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Gail Davey - One of the best experts on this subject based on the ideXlab platform.

  • the impact of Podoconiosis lymphatic filariasis and leprosy on disability and mental well being a systematic review
    PLOS Neglected Tropical Diseases, 2021
    Co-Authors: Gail Davey, Asrat Mengiste, Maya Semrau, Oumer Ali, Abraham Tesfaye, Abebaw Fekadu
    Abstract:

    Leprosy, Podoconiosis, and lymphatic filariasis (LF) are among the priority neglected tropical diseases (NTDs) in Ethiopia. The disability, psychosocial, and mental health status of people affected by these NTDs are still overlooked in global NTD discourse. The objective of this systematic review was to synthesize the existing evidence describing the disability, psychosocial, and mental health status of people affected by leprosy, Podoconiosis, and LF prior to developing a holistic physical and psychosocial care package for these individuals. We searched papers reporting on disability, psychosocial, and mental health status linked to these 3 NTDs. The protocol was registered in PROSPERO with registration number CRD42019128400. Peer-reviewed articles were searched and extracted from Medline, PsycINFO, Global Health, and Embase. Articles published in English, irrespective of the year of publication, using a quantitative study methodology, were included. Abstracts and full texts were reviewed by 2 reviewers. Data were extracted and narratively summarized, as the studies were heterogeneous and used different outcome measures. Out of 1,318 titles/abstracts screened and 59 full text studies reviewed, 24 fulfilled the inclusion criteria. Fourteen studies provided evidence of the disability associated with leprosy, Podoconiosis, or LF. Ten studies provided evidence on the association between the 3 NTDs and mental health or psychosocial outcomes. The prevalence of grade 2 disability varied from 3.9% to 86%. The most commonly reported mental health impacts were depression and mental distress. A high burden of mental illness was reported, varying from 12.6% to 71.7%; the suicidal ideation was also high (18.5%). In conclusion, disability and poor psychosocial and mental health status are associated with leprosy, Podoconiosis, and LF. For optimum management of these NTDs, holistic care including both physical and psychosocial interventions is vital.

  • replication of hla class ii locus association with susceptibility to Podoconiosis in three ethiopian ethnic groups
    Scientific Reports, 2021
    Co-Authors: Tewodros Tariku Gebresilase, Gail Davey, Chris Finan, Daniel Suveges, Tesfaye Sisay Tessema, Abraham Aseffa, Konstantinos Hatzikotoulas, Eleftheria Zeggini
    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.

  • a cross sectional survey to assess the risk factors associated with stigmatizing attitudes towards patients with Podoconiosis among rural youth in southern ethiopia
    Transactions of The Royal Society of Tropical Medicine and Hygiene, 2020
    Co-Authors: Kibur Engdawork, Gail Davey, Desta Ayode, Colleen M Mcbride, Getnet Tadele
    Abstract:

    BACKGROUND Many health conditions are associated with stigma due to beliefs about their causes and the physical changes experienced by patients. Among such conditions are several neglected tropical diseases (NTDs). Podoconiosis, classified as an NTD, is a form of lymphoedema caused by the co-influence of genetic and environmental factors. It is a major public health problem in Ethiopia and is associated with intense stigma. Despite this, little is known about the factors contributing to stigmatizing attitudes against patients with the disease. METHODS A cross-sectional survey was conducted in southern Ethiopia to analyse the attitudes of rural youth and associated risk factors for stigmatizing attitudes towards patients with Podoconiosis, with the aim of informing stigma reduction strategies. RESULTS The survey included 336 randomly selected youth. Of the 177 (52.7%) youth who held more stigmatizing attitudes toward patients with Podoconiosis, 105 (59.3%) were females and 171 (96.6%) did not have affected friends. Accurate knowledge about gene-environment influences and rejection of infectious causes of Podoconiosis were associated with less stigmatizing attitudes. CONCLUSIONS Improving understanding of the gene-environment interaction and dispelling beliefs about infectious causes may reduce negative attitudes about Podoconiosis. Affected youth may play an important role as agents of change to spread non-stigmatizing messages.

  • individual and familial characteristics of patients with Podoconiosis attending a clinic in musanze district rwanda a retrospective study
    Transactions of The Royal Society of Tropical Medicine and Hygiene, 2020
    Co-Authors: Jean Paul Bikorimana, Ursin Bayisenge, Tonya Huston, Eugene Ruberanziza, Jean Bosco Mbonigaba, Marie Josee Dukuzimana, Gail Davey
    Abstract:

    BACKGROUND Podoconiosis is a progressive swelling of the legs affecting genetically susceptible people who live in areas with irritant red clay soils and walk barefoot. The disease is a public health concern in many countries, including Rwanda. METHODS This retrospective study described individual and familial characteristics of patients with Podoconiosis attending the Heart and Sole Africa (HASA) clinics in Rwanda. Data on patient characteristics and family history were retrieved from electronic medical records (January 2013 - August 2019). A multiple regression analysis was used to explore factors influencing age of onset of Podoconiosis. RESULTS Among 467 patients with Podoconiosis, the mean (standard deviation) age of onset was 34.4 (19.6) years, 139 (29.8%) patients developed Podoconiosis at <20 years of age, 417 (89%) came from Musanze or neighboring Burera Districts, and 238 (51.0%) had a family history of Podoconiosis. Increasing patient age was associated with older age at onset of disease (p<0.001), while an increased number of relatives with Podoconiosis (p<0.002) was significantly associated with earlier disease onset. CONCLUSION Most patients with Podoconiosis were women, and more than half had a family history of Podoconiosis. An increased number of relatives with Podoconiosis was associated with a significantly younger age at disease onset.

  • the impact of acute adenolymphangitis in Podoconiosis on caregivers a case study in wayu tuka woreda oromia western ethiopia if she was healthy i would be free
    PLOS Neglected Tropical Diseases, 2019
    Co-Authors: Clare Phillips, Gail Davey, Kebede Deribe, Abdi Samuel, Gemechu Tiruneh
    Abstract:

    Background Podoconiosis, also known as mossy foot or endemic non-filarial elephantiasis, is a preventable form of lower-leg lymphoedema caused by prolonged (typically barefoot) exposure to soil derived from volcanic rocks. Acute adenolymphangitis (also called ‘acute attack’) is a serious complication of Podoconiosis resulting in significant symptoms and worsening disability. Despite the well-known morbidity associated with Podoconiosis, to date there have been no studies looking at the impact, or burden, of Podoconiosis on caregivers. This study explored the experiences and impact of acute attacks on the caregivers of those with Podoconiosis in one endemic district of Ethiopia. Methods/Principal findings This qualitative study was based in Wayu Tuka woreda (district), Oromia, Western Ethiopia. 27 semi-structured interviews of those with Podoconiosis and their caregivers were conducted in June 2018. Here we report the findings from the caregiver’s interviews. Data were analysed using NVivo 12. Directed content analysis, a qualitative approach related to thematic analysis, was used to analyse the results. This study highlights a previously unreported impact of acute attacks on the caregivers of those affected by Podoconiosis. The findings demonstrate the significant social and financial pressures placed on Podoconiosis-affected families which are exacerbated during acute attacks. This study also highlighted the emotional burden experienced by caregivers, the range of care activities placed on them and the limited support available. Conclusions This study found a significant impact on the caregivers of those with Podoconiosis, especially during acute attacks, in in Wayu Tuka woreda. It also highlighted the limited support available to caregivers. Further research is needed to understand whether this impact applies to Podoconiosis caregivers across Ethiopia, and beyond, and to establish if there are wider implications of this important consequence of Podoconiosis, for example on the economy and caregivers’ mental and physical health.

Kebede Deribe - One of the best experts on this subject based on the ideXlab platform.

  • Podoconiosis from known to unknown obstacles to tackle
    Acta Tropica, 2021
    Co-Authors: Samuel Wanji, Kebede Deribe, Jessica Minich, Alexander Yaw Debrah, Akili K Kalinga, Inge Kroidl, Ambre Luguet, Achim Hoerauf, Manuel Ritter
    Abstract:

    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.

  • predicting the environmental suitability and population at risk of Podoconiosis in africa
    bioRxiv, 2020
    Co-Authors: Kebede Deribe, Hope Simpson, Nicole Davis Weaver, Rachel L Pullan, Mbonigaba Jean Bosco, Samuel Wanji, Christopher J L Murray, Melanie J Newport
    Abstract:

    Abstract Background 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 is uncertain. Methods 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 suitability and human population at risk. Results In Africa, environmental suitability for Podoconiosis was predicted in 29 countries. By 2020, the total population in areas suitable for Podoconiosis was estimated at 114.5 million people, (95% confidence interval: 109.4-123.9) with 16.9 million in areas suitable for both lymphatic filariasis and Podoconiosis. Of the total 5,712 implementation units defined by WHO in Africa, 1,655 (29.0%) were found to be environmentally suitable for Podoconiosis. The majority of IUs with high environmental suitability are located in Angola (80 IUs), Cameroon (170 IUs), the DRC (244 IUs), Ethiopia (495 IUs), Kenya (217 IUs), Uganda (116 IUs) and Tanzania (112 IUs). Of the 1,655 environmental suitable IUs, 960 (58.0%) require more detailed community-level mapping Conclusions 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.

  • mapping the global distribution of Podoconiosis applying an evidence consensus approach
    PLOS Neglected Tropical Diseases, 2019
    Co-Authors: Kebede Deribe, Jorge Cano, David M Pigott, Hope Simpson, Nicole Davis Weaver, Elizabeth A Cromwell, Oliver J Brady, Rachel L Pullan, Abdisalan M Noor
    Abstract:

    Background Podoconiosis is a type of elephantiasis characterised by swelling of the lower legs. It is often confused with other causes of tropical lymphedema and its global distribution is uncertain. Here we synthesise the available information on the presence of Podoconiosis to produce evidence consensus maps of its global geographical distribution. Methods and findings We systematically searched available data on Podoconiosis in SCOPUS and MEDLINE from inception, updated to 10 May, 2019, and identified observational and population-based studies reporting Podoconiosis. To establish existence of Podoconiosis, we used the number of cases reported in studies and prevalence data with geographical locations. We then developed an index to assess evidence quality and reliability, assigning each country an evidence consensus score. Using these summary scores, we then developed a contemporary global map of national-level Podoconiosis status. There is evidence of Podoconiosis in 17 countries (12 in Africa, three in Latin America, and two in Asia) and consensus on presence in six countries (all in Africa). We have identified countries where surveillance is required to further define the presence or absence of Podoconiosis. We have highlighted areas where evidence is currently insufficient or conflicting, and from which more evidence is needed. Conclusion The global distribution of Podoconiosis is not clearly known; the disease extent and limits provided here inform the best contemporary map of the distribution of Podoconiosis globally from available data. These results help identify surveillance needs, direct future mapping activities, and inform prevention plans and burden estimation of Podoconiosis.

  • the impact of acute adenolymphangitis in Podoconiosis on caregivers a case study in wayu tuka woreda oromia western ethiopia if she was healthy i would be free
    PLOS Neglected Tropical Diseases, 2019
    Co-Authors: Clare Phillips, Gail Davey, Kebede Deribe, Abdi Samuel, Gemechu Tiruneh
    Abstract:

    Background Podoconiosis, also known as mossy foot or endemic non-filarial elephantiasis, is a preventable form of lower-leg lymphoedema caused by prolonged (typically barefoot) exposure to soil derived from volcanic rocks. Acute adenolymphangitis (also called ‘acute attack’) is a serious complication of Podoconiosis resulting in significant symptoms and worsening disability. Despite the well-known morbidity associated with Podoconiosis, to date there have been no studies looking at the impact, or burden, of Podoconiosis on caregivers. This study explored the experiences and impact of acute attacks on the caregivers of those with Podoconiosis in one endemic district of Ethiopia. Methods/Principal findings This qualitative study was based in Wayu Tuka woreda (district), Oromia, Western Ethiopia. 27 semi-structured interviews of those with Podoconiosis and their caregivers were conducted in June 2018. Here we report the findings from the caregiver’s interviews. Data were analysed using NVivo 12. Directed content analysis, a qualitative approach related to thematic analysis, was used to analyse the results. This study highlights a previously unreported impact of acute attacks on the caregivers of those affected by Podoconiosis. The findings demonstrate the significant social and financial pressures placed on Podoconiosis-affected families which are exacerbated during acute attacks. This study also highlighted the emotional burden experienced by caregivers, the range of care activities placed on them and the limited support available. Conclusions This study found a significant impact on the caregivers of those with Podoconiosis, especially during acute attacks, in in Wayu Tuka woreda. It also highlighted the limited support available to caregivers. Further research is needed to understand whether this impact applies to Podoconiosis caregivers across Ethiopia, and beyond, and to establish if there are wider implications of this important consequence of Podoconiosis, for example on the economy and caregivers’ mental and physical health.

  • Geographical distribution and prevalence of Podoconiosis in Rwanda: a cross-sectional country-wide survey
    Elsevier, 2019
    Co-Authors: Kebede Deribe, Jorge Cano, Emanuele Giorgi, Ursin Bayisenge, Eugene Ruberanziza, Aimable Mbituyumuremyi, Mbonigaba Jean Bosco Bsc, Uwayezu Leonard Bsc, Jean Paul Bikorimana Msc, Aniceth Rucogoza Msc
    Abstract:

    Summary: 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

Abreham Tamiru - One of the best experts on this subject based on the ideXlab platform.

  • lymphoedema management to prevent acute dermatolymphangioadenitis in Podoconiosis in northern ethiopia golbet a pragmatic randomised controlled trial
    The Lancet Global Health, 2018
    Co-Authors: Henok Negussie, Meseret Molla, Moses Ngari, James A Berkley, Esther Kivaya, Greg Fegan, Patricia Njuguna, Abreham Tamiru
    Abstract:

    Summary 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 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).

  • willingness to pay for footwear and associated factors related to Podoconiosis in northern ethiopia
    International Health, 2016
    Co-Authors: Girmay Tsegay, Gail Davey, Abreham Tamiru, Tsige Amberbir, Kebede Deribe
    Abstract:

    Background: In Northern Ethiopia, use of footwear by the rural community is limited, and non-governmental organizations provide footwear for school children as a means of preventing Podoconiosis. However, this is not a sustainable strategy. This study assessed willingness to pay for footwear among people with and without Podoconiosis. Methods: A comparative cross-sectional community-based study was conducted in Mecha and Gozamen woredas among randomly selected people with and without Podoconiosis. Trained health extension workers collected data using an interviewer-administered structured questionnaire. The data were entered into EPI-Data and exported to SPSS version 16.0 statistical software package for analysis. Results: The willingness to pay for footwear among people with and without Podoconiosis was 72.3% and 76.7% respectively (p=0.30). People with Podoconiosis in the lower quintiles of economic status were less likely to be willing to pay for footwear than those in the higher quintiles. Conclusions: There is substantial willingness to pay for footwear. The expressed willingness to pay indicates demand for footwear in the community, suggesting an opportunity for shoe companies. There are still a substantial proportion of individuals not willing to pay for footwear. This requires intensified public education and social transformation to bring about change in behavior towards footwear use if elimination of Podoconiosis within our generation is to be achieved.

  • using qualitative methods to explore lay explanatory models health seeking behaviours and self care practices of Podoconiosis patients in north west ethiopia
    PLOS Neglected Tropical Diseases, 2016
    Co-Authors: Harrison S Banks, Gail Davey, Girmay Tsegay, Abreham Tamiru, Moges Wubie, Max Cooper
    Abstract:

    Background: Podoconiosis (endemic non-filarial elephantiasis) is a chronic, non-infectious disease resulting from exposure of bare feet to red-clay soil in tropical highlands. This study examined lay beliefs about three under-researched aspects of Podoconiosis patients’ care: explanatory models, health-seeking behaviours and self-care. Methods: In-depth interviews and focus group discussions were undertaken with 34 participants (19 male, 15 female) between April-May 2015 at Podoconiosis treatment centres across East and West Gojjam regions in north-west Ethiopia. Results: Explanatory models for Podoconiosis included contamination from blood, magic, soil or affected individuals. Belief in heredity or divine punishment often delayed clinic attendance. All participants had tried holy water treatment and some, holy soil. Herbal treatments were considered ineffectual, costly and appeared to promote fluid escape. Motivators for clinic attendance were failure of traditional treatments and severe or disabling symptoms. Patients did not report self-treatment with antibiotics. Self-care was hindered by water being unavailable or expensive and patient fatigue. Conclusion: A pluralistic approach to Podoconiosis self-treatment was discovered. Holy water is widely valued, though some patients prefer holy soil. Priests and traditional healers could help promote self-care and “signpost” patients to clinics. Change in behaviour and improving water access is key to self-care.

  • depression and disability in people with Podoconiosis a comparative cross sectional study in rural northern ethiopia
    International Health, 2016
    Co-Authors: Joanna Bartlett, Kebede Deribe, Abreham Tamiru, Tsige Amberbir, Girmay Medhin, Muzaffar Malik, Charlotte Hanlon, Gail Davey
    Abstract:

    BACKGROUND Little is known about depressive symptoms in Podoconiosis despite the independent contribution of depression to worse health outcomes and disability in people with other chronic disorders. METHOD Two-hundred and seventy-one individuals with Podoconiosis and 268 healthy neighbours (individuals from the nearest household in any direction) were investigated for depressive symptoms using a validated Amharic version of the Patient Health Questionnaire (PHQ-9). The WHO Disability Assessment Schedule II (WHODAS II) tool was used to measure disability. Logistic regression and zero inflated negative binomial regression were used to identify factors associated with elevated depressive symptoms, and disability, respectively. RESULTS Among study participants with Podoconiosis, 12.6% (34/269) had high levels of depressive symptoms (scoring 5 or more points on the PHQ-9, on two assessments two weeks apart) compared to 0.7% (2/268) of healthy neighbours (p<0.001). Having Podoconiosis and being older were significantly associated with increased odds of a high PHQ-9 score (adjusted odds ratios [AOR] 11.42; 95% CI 2.44-53.44 and AOR 1.04; 95% CI 1.00-1.08, respectively). Significant predictors of a higher disability score were having Podoconiosis (WHODAS II multiplier value: 1.48; 95% CI 1.39-1.58) and having a high PHQ-9 score (1.07; 95% CI 1.06-1.08). CONCLUSION We recommend integrating evidence-based treatments for depression into Podoconiosis interventions.

  • reasons for loss to follow up of patients with Podoconiosis in the amhara region northern ethiopia
    International Health, 2015
    Co-Authors: Alice Campion, Abreham Tamiru, Girmay Tsegay, Gail Davey
    Abstract:

    BACKGROUND Podoconiosis is a non-infectious form of tropical lymphoedema characterised by swelling of the feet and lower legs. Treatment is simple and effective yet evidence indicates that a proportion of patients become lost to follow-up. METHODS This study was a quantitative questionnaire-based study which aimed to identify the most common reasons for loss to follow-up of patients. A total of 191 participants registered with the International Orthodox Christian Charities (IOCC) who had become lost to follow-up were included in a cross-sectional survey based in the Amhara Region, northern Ethiopia. RESULTS The most common reason was distance, stated by 26.7% (51/191). This was significantly associated with living further from the treatment site (p=0.02). Having had Podoconiosis for longer was protective against this (p=0.03). For each additional hour of travel time a patient lived from the treatment centre, the odds of them reporting 'distance' as the main reason for becoming lost to follow-up increased by 1.61 (95% CI 1.25-2.08). CONCLUSIONS The consequences of Podoconiosis are exacerbated by walking long distances, but in most areas, this is currently required of patients in order to receive treatment. We recommend expansion of services to widen treatment availability, since provision of transport to and from treatment centres is unlikely to be feasible.

Getnet Tadele - One of the best experts on this subject based on the ideXlab platform.

  • a cross sectional survey to assess the risk factors associated with stigmatizing attitudes towards patients with Podoconiosis among rural youth in southern ethiopia
    Transactions of The Royal Society of Tropical Medicine and Hygiene, 2020
    Co-Authors: Kibur Engdawork, Gail Davey, Desta Ayode, Colleen M Mcbride, Getnet Tadele
    Abstract:

    BACKGROUND Many health conditions are associated with stigma due to beliefs about their causes and the physical changes experienced by patients. Among such conditions are several neglected tropical diseases (NTDs). Podoconiosis, classified as an NTD, is a form of lymphoedema caused by the co-influence of genetic and environmental factors. It is a major public health problem in Ethiopia and is associated with intense stigma. Despite this, little is known about the factors contributing to stigmatizing attitudes against patients with the disease. METHODS A cross-sectional survey was conducted in southern Ethiopia to analyse the attitudes of rural youth and associated risk factors for stigmatizing attitudes towards patients with Podoconiosis, with the aim of informing stigma reduction strategies. RESULTS The survey included 336 randomly selected youth. Of the 177 (52.7%) youth who held more stigmatizing attitudes toward patients with Podoconiosis, 105 (59.3%) were females and 171 (96.6%) did not have affected friends. Accurate knowledge about gene-environment influences and rejection of infectious causes of Podoconiosis were associated with less stigmatizing attitudes. CONCLUSIONS Improving understanding of the gene-environment interaction and dispelling beliefs about infectious causes may reduce negative attitudes about Podoconiosis. Affected youth may play an important role as agents of change to spread non-stigmatizing messages.

  • rural youths understanding of gene x environmental contributors to heritable health conditions the case of Podoconiosis in ethiopia
    PLOS Neglected Tropical Diseases, 2018
    Co-Authors: Kibur Engdawork, Gail Davey, Desta Ayode, Colleen M Mcbride, Caitlin G Allen, Getnet Tadele
    Abstract:

    Objectives Assess the feasibility of engaging youth to disseminate accurate information about gene by environmental (GxE) influences on Podoconiosis, a neglected tropical lymphedema endemic in southern Ethiopia. Methods A cross sectional survey was conducted with 377 youth randomly selected from 2 districts of Southern Ethiopia. Measures included GxE knowledge (4 true/false statements), preventive action knowledge (endorse wearing shoes and foot hygiene), causal misconceptions (11 items related to contagion) and confidence to explain GxE (9 disagree/agree statements). Results Over half (59%) accurately endorsed joint contributions of gene and environment to Podoconiosis and preventive mechanisms (e.g., wearing protective shoes and keeping foot hygiene). Multivariable logistic regression showed that youth with accurate understanding about GxE contributors reported having: some education, friends or kin who were affected by the condition, and prior interactions with health extension workers. Surprisingly, higher accurate GxE knowledge was positively associated with endorsing contagion as a causal factor. Accuracy of GxE and preventive action knowledge were positively associated with youth’s confidence to explain Podoconiosis-related information. Conclusions Youth have the potential to be competent disseminators of GxE information about Podoconiosis. Interventions to foster confidence among youth in social or kin relationships with affected individuals may be most promising. Efforts to challenge youth’s co-existing inaccurate beliefs about contagion could strengthen the link of GxE explanations to preventive actions.

  • health beliefs of school age rural children in Podoconiosis affected families a qualitative study in southern ethiopia
    PLOS Neglected Tropical Diseases, 2017
    Co-Authors: Abebayehu Tora, Getnet Tadele, Colleen M Mcbride, Abraham Aseffa, Gail Davey
    Abstract:

    Background Several studies have suggested investigation of health beliefs in children to be an important pre-condition for primary prevention of disease. However, little effort has been made to understand these in the context of Podoconiosis. This study therefore aimed to explore the health beliefs of school-age rural children in Podoconiosis-affected families. Methodology/Principal findings A cross sectional qualitative study was conducted in March 2016 in Wolaita Zone, Southern Ethiopia. Data were collected through in-depth individual interviews (IDIs) and focus group discussions (FGDs), with a total of one hundred seventeen 9 to15-year-old children recruited from Podoconiosis affected families. The study revealed various misconceptions regarding risk factors for Podoconiosis. Most children believed barefoot exposure to dew, worms, snake bite, frog urine, other forms of poison, and contact with affected people to be major causes of the disease. Their knowledge about the role of heredity and that of long term barefoot exposure to irritant mineral particles was also weak. Though most participants correctly appraised their susceptibility to Podoconiosis in relation to regular use of footwear and foot hygiene, others based their risk perceptions on factors they think beyond their control. They described several barriers to preventive behaviour, including uncomfortable footwear, shortage and poor adaptability of footwear for farm activities and sports, and shortage of soap for washing. Children also perceived low self-efficacy to practice preventive behaviour in spite of the barriers. Conclusion/Significance Health education interventions may enhance school-age children’s health literacy and be translated to preventive action. Overcoming practical challenges such as shortage of footwear and other hygiene facilities requires other forms of interventions such as livelihood strengthening activities. Linking Podoconiosis-affected families with local governmental or non-governmental organizations providing socio-economic support for households may assist school-age children in those families to sustainably engage in preventive behaviours.

  • association between causal beliefs and shoe wearing to prevent Podoconiosis a baseline study
    American Journal of Tropical Medicine and Hygiene, 2016
    Co-Authors: Desta Ayode, Gail Davey, Getnet Tadele, Abebayehu Tora, David Farrell, Colleen M Mcbride
    Abstract:

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

  • the association of beliefs about heredity with preventive and interpersonal behaviors in communities affected by Podoconiosis in rural ethiopia
    American Journal of Tropical Medicine and Hygiene, 2012
    Co-Authors: Desta Ayode, Colleen M Mcbride, Hendrik D De Heer, Emi Watanabe, Tsega Gebreyesus, Getnet Tadele, Abebayehu Tora, Gail Davey
    Abstract:

    Little is known about how beliefs about heredity as a cause of health conditions might influence preventive and interpersonal behaviors among those individuals with low genetic and health literacy. We explored causal beliefs about Podoconiosis, a neglected tropical disease (NTD) endemic in Ethiopia. Podoconiosis clusters in families but can be prevented if individuals at genetically high risk wear shoes consistently. Adults (N = 242) from four rural Ethiopian communities participated in qualitative assessments of beliefs about the causes of Podoconiosis. Heredity was commonly mentioned, with heredity being perceived as (1) the sole cause of Podoconiosis, (2) not a causal factor, or (3) one of multiple causes. These beliefs influenced the perceived controllability of Podoconiosis and in turn, whether individuals endorsed preventive and interpersonal stigmatizing behaviors. Culturally informed education programs that increase the perceived controllability of stigmatized hereditary health conditions like Podoconiosis have promise for increasing preventive behaviors and reducing interpersonal stigma.

Sara Tomczyk - One of the best experts on this subject based on the ideXlab platform.

  • Podoconiosis in ethiopia from neglect to priority public health problem
    Ethiopian Medical Journal, 2017
    Co-Authors: Kebede Deribe, Sara Tomczyk, Fasil Tekolaayele, Biruck Kebede, Belete Mengistu, Henok Negussie, Biruk Kebede, Mesfin Sileshi, Mossie Tamiru, Gail Davey
    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.

  • mental distress and Podoconiosis in northern ethiopia a comparative cross sectional study
    International Health, 2015
    Co-Authors: Elizabeth Mousley, Kebede Deribe, Abreham Tamiru, Sara Tomczyk, Charlotte Hanlon, Gail Davey
    Abstract:

    Background: The stigma, deformity and disability related to most neglected tropical diseases may lead to poor mental health. We aimed to assess the comorbidity of Podoconiosis and mental distress. Methods: A comparative cross-sectional study was conducted in 2012, including 346 people with Podoconiosis and 349 healthy neighbourhood controls. Symptoms of mental distress were assessed using the validated Amharic translation of the Kessler-10 scale (K10). A linear regression analysis was conducted to identify factors associated with mental distress. Results: The mean K10 score was 15.92 (95% CI: 15.27 to 16.57) in people with Podoconiosis and 14.49 (95% CI: 13.85 to 15.12) in controls (average K10 scores 1.43 points higher [95% CI: 0.52 to 2.34]). In multivariate linear regression of K10 scores, the difference remained significant when adjusted for gender, income, alcohol use, age, place of residence and family history of mental illness. In the adjusted model, people with Podoconiosis had K10 scores 1.37 points higher than controls (95% CI: 0.64 to 2.18). Other variables were also associated with high K10 scores: women had K10 scores 1.41 points higher than men (95% CI: 0.63 to 2.18). Those with family history of mental illness had K10 scores 3.56 points higher than those without (95% CI: 0.55 to 6.56). Conclusions: This study documented a high burden of mental distress among people with Podoconiosis compared with healthy controls. Taking this finding in the context of the high stigma and reduced quality of life, we recommend integration of psychosocial care into the current morbidity management of Podoconiosis.

  • Podoconiosis patients willingness to pay for treatment services in northwest ethiopia potential for cost recovery
    BMC Public Health, 2014
    Co-Authors: Abreham Tamiru, Girmay Tsegay, Moges Wubie, Molla Gedefaw, Sara Tomczyk, Fasil Tekolaayele
    Abstract:

    Podoconiosis is non-filarial elephantiasis of the lower legs. It is more commonly found in tropical Africa, Central and South America, and northwest India. In Ethiopia, a few non-governmental organizations provide free treatment to Podoconiosis patients, but sustainability of free treatment and scale-up of services to reach the huge unmet need is challenged by resource limitations. We aimed to determine Podoconiosis patient’s willingness to pay (WTP) for a treatment package (composed of deep cleaning of limbs with diluted antiseptic solution, soap, and water, bandaging, application of emollient on the skin, and provision of shoes), and factors associated with WTP in northwestern Ethiopia. A cross-sectional study was conducted among randomly selected untreated Podoconiosis patients (n = 393) in Baso Liben woreda, northwestern Ethiopia. The contingent valuation method was used with a pre-tested interviewer-administered questionnaire. The majority of Podoconiosis patients (72.8%) were willing to pay for treatment services. The median WTP amount was 64 Birr (US$ 3.28) per person per year. More than one-third of patients (36.7%) were willing to pay at least half of the full treatment cost and 76.2% were willing to pay at least half of the cost of shoes. A multivariate analysis showed that having a higher monthly income, being a woman, older age, being aware of the role of shoes to prevent Podoconiosis, and possession of a functional radio were significantly associated with higher odds of WTP. The considerable WTP estimates showed that Podoconiosis treatment could improve sustainability and service utilization. A subsidized cost recovery scheme could reduce treatment costs and more feasibility integrate Podoconiosis treatment service with other NTDs and the government’s primary health care system.

  • Podoconiosis patients willingness to pay for treatment services in northwest ethiopia potential for cost recovery
    BMC Public Health, 2014
    Co-Authors: Abreham Tamiru, Girmay Tsegay, Moges Wubie, Molla Gedefaw, Sara Tomczyk, Fasil Tekolaayele
    Abstract:

    Background Podoconiosis is non-filarial elephantiasis of the lower legs. It is more commonly found in tropical Africa, Central and South America, and northwest India. In Ethiopia, a few non-governmental organizations provide free treatment to Podoconiosis patients, but sustainability of free treatment and scale-up of services to reach the huge unmet need is challenged by resource limitations. We aimed to determine Podoconiosis patient’s willingness to pay (WTP) for a treatment package (composed of deep cleaning of limbs with diluted antiseptic solution, soap, and water, bandaging, application of emollient on the skin, and provision of shoes), and factors associated with WTP in northwestern Ethiopia.

  • stigma towards a neglected tropical disease felt and enacted stigma scores among Podoconiosis patients in northern ethiopia
    BMC Public Health, 2013
    Co-Authors: Elizabeth Mousley, Kebede Deribe, Abreham Tamiru, Sara Tomczyk, Gail Davey
    Abstract:

    Podoconiosis, or non-filarial elephantiasis, is a neglected tropical disease (NTD) characterised by swelling of the lower legs. When left untreated, this disfiguring condition has a significant social impact. This study aimed to describe the stigma experience among Podoconiosis patients in Dembecha, Northern Ethiopia and assess potential associations between stigma and sociodemographic determinants. The study was conducted in May 2012 in Northern Ethiopia. A questionnaire-based cross-sectional study design was used and stigma was assessed using a validated Podoconiosis stigma scale including 'felt’ and 'enacted’ stigma domains. Enacted stigma includes the experience of discrimination such as abuse, loss of employment or prejudicial attitudes, while felt stigma is the perceived fear of enacted stigma. A multivariable linear regression model was used to explore determinants that may be associated with stigma. A total of 346 clinically confirmed Podoconiosis patients participated in the study. The total mean score of all stigma scale items was 30.7 (Range = 0 to 96). There was a higher mean score of scale items in domains of felt stigma (21.7; Range = 0 to 45) as compared to enacted stigma (9.0; Range = 0 to 51). The total mean score of all stigma scale items appeared to increase with disease stage. A final adjusted linear regression model found an association between stigma and factors including monthly income, duration lived in the current residence, and disease stage, after controlling for confounders. Podoconiosis is a stigmatized disease with a clear social impact. This paper documented the burden of Podoconiosis-related stigma and identified associated factors. Programs aimed at preventing and treating Podoconiosis should incorporate interventions to mitigate both felt and enacted stigma. Interventions targeting patients should prioritize those with advanced disease.