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

Hadley Matendechero Sultani Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya;

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Collins Okoyo Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya;

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Henry M. Kanyi Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya;

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Sammy M. Njenga Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya;

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Wyckliff P. Omondi Division of Vector Borne and Neglected Tropical Diseases, Ministry of Health, Nairobi, Kenya;

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Isabella Ayagah Division of Global Health Security, Ministry of Health, Nairobi, Kenya;

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Morris Buliva Interconnected Health Solutions, Nairobi, Kenya;

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Isaac Ngere Global Health Program, Washington State University, Nairobi, Kenya;

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John Gachohi Global Health Program, Washington State University, Nairobi, Kenya;
School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya;

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Jacinta Muli School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya;

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Melanie J. Newport Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom;

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Kebede Deribe Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom;
School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

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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.

  • 1.

    WHO , 2015. Podoconiosis: endemic non-filarial elephantiasis.

  • 2.

    Deribe K, Wanji S, Shafi O, Tukahebwa EM, Umulisa I, Molyneux DH, Davey G, 2015. The feasibility of eliminating podoconiosis. Bull World Health Organ 93: 712718.

  • 3.

    Deribe K, Tomczyk S, Tekola-Ayele F, 2013. Ten years of podoconiosis research in Ethiopia. PLoS Negl Trop Dis 7. doi: 10.1371/journal.pntd.0002301.

  • 4.

    Deribe K, Cano J, Trueba ML, Newport MJ, Davey G, 2018. Global epidemiology of podoconiosis: a systematic review. PLoS Negl Trop Dis 12. doi: 10.1371/journal.pntd.0006324.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Davey G et al., 2012. Launch of the international podoconiosis initiative. Lancet 379: 1004.

  • 6.

    Price E, 1990. Podoconiosis: Non-filarial Elephantiasis. Available at: https://www.cabdirect.org/cabdirect/abstract/19912080942. Accessed June 4, 2020.

    • PubMed
    • Export Citation
  • 7.

    Wanji S, Tendongfor N, Esum M, Che JN, Mand S, Mbi CT, Enyong P, Hoerauf A, 2008. Elephantiasis of non-filarial origin (podoconiosis) in the highlands of north-western Cameroon. Ann Trop Med Parasitol 102: 529540.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Ruberanziza E et al., 2009. Mapping of lymphatic filariasis in Rwanda. J Lymphoedema 4: 2023. Available at: https://www.researchgate.net/publication/313143052 Accessed May 30, 2020.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Sikorski C, Ashine M, Zeleke Z, Davey G, 2010. Effectiveness of a simple lymphoedema treatment regimen in podoconiosis management in southern Ethiopia: one year follow-up. PLoS Negl Trop Dis 4. doi: 10.1371/journal.pntd.0000902.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Douglass J, Kelly-Hope L, 2019. Comparison of staging systems to assess lymphedema caused by cancer therapies, lymphatic filariasis, and podoconiosis. Lymphat Res Biol 17: 550556.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Tekola F, Bull SJ, Farsides B, Newport MJ, Adeyemo A, Rotimi CN, Davey G, 2009. Tailoring consent to context: designing an appropriate consent process for a biomedical study in a low income setting. PLoS Negl Trop Dis 3. doi: 10.1371/journal.pntd.0000482.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Ayele FT, Adeyemo A, Finan C, Hailu E, Sinnott P, Burlinson ND, Aseffa A, Rotimi CN, Newport MJ, Davey G, 2012. HLA class II locus and susceptibility to podoconiosis. N Engl J Med 366: 12001208.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Deribe K et al., 2015. Epidemiology and individual, household and geographical risk factors of podoconiosis in Ethiopia: results from the first nationwide mapping. Am J Trop Med Hyg 92: 148158.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Price EW, 1984. Pre-elephantiasic stage of endemic nonfilarial elephantiasis of lower legs: “Podoconiosis.” Trop Doct 14: 115119.

  • 15.

    Deribe K et al., 2015. Mapping and modelling the geographical distribution and environmental limits of podoconiosis in Ethiopia. PLoS Negl Trop Dis 9: 118.

  • 16.

    Yimer M, Hailu T, Mulu W, Abera B, 2015. Epidemiology of elephantiasis with special emphasis on podoconiosis in Ethiopia: a literature review. J Vector Borne Dis52: 111115.

    • PubMed
    • Export Citation
  • 17.

    Davey G, 2010. Podoconiosis, non-filarial elephantiasis, and lymphology. Lymphology 43: 168177.

  • 18.

    Nenoff P, Simon JC, Muylowa GK, Davey G, 2009. Podoconiosis - non-filarial geochemical elephantiasis - a neglected tropical disease? J der Dtsch Dermatologischen Gesellschaft 8: 713.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Deribe K et al., 2019. Geographical distribution and prevalence of podoconiosis in Rwanda: a cross-sectional country-wide survey. Lancet Glob Health 7: e671e680.

  • 20.

    Deribe K et al., 2018. Mapping the geographical distribution of podoconiosis in Cameroon using parasitological, serological, and clinical evidence to exclude other causes of lymphedema. PLoS Negl Trop Dis 12. doi: 10.1371/journal.pntd.0006126.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Davey G, Tekola F, Newport MJ, 2007. Podoconiosis: non-infectious geochemical elephantiasis. Trans R Soc Trop Med Hyg 101: 11751180.

  • 22.

    Tora A, Davey G, Tadele G, 2011. A qualitative study on stigma and coping strategies of patients with podoconiosis in Wolaita zone, southern Ethiopia. Int Health 3: 176181.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Yakob B, Deribe K, Davey G, 2008. High levels of misconceptions and stigma in a community highly endemic for podoconiosis in southern Ethiopia. Trans R Soc Trop Med Hyg 102: 439444.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Tora A, Mengiste A, Davey G, Semrau M, 2018. Community involvement in the care of persons affected by podoconiosis—a lesson for other skin NTDs. Trop Med Infect Dis 3: 87.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Mousley E, Deribe K, Tamiru A, Davey G, 2013. The impact of podoconiosis on quality of life in northern Ethiopia. Health Qual Life Outcomes 11. doi: 10.1186/1477-7525-11-122.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Ali O, Deribe K, Semrau M, Mengiste A, Kinfe M, Tesfaye A, Bremner S, Davey G, Fekadu A, 2020. A cross-sectional study to evaluate depression and quality of life among patients with lymphoedema due to podoconiosis, lymphatic filariasis and leprosy. Trans R Soc Trop Med Hyg 114: 983994.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Tekola F, Mariam DH, Davey G, 2006. Economic costs of endemic non-filarial elephantiasis in Wolaita Zone, Ethiopia. Trop Med Int Health 11: 11361144.

  • 28.

    Bartlett J, Deribe K, Tamiru A, Amberbir T, Medhin G, Malik M, Hanlon C, Davey G, 2015. Depression and disability in people with podoconiosis: a comparative cross-sectional study in rural northern Ethiopia. Int Health 8: 124131.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Semrau M, Davey G, Bayisenge U, Deribe K, 2020. High levels of depressive symptoms among people with lower limb lymphoedema in Rwanda: a cross-sectional study. Trans R Soc Trop Med Hyg 114: 974982.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Kihembo C et al., 2017. Risk factors for podoconiosis: Kamwenge district, western Uganda, September 2015. Am J Trop Med Hyg 96: 14901496.

  • 31.

    Molla YB, Le Blond JS, Wardrop N, Baxter P, Atkinson PM, Newport MJ, Davey G, 2013. Individual correlates of podoconiosis in areas of varying endemicity: a case-control study. PLoS Negl Trop Dis 7. doi: 10.1371/journal.pntd.0002554.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Deribe K et al., 2018. Predicted distribution and burden of podoconiosis in Cameroon. BMJ Glob Heal. doi: 10.1136/bmjgh-2018-000730.

    • PubMed
    • Export Citation
  • 33.

    Sime H et al., 2014. Integrated mapping of lymphatic filariasis and podoconiosis: Lessons learnt from Ethiopia. Parasit Vectors 7. doi: 10.1186/1756-3305-7-397.

  • 34.

    SDK , 2020. Secure Data Kit. Available at: https://www.securedatakit.com/. Accessed October 26, 2020.

    • PubMed
    • Export Citation
  • 35.

    Ayugi B, Wen W, Chepkemoi D, 2016. Analysis of spatial and temporal patterns of rainfall variations over Kenya. J Environ Earth Sci 6: 6983.

  • 36.

    Onapa AW, Simonsen PE, Pedersen EM, 2001. Non-filarial elephantiasis in the Mt. Elgon area (Kapchorwa District) of Uganda. Acta Trop 78: 171176.

  • 37.

    Speck H, 1982. Soils of the Mount Kenya area: their formation, ecological and agricultural significance (with soil map, scale 1:125,000). Mt Res Dev 2: 201221.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Owino CO, Owuor PO, Sigunga DO, 2015. Elucidating the causes of low phosphorus levels in ferralsols of Siaya County, western Kenya. J Soil Sci Environ Manag 6: 260267. doi: 10.5897/JSSEM15.0484.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Kebeney S, Msanya B, Ng’etich W, Semoka J, Serrem C, 2015. Pedological characterization of some typical soils of Busia County, western Kenya: soil morphology, physico-chemical properties, classification and fertility trends. Int J Plant Soil Sci 4: 2944.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Chandler DJ, Grijsen ML, Fuller LC, 2020. With bare feet in the soil: podoconiosis, a neglected cause of tropical lymphoedema. Dermatology 237: 112.

  • 41.

    Muli J, Gachohi J, Kagai J, 2017. Soil iron and aluminium concentrations and feet hygiene as possible predictors of podoconiosis occurrence in Kenya. PLoS Negl Trop Dis 11. doi: 10.1371/journal.pntd.0005864.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42.

    Le Blond JS, Baxter PJ, Bello D, Raftis J, Molla YB, Cuadros J, Davey G, 2017. Haemolytic activity of soil from areas of varying podoconiosis endemicity in Ethiopia. PLoS One 12. doi: 10.1371/journal.pone.0177219.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43.

    Molla YB, Wardrop NA, Le Blond JS, Baxter P, Newport MJ, Atkinson PM, Davey G, 2014. Modelling environmental factors correlated with podoconiosis: a geospatial study of non-filarial elephantiasis. Int J Health Geogr 13: 24.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Deribe K, Cano J, Newport MJ, Pullan RL, Noor AM, Enquselassie F, Murray CJL, Hay SI, Brooker SJ, Davey G, 2017. The global atlas of podoconiosis. Lancet Glob Health 5: e477e479.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Elias A, 2016. Podoconiosis prevalence and its associated factors in Soddo Zuria District, Wolaita Zone, South Ethiopia. Pharm Altern Med 13: 48–56.

    • PubMed
    • Export Citation
  • 46.

    Dejene F, Merga H, Asefa H, 2019. Community based cross sectional study of podoconiosis and associated factors in Dano district, central Ethiopia. PLoS Negl Trop Dis 13. doi: 10.1371/journal.pntd.0007050.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47.

    Harvey R, Powell JJ, Thompson RPH, 1996. A review of the geochemical factors linked to podoconiosis. Geol Soc Spec Publ 113: 255260.

  • 48.

    Bekele K, Deribe K, Amberbir T, Tadele G, Davey G, Samuel A, 2016. Burden assessment of podoconiosis in Wayu Tuka Woreda, east Wollega zone, western Ethiopia: a community-based cross-sectional study. BMJ Open 6. doi: 10.1136/bmjopen-2016-012308.

    • PubMed
    • Search Google Scholar
    • Export Citation
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