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Mapping of Podoconiosis Cases and Risk Factors in Kenya: A Nationwide Cross-sectional Study

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  • 1 Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya;
  • | 2 Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya;
  • | 3 Division of Global Health Security, Ministry of Health, Nairobi, Kenya;
  • | 4 Interconnected Health Solutions, Nairobi, Kenya;
  • | 5 Global Health Program, Washington State University, Nairobi, Kenya;
  • | 6 School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya;
  • | 7 Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom;
  • | 8 School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

ABSTRACT.

Podoconiosis is a type of tropical lymphedema that is clinically distinguished from lymphatic filariasis (LF) because it is ascending and commonly bilateral but asymmetric. The disease is a result of a genetically determined inflammatory reaction to long-term exposure to mineral particles in irritant red clay soils derived mainly from volcanic soils. We conducted the first nationwide mapping of the prevalence and risk factors of podoconiosis in Kenya. We performed a population-based cross-sectional survey to determine the national prevalence of podoconiosis and included 6,228 individuals from 48 villages in 24 sub-counties across 15 counties. Participants answered a questionnaire about the history of symptoms compatible with podoconiosis, received a point-of-care antigen test, and underwent a physical examination if they had lymphedema. A confirmed case of podoconiosis was defined as a case in a resident of the study village who had lower limb bilateral and asymmetric lymphedema lasting more than 1 year, negative test results for Wuchereria bancrofti antigen, and other causes of lymphedema ruled out. Of all the individuals surveyed, 89 had lymphedema; of those, 16 of 6228 (0.3%; 95% confidence interval [CI], 0.1–0.5) were confirmed to have podoconiosis. A high prevalence of podoconiosis was found in western (Siaya, 3.1%; Busia, 0.9%) and central (Meru, 1.1%) regions, and a low prevalence was observed in northern (Marsabit, 0.2%), eastern (Makueni, 0.2%), and coastal (Tana River, 0.1%) regions. The identified risk factors were age 56 years or older (adjusted odds ratio [aOR], 5.66; 95% CI, 2.32–13.83; P < 0.001) and rarely wearing shoes (aOR, 18.92; 95% CI, 4.55–78.71; P < 0.001). These results indicated that the podoconiosis prevalence is low and localized in Kenya; therefore, elimination is achievable if appropriate disease prevention, management, and behavioral strategies are promoted.

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Author Notes

Address correspondence to Hadley Matendechero Sultani, Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, P.O. Box 30016-00100, Nairobi, Kenya. E-mail: hadleysultani@gmail.com

Disclosure: All relevant data are provided within the article. The raw datasets used to generate the analysis are available on request to the Division of Vector Borne and Neglected Tropical Diseases of the Ministry of Health, Nairobi, Kenya.

Financial support: The study received funding from the Wellcome Trust (grant number 201900/Z/16/Z) as part of KD’s International Intermediate Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Authors’ addresses: Hadley Matendechero Sultani, Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya, E-mail: hadleysultani@gmail.com. Collins Okoyo, Henry M. Kanyi, and Sammy M. Njenga, Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya, E-mails: collinsomondiokoyo@gmail.com, kanyi2009@gmail.com, and snjenga@kemri.org. Wyckliff P. Omondi, Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya, E-mail: wyckliff.omondi@gmail.com. Isabella Ayagah, Division of Global Health Security, Ministry of Health, Nairobi, Kenya, E-mail: isabella.ayagah@gmail.com. Morris Buliva, Interconnected Health Solutions, Nairobi, Kenya, E-mail: morris.buliva@ihsafrica.org. Isaac Ngere and John Gachohi, Global Health Program, Washington State University, Nairobi, Kenya, E-mails: ngereisaac@gmail.com and john.gachohi@wsu.edu. Jacinta Muli, School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya, E-mail: jacintamuli@gmail.com. Melanie J. Newport and Kebede Deribe, Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom, E-mails: m.j.newport@bsms.ac.uk and kebededeka@yahoo.com.

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