, treatment of one exacerbates the other disease condition or is dampened by the debilitation caused by the other. In this paper, we elaborate on the immunopathogenesis of podoconiosis and examine the possible immunological dynamics of hookworm co-infection in the immunopathology of podoconiosis, with a view toward improved management of the disease that will facilitate its feasible elimination.
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Affiliation(s)
- Damilare O Famakinde
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Idi-Araba, Surulere P.M.B 12003, Lagos 100254, Nigeria.
| | - Adedotun A Adenusi
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Idi-Araba, Surulere P.M.B 12003, Lagos 100254, Nigeria.
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Deribe K, Cano J, Trueba ML, Newport MJ, Davey G. Global epidemiology of podoconiosis: A systematic review. PLoS Negl Trop Dis 2018; 12:e0006324. [PMID: 29494642 PMCID: PMC5849362 DOI: 10.1371/journal.pntd.0006324] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/13/2018] [Accepted: 02/16/2018] [Indexed: 11/18/2022] Open
Abstract
Background Podoconiosis is one of the few diseases that could potentially be eliminated within one generation. Nonetheless, the global distribution of the disease remains largely unknown. The global atlas of podoconiosis was conceived to define the epidemiology and distribution of podoconiosis through dedicated surveys and assembling the available epidemiological data. Methods We have synthesized the published literature on the epidemiology of podoconiosis. Through systematic searches in SCOPUS and MEDLINE from inception to February 14, 2018, we identified observational and population-based studies reporting podoconiosis. To establish existence of podoconiosis, we used case reports and presence data. For a study to be included in the prevalence synthesis, it needed to be a population-based survey that involved all residents within a specific area. Studies that did not report original data were excluded. We undertook descriptive analyses of the extracted data. This study is registered with PROSPERO, number CRD42018084959. Results We identified 3,260 records, of which 27 studies met the inclusion criteria. Podoconiosis was described to exist or be endemic in 32 countries, 18 from the African Region, 3 from Asia and 11 from Latin America. Overall, podoconiosis prevalence ranged from 0·10% to 8.08%, was highest in the African region, and was substantially higher in adults than in children and adolescents. The highest reported prevalence values were in Africa (8.08% in Cameroon, 7.45% in Ethiopia, 4.52% in Uganda, 3.87% in Kenya and 2.51% in Tanzania). In India, a single prevalence of 0.21% was recorded from Manipur, Mizoram and Rajasthan states. None of the Latin American countries reported prevalence data. Conclusion Our data suggest that podoconiosis is more widespread in the African Region than in the rest of the regions, although this could be related to the fact that most podoconiosis epidemiological research has been focused in the African continent. The assembled dataset confirms that comprehensive podoconiosis control strategies such as promotion of footwear and personal hygiene are urgently needed in endemic parts of Africa. Mapping, active surveillance and a systematic approach to the monitoring of disease burden must accompany the implementation of podoconiosis control activities. Podoconiosis is one of the Neglected Tropical Diseases, and causes painful and massive swelling of the lower legs. Despite the importance of the disease, its global distribution and epidemiology are poorly understood. We conducted a systematic review to assess the global epidemiology of podoconiosis. We found that podoconiosis was described to exist or be endemic in 32 countries, 18 from Africa, 3 from Asia and 11 from Latin America. Almost all prevalence data recorded corresponded to the African region. None of the Latin American countries reported prevalence data, although some countries are suspected to be endemic. We recommend that comprehensive podoconiosis control strategies such as promotion of footwear and personal hygiene are urgently needed in endemic countries in the African Region. Mapping, active surveillance and a systematic approach to the monitoring of disease burden must accompany the implementation of podoconiosis control activities.
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Affiliation(s)
- Kebede Deribe
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Jorge Cano
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mei L. Trueba
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Melanie J. Newport
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Gail Davey
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
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Deribe K, Beng AA, Cano J, Njouendo AJ, Fru-Cho J, Awah AR, Eyong ME, Chounna Ndongmo PW, Giorgi E, Pigott DM, Golding N, Pullan RL, Noor AM, Enquselassie F, Murray CJL, Brooker SJ, Hay SI, Enyong P, Newport MJ, Wanji S, Davey G. Mapping the geographical distribution of podoconiosis in Cameroon using parasitological, serological, and clinical evidence to exclude other causes of lymphedema. PLoS Negl Trop Dis 2018; 12:e0006126. [PMID: 29324858 PMCID: PMC5764238 DOI: 10.1371/journal.pntd.0006126] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/21/2017] [Indexed: 11/20/2022] Open
Abstract
Background Podoconiosis is a non-filarial elephantiasis, which causes massive swelling of the lower legs. It was identified as a neglected tropical disease by WHO in 2011. Understanding of the geographical distribution of the disease is incomplete. As part of a global mapping of podoconiosis, this study was conducted in Cameroon to map the distribution of the disease. This mapping work will help to generate data on the geographical distribution of podoconiosis in Cameroon and contribute to the global atlas of podoconiosis. Methods We used a multi‐stage sampling design with stratification of the country by environmental risk of podoconiosis. We sampled 76 villages from 40 health districts from the ten Regions of Cameroon. All individuals of 15-years old or older in the village were surveyed house-to-house and screened for lymphedema. A clinical algorithm was used to reliably diagnose podoconiosis, excluding filarial-associated lymphedema. Individuals with lymphoedema were tested for circulating Wuchereria bancrofti antigen and specific IgG4 using the Alere Filariasis Test Strips (FTS) test and the Standard Diagnostics (SD) BIOLINE lymphatic filariasis IgG4 test (Wb123) respectively, in addition to thick blood films. Presence of DNA specific to W. bancrofti was checked on night blood using a qPCR technique. Principal findings Overall, 10,178 individuals from 4,603 households participated in the study. In total, 83 individuals with lymphedema were identified. Of the 83 individuals with lymphedema, two were found to be FTS positive and all were negative using the Wb123 test. No microfilaria of W. bancrofti were found in the night blood of any individual with clinical lymphedema. None were found to be positive for W. bancrofti using qPCR. Of the two FTS positive cases, one was positive for Mansonella perstans DNA, while the other harbored Loa loa microfilaria. Overall, 52 people with podoconiosis were identified after applying the clinical algorithm. The overall prevalence of podoconiosis was found to be 0.5% (95% [confidence interval] CI; 0.4–0.7). At least one case of podoconiosis was found in every region of Cameroon except the two surveyed villages in Adamawa. Of the 40 health districts surveyed, 17 districts had no cases of podoconiosis; in 15 districts, mean prevalence was between 0.2% and 1.0%; and in the remaining eight, mean prevalence was between 1.2% and 2.7%. Conclusions Our investigation has demonstrated low prevalence but almost nationwide distribution of podoconiosis in Cameroon. Designing a podoconiosis control program is a vital next step. A health system response to the burden of podoconiosis is important, through case surveillance and morbidity management services. Podoconiosis is a geochemical neglected tropical disease, which causes massive swelling of the lower legs and feet. Although podoconiosis is one of the major causes of lower leg swelling worldwide, understanding of the geographical distribution of the disease is incomplete. In Cameroon, few studies have been conducted, and these have indicated varied and localized distribution of the disease. We conducted this countrywide mapping survey to determine the prevalence and spatial distribution of podoconiosis in Cameroon. We undertook nationwide mapping of podoconiosis in Cameroon by surveying 10,178 individuals from 4,603 households, in 76 communities. During the survey, individuals with lymphedema underwent a rapid-format antigen antibody test, and a thick blood film (TBF) for microscopic examination, as a confirmatory tool for detecting W. bancrofti micro filarial. Peripheral night blood and parasite DNA detection was used to exclude lymphatic filariasis, and a clinical history and physical examination was conducted to diagnosis podoconiosis. The overall prevalence of podoconiosis was found to be 0.5%. At least one case of podoconiosis was found in every region of Cameroon except Adamawa, where in the two surveyed villages no cases of podoconiosis were identified. Our investigation has demonstrated low prevalence but almost nationwide distribution of podoconiosis in Cameroon. Designing a podoconiosis control program is a vital next step. A health system response to the burden of podoconiosis is important, through case surveillance and morbidity management services.
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Affiliation(s)
- Kebede Deribe
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Amuam Andrew Beng
- Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Jorge Cano
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Abdel Jelil Njouendo
- Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Jerome Fru-Cho
- Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Abong Raphael Awah
- Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Mathias Esum Eyong
- Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Patrick W. Chounna Ndongmo
- Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Emanuele Giorgi
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Lancaster Medical School, Faculty of Health and Medicine Lancaster University, Lancaster, United Kingdom
| | - David M. Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - Nick Golding
- School of BioSciences, University of Melbourne, Parkville, Australia
- Spatial Ecology and Epidemiology Group, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Rachel L. Pullan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Abdisalan M. Noor
- Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Christopher J. L. Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - Simon J. Brooker
- Bill and Melinda Gates Foundation, Seattle, WA, United States of America
| | - Simon I. Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Peter Enyong
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Melanie J. Newport
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Samuel Wanji
- Parasites and Vector Biology research unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
| | - Gail Davey
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
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Deribe K, Cano J, Giorgi E, Pigott DM, Golding N, Pullan RL, Noor AM, Cromwell EA, Osgood-Zimmerman A, Enquselassie F, Hailu A, Murray CJL, Newport MJ, Brooker SJ, Hay SI, Davey G. Estimating the number of cases of podoconiosis in Ethiopia using geostatistical methods. Wellcome Open Res 2017. [PMID: 29152596 DOI: 10.12688/wellcomeopenres.12483.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In 2011, the World Health Organization recognized podoconiosis as one of the neglected tropical diseases. Nonetheless, the number of people with podoconiosis and the geographical distribution of the disease is poorly understood. Based on a nationwide mapping survey and geostatistical modelling, we predict the prevalence of podoconiosis and estimate the number of cases across Ethiopia. METHODS We used nationwide data collected in Ethiopia between 2008 and 2013. Data were available for 141,238 individuals from 1,442 villages in 775 districts from all nine regional states and two city administrations. We developed a geostatistical model of podoconiosis prevalence among adults (individuals aged 15 years or above), by combining environmental factors. The number of people with podoconiosis was then estimated using a gridded map of adult population density for 2015. RESULTS Podoconiosis is endemic in 345 districts in Ethiopia: 144 in Oromia, 128 in Southern Nations, Nationalities and People's [SNNP], 64 in Amhara, 4 in Benishangul Gumuz, 4 in Tigray and 1 in Somali Regional State. Nationally, our estimates suggest that 1,537,963 adults (95% confidence intervals, 290,923-4,577,031 adults) were living with podoconiosis in 2015. Three regions (SNNP, Oromia and Amhara) contributed 99% of the cases. The highest proportion of individuals with podoconiosis resided in the SNNP (39%), while 32% and 29% of people with podoconiosis resided in Oromia and Amhara Regional States, respectively. Tigray and Benishangul Gumuz Regional States bore lower burdens, and in the remaining regions, podoconiosis was almost non-existent. Discussion: The estimates of podoconiosis cases presented here based upon the combination of currently available epidemiological data and a robust modelling approach clearly show that podoconiosis is highly endemic in Ethiopia. Given the presence of low cost prevention, and morbidity management and disability prevention services, it is our collective responsibility to scale-up interventions rapidly.
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Affiliation(s)
- Kebede Deribe
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.,Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | - Jorge Cano
- London School of Hygiene & Tropical Medicine, London, UK
| | - Emanuele Giorgi
- London School of Hygiene & Tropical Medicine, London, UK.,Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - David M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nick Golding
- Spatial Ecology and Epidemiology Group, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.,School of BioSciences, University of Melbourne, Parkville, VIC, Australia
| | | | - Abdisalan M Noor
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Nairobi, Kenya
| | - Elizabeth A Cromwell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | - Asrat Hailu
- Department of Microbiology, Immunology and Parasitology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Melanie J Newport
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Gail Davey
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
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Modeling the environmental suitability of anthrax in Ghana and estimating populations at risk: Implications for vaccination and control. PLoS Negl Trop Dis 2017; 11:e0005885. [PMID: 29028799 PMCID: PMC5656412 DOI: 10.1371/journal.pntd.0005885] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/25/2017] [Accepted: 08/21/2017] [Indexed: 01/05/2023] Open
Abstract
Anthrax is hyper-endemic in West Africa. Despite the effectiveness of livestock vaccines in controlling anthrax, underreporting, logistics, and limited resources makes implementing vaccination campaigns difficult. To better understand the geographic limits of anthrax, elucidate environmental factors related to its occurrence, and identify human and livestock populations at risk, we developed predictive models of the environmental suitability of anthrax in Ghana. We obtained data on the location and date of livestock anthrax from veterinary and outbreak response records in Ghana during 2005–2016, as well as livestock vaccination registers and population estimates of characteristically high-risk groups. To predict the environmental suitability of anthrax, we used an ensemble of random forest (RF) models built using a combination of climatic and environmental factors. From 2005 through the first six months of 2016, there were 67 anthrax outbreaks (851 cases) in livestock; outbreaks showed a seasonal peak during February through April and primarily involved cattle. There was a median of 19,709 vaccine doses [range: 0–175 thousand] administered annually. Results from the RF model suggest a marked ecological divide separating the broad areas of environmental suitability in northern Ghana from the southern part of the country. Increasing alkaline soil pH was associated with a higher probability of anthrax occurrence. We estimated 2.2 (95% CI: 2.0, 2.5) million livestock and 805 (95% CI: 519, 890) thousand low income rural livestock keepers were located in anthrax risk areas. Based on our estimates, the current anthrax vaccination efforts in Ghana cover a fraction of the livestock potentially at risk, thus control efforts should be focused on improving vaccine coverage among high risk groups. Anthrax is a soil-borne zoonotic disease found worldwide. In the West African nation of Ghana, anthrax outbreaks occur annually with a high burden to livestock keepers and their animals. To control anthrax in both humans and animals, annual livestock vaccination is recommended in endemic regions. However, in resource poor areas distributing and administering vaccine is difficult, in part, due to underreporting, logistical issues, limited resources, and an under appreciation of the geographic extent of anthrax risk zones. Our objective was to model high spatial resolution anthrax outbreak data, collected in Ghana, using a machine learning algorithm (random forest). To achieve this, we used a combination of climatic and environmental characteristics to predict the potential environmental suitability of anthrax, map its distribution, and identify livestock and human populations at risk. Results indicate a marked ecological divide separating the broad areas of environmental suitability in northern Ghana from the southern part of the country, which closely mirrors the ecotone transitions from southern tropical and deciduous forests to the northern Sudanian and Guinea Savanna. Based on our model prediction, we estimated >3 million combined ruminant livestock and low income livestock keepers are situated in anthrax risk zones. These findings suggest a low level of annual livestock vaccination coverage among high risk groups. Thus, integrating control strategies from both the veterinary and human health sectors are needed to improve surveillance and increase vaccine dissemination and adoption by rural livestock keepers in Ghana and the surrounding region.
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Deribe K, Cano J, Giorgi E, Pigott DM, Golding N, Pullan RL, Noor AM, Cromwell EA, Osgood-Zimmerman A, Enquselassie F, Hailu A, Murray CJL, Newport MJ, Brooker SJ, Hay SI, Davey G. Estimating the number of cases of podoconiosis in Ethiopia using geostatistical methods. Wellcome Open Res 2017; 2:78. [PMID: 29152596 PMCID: PMC5668927 DOI: 10.12688/wellcomeopenres.12483.2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In 2011, the World Health Organization recognized podoconiosis as one of the neglected tropical diseases. Nonetheless, the number of people with podoconiosis and the geographical distribution of the disease is poorly understood. Based on a nationwide mapping survey and geostatistical modelling, we predict the prevalence of podoconiosis and estimate the number of cases across Ethiopia. METHODS We used nationwide data collected in Ethiopia between 2008 and 2013. Data were available for 141,238 individuals from 1,442 villages in 775 districts from all nine regional states and two city administrations. We developed a geostatistical model of podoconiosis prevalence among adults (individuals aged 15 years or above), by combining environmental factors. The number of people with podoconiosis was then estimated using a gridded map of adult population density for 2015. RESULTS Podoconiosis is endemic in 345 districts in Ethiopia: 144 in Oromia, 128 in Southern Nations, Nationalities and People's [SNNP], 64 in Amhara, 4 in Benishangul Gumuz, 4 in Tigray and 1 in Somali Regional State. Nationally, our estimates suggest that 1,537,963 adults (95% confidence intervals, 290,923-4,577,031 adults) were living with podoconiosis in 2015. Three regions (SNNP, Oromia and Amhara) contributed 99% of the cases. The highest proportion of individuals with podoconiosis resided in the SNNP (39%), while 32% and 29% of people with podoconiosis resided in Oromia and Amhara Regional States, respectively. Tigray and Benishangul Gumuz Regional States bore lower burdens, and in the remaining regions, podoconiosis was almost non-existent. Discussion: The estimates of podoconiosis cases presented here based upon the combination of currently available epidemiological data and a robust modelling approach clearly show that podoconiosis is highly endemic in Ethiopia. Given the presence of low cost prevention, and morbidity management and disability prevention services, it is our collective responsibility to scale-up interventions rapidly.
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Affiliation(s)
- Kebede Deribe
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.,Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | - Jorge Cano
- London School of Hygiene & Tropical Medicine, London, UK
| | - Emanuele Giorgi
- London School of Hygiene & Tropical Medicine, London, UK.,Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - David M Pigott
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nick Golding
- Spatial Ecology and Epidemiology Group, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.,School of BioSciences, University of Melbourne, Parkville, VIC, Australia
| | | | - Abdisalan M Noor
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Nairobi, Kenya
| | - Elizabeth A Cromwell
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | - Asrat Hailu
- Department of Microbiology, Immunology and Parasitology, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Melanie J Newport
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | | | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Gail Davey
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
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Muli J, Gachohi J, Kagai J. Soil iron and aluminium concentrations and feet hygiene as possible predictors of Podoconiosis occurrence in Kenya. PLoS Negl Trop Dis 2017; 11:e0005864. [PMID: 28832604 PMCID: PMC5584976 DOI: 10.1371/journal.pntd.0005864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 09/05/2017] [Accepted: 08/08/2017] [Indexed: 11/18/2022] Open
Abstract
Background Podoconiosis (mossy foot) is a neglected non-filarial elephantiasis considered to be caused by predisposition to cumulative contact of uncovered feet to irritative red clay soil of volcanic origins in the tropical regions. Data from structured observational studies on occurrence of Podoconiosis and related factors are not available in Kenya. Methodology/Principal findings To establish the occurrence and aspects associated with Podoconiosis, a cross-sectional survey was implemented in an area located within 30 km from the foot of volcanic Mount Longonot in the Great Rift Valley in Kenya. Five villages and 385 households were selected using multistage and systematic random sampling procedures respectively during the survey. Podoconiosis was determined by triangulating (1) the clinical diagnosis, (2) molecular assaying of sputum samples to rule out Wuchereria bancrofti microfilaria and (3) determining the concentration of six elements and properties in the soil known to be associated with Podoconiosis. A structured questionnaire was used to identify possible risk factors. Univariable and multivariable Poisson regression analyses were carried out to determine factors associated with Podoconiosis. Thirteen participants were clinically positive for Podoconiosis giving an overall prevalence of 3.4%. The prevalence ranged between 0% and 18.8% across the five villages. Molecular assay for W. bancrofti test turned negative in the 13 samples. The following factors were positively associated with the Podoconiosis prevalence (P<0.1) in the univariable analyses: (i) age, (ii) gender, (iii) education level, (iv) frequency of washing legs, (v) frequency of wearing shoes, (vi) soil pH, and (vii) village. Unexpectedly, the concentration of soil minerals previously thought to be associated with Podoconiosis was found to be negatively associated with the Podoconiosis prevalence (P<0.1). In the multivariable analyses, only frequency of wearing shoes and village turned out significant (P≤0.05). By modeling the different soil mineral concentrations and pH while adjusting for the variable frequency of wearing shoes, only iron concentration was significant and in the negative dimension (P≤0.05). However, controlling for Iron, Aluminum concentrations turned significant. Conclusion/Significance This study has pointed to a hitherto unreported occurrence of Podoconiosis cases and has contributed to the baseline knowledge on the occurrence of Podoconiosis in Kenya. Consistent with many studies, wearing shoes remain an important risk factor for the occurrence of the disease. However, our findings are inconsistent with some of the hitherto postulations that associate Podoconiosis prevalence with certain minerals in the soil in other regions in Africa. These findings provide new beginnings for the cross-disciplinary research of Podoconiosis in environmental health, socio-ecology and ecological niche and geo-spatial modeling and prediction. Podoconiosis is a neglected disease in the tropical regions of the world considered to be caused by prolonged contact of uncovered feet to irritant particles found in red clay soil from volcanic origins. The disease presents like filarial elephantiasis. Data from observational studies from Kenya are not available. We conducted a cross-sectional household survey to establish the prevalence and aspects related with Podoconiosis at the foot of Mount Longonot in the Great Rift Valley in Kenya. Podoconiosis was determined by combining results of clinical diagnosis, ruling out filarial elephantiasis in clinically positive Podoconiosis patients using molecular techniques and determining the concentration of elements and properties in the soil known to be associated with Podoconiosis. A structured questionnaire was used to identify possible risk factors. Out of 385 study participants, thirteen were clinically positive for Podoconiosis giving an overall prevalence of 3.4%. Molecular tests for filarial elephantiasis turned negative in the 13 participants. Factors that were associated with Podoconiosis prevalence were age, gender, education level, and frequency of washing legs, frequency of wearing shoes, soil pH and village. The concentration of soil minerals previously thought to be associated with Podoconiosis was found to be negatively associated with the Podoconiosis prevalence. However, the final analyses found frequency of wearing shoes, iron and aluminium as possible predictors of Podoconiosis occurrence in the study area. This is the first structured observational study to report occurrence of Podoconiosis in Kenya. Although some of our findings are inconsistent with some previous reports about the association of Podoconiosis and certain minerals in the soil, this study offers new beginnings for the cross-disciplinary research of Podoconiosis in fields known to influence occurrence of the disease including environmental health, socio-ecology and medical geographical approaches and predictions.
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Affiliation(s)
- Jacinta Muli
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - John Gachohi
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Washington State University–Global Health Kenya, University of Nairobi Institute of Tropical and Infectious Diseases, Kenyatta National Hospital Campus, Nairobi, Kenya
- * E-mail: , ,
| | - Jim Kagai
- Centre for Biotechnology Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
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Odongo-Aginya EI, Olia A, Luwa KJ, Nagayasu E, Auma AM, Egitat G, Mwesigwa G, Ogino Y, Kimura E, Horii T. Wuchereria bancrofti infection at four primary schools and surrounding communities with no previous blood surveys in northern Uganda: the prevalence after mass drug administrations and a report on suspected non-filarial endemic elephantiasis. Trop Med Health 2017; 45:20. [PMID: 28814926 PMCID: PMC5556395 DOI: 10.1186/s41182-017-0060-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A prevalence study of Wuchereria bancrofti infection was carried out in 2014 at 4 study sites in northern Uganda using antigen and microfilaria tests. Each study site consists of a primary school and surrounding communities. These sites are inside the filariasis endemic area and have been covered by mass drug administration under the national elimination programme. However, no prevalence study had been conducted there before the present study. Without information on past and present endemicity levels, our study was meant to be an independent third-party investigation to know the latest filariasis situation. RESULTS A total of 982 people including 570 schoolchildren (7-19 years) and 412 community people (7-25 years) were examined, all of them for filarial antigen and 695 for microfilariae. The study revealed that all subjects were negative by both methods. CONCLUSIONS It was considered that annual mass drug administrations together with anti-malarial activities such as indoor residual spraying had contributed to the reduction of the filarial infection. However, based on the past data obtained near our study sites, we cannot exclude the possibility that filarial prevalence rates in our study sites were very low or even zero originally. During the study, we encountered several patients with lower leg edema and pachydermic (elephant skin-like), mossy skin lesion of the foot. Judging from clinical features and bare-footed life-style of people in the area, non-filarial elephantiasis, possibly podoconiosis, was suspected. This elephantiasis has been reported in areas where filariasis is not endemic.
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Affiliation(s)
| | - Alex Olia
- Department of Microbiology and Immunology, Faculty of Medicine, Gulu University, P.O. Box 166, Gulu, Uganda
| | - Kilama Justin Luwa
- Department of Biology, Faculty of Science, Gulu University, P.O.Box 166, Gulu, Uganda
| | - Eiji Nagayasu
- Division of Parasitology, Department of Infectious Diseases, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692 Japan
| | - Anna Mary Auma
- Vector Control Division, Ministry of Health, P.O.Box 1661, Kampala, Uganda
| | - Geoffrey Egitat
- Vector Control Division, Ministry of Health, P.O.Box 1661, Kampala, Uganda
| | - Gerald Mwesigwa
- Vector Control Division, Ministry of Health, P.O.Box 1661, Kampala, Uganda
| | - Yoshitaka Ogino
- Department of Parasitology, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505 Japan.,Department of Haematology and Respiratory Medicine, Kochi Medical School, Kochi University, Nankoku, Kochi 783-8505 Japan
| | - Eisaku Kimura
- Department of Molecular Protozoology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka 565-0871 Japan
| | - Toshihiro Horii
- Department of Molecular Protozoology, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka 565-0871 Japan
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Deribe K, Kebede B, Tamiru M, Mengistu B, Kebede F, Martindale S, Sime H, Mulugeta A, Kebede B, Sileshi M, Mengiste A, McPherson S, Fentaye A. Integrated morbidity management for lymphatic filariasis and podoconiosis, Ethiopia. Bull World Health Organ 2017; 95:652-656. [PMID: 28867846 PMCID: PMC5578380 DOI: 10.2471/blt.16.189399] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/22/2017] [Accepted: 05/26/2017] [Indexed: 11/27/2022] Open
Abstract
PROBLEM Lymphatic filariasis and podoconiosis are the major causes of tropical lymphoedema in Ethiopia. The diseases require a similar provision of care, but until recently the Ethiopian health system did not integrate the morbidity management. APPROACH To establish health-care services for integrated lymphoedema morbidity management, the health ministry and partners used existing governmental structures. Integrated disease mapping was done in 659 out of the 817 districts, to identify endemic districts. To inform resource allocation, trained health extension workers carried out integrated disease burden assessments in 56 districts with a high clinical burden. To ensure standard provision of care, the health ministry developed an integrated lymphatic filariasis and podoconiosis morbidity management guideline, containing a treatment algorithm and a defined package of care. Experienced professionals on lymphoedema management trained government-employed health workers on integrated morbidity management. To monitor the integration, an indicator on the number of lymphoedema-treated patients was included in the national health management information system. LOCAL SETTING In 2014, only 24% (87) of the 363 health facilities surveyed provided lymphatic filariasis services, while 12% (44) provided podoconiosis services. RELEVANT CHANGES To date, 542 health workers from 53 health centres in 24 districts have been trained on integrated morbidity management. Between July 2013 and June 2016, the national health management information system has recorded 46 487 treated patients from 189 districts. LESSONS LEARNT In Ethiopia, an integrated approach for lymphatic filariasis and podoconiosis morbidity management was feasible. The processes used could be applicable in other settings where these diseases are co-endemic.
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Affiliation(s)
- Kebede Deribe
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Falmer, Brighton, East Sussex, BN1 9PX, England
| | - Biruck Kebede
- NTD case team, Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Mossie Tamiru
- NTD case team, Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Sarah Martindale
- Center for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, England
| | - Heven Sime
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Abate Mulugeta
- Country Office, World Health Organization, Addis Ababa, Ethiopia
| | | | - Mesfin Sileshi
- NTD case team, Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Asrat Mengiste
- National Podoconiosis Action Network, Addis Ababa, Ethiopia
| | | | - Amha Fentaye
- NTD case team, Diseases Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
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49
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Sun RX, Lai SJ, Yang Y, Li XL, Liu K, Yao HW, Zhou H, Li Y, Wang LP, Mu D, Yin WW, Fang LQ, Yu HJ, Cao WC. Mapping the distribution of tick-borne encephalitis in mainland China. Ticks Tick Borne Dis 2017; 8:631-639. [DOI: 10.1016/j.ttbdis.2017.04.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 12/15/2022]
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50
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Deribe K, Kebede B, Mengistu B, Negussie H, Sileshi M, Tamiru M, Tomczyk S, Tekola-Ayele F, Davey G, Fentaye A. Podoconiosis in Ethiopia: From Neglect to Priority Public Health Problem. ETHIOPIAN MEDICAL JOURNAL 2017; 55:65-74. [PMID: 28878431 PMCID: PMC5582632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Podoconiosis is a geochemical disease occurring in individuals exposed to red clay soil of volcanic origin. This Neglected Tropical Disease (NTD) is highly prevalent in Ethiopia. According to the nationwide mapping in 2013, the disease is endemic in 345 districts, where an estimated 35 million people live. The government of Ethiopia prioritized podoconiosis as one of eight priority NTDs and included it in the national integrated master plan for NTDs. An integrated lymphoedema management guideline has been developed. Service expansion has continued in the last few years and lymphoedema management services have been expanded to over one hundred endemic districts. The last few years have been critical in generating evidence about the distribution, burden and effective interventions for podoconiosis in Ethiopia. Although the extent of the problem within Ethiopia is considerable, the country is well positioned to now scale-up elimination efforts. Given the extraordinary progress of the past ten years and the current commitment of government, private and third sectors, Ethiopia seems to be on course for the elimination of podoconiosis in our lifetime. We need continued strong partner commitment, evidence-building, and scale-up of activities to accomplish this.
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Affiliation(s)
- Kebede Deribe
- Federal Ministry of Health, Addis Ababa, Ethiopia
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK
- Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia
- RTI International, Addis Ababa, Ethiopia
| | | | | | - Henok Negussie
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK
| | - Mesfin Sileshi
- Federal Ministry of Health, Addis Ababa, Ethiopia
- RTI International, Addis Ababa, Ethiopia
| | | | - Sara Tomczyk
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland, USA
| | - Gail Davey
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK
| | - Amha Fentaye
- Federal Ministry of Health, Addis Ababa, Ethiopia
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