Risk Factors for Podoconiosis: Kamwenge District, Western Uganda, September 2015

Christine Kihembo Uganda Public Health Fellowship Program, Field Epidemiology Track, Kampala, Uganda.
Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda.

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Ben Masiira Uganda Public Health Fellowship Program, Field Epidemiology Track, Kampala, Uganda.
Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda.

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William Z. Lali World Health Organization Uganda Country Office, Kampala, Uganda.

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Gabriel K. Matwale Vector Control Division, Ministry of Health, Kampala, Uganda.

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Joseph K. B. Matovu Makerere University School of Public Health, Kampala, Uganda.

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Frank Kaharuza Makerere University School of Public Health, Kampala, Uganda.

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Alex R. Ario Uganda Public Health Fellowship Program, Field Epidemiology Track, Kampala, Uganda.

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Immaculate Nabukenya Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda.

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Issa Makumbi Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda.

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Monica Musenero Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda.

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Bao-Ping Zhu U.S. Centers for Disease Control and Prevention, Kampala, Uganda.

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Miriam Nanyunja World Health Organization Uganda Country Office, Kampala, Uganda.

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Podoconiosis, a noninfectious elephantiasis, is a disabling neglected tropical disease. In August 2015, an elephantiasis case-cluster was reported in Kamwenge District, western Uganda. We investigated to identify the disease's nature and risk factors. We defined a suspected podoconiosis case as onset in a Kamwenge resident of bilateral asymmetrical lower limb swelling lasting ≥ 1 month, plus ≥ 1 of the following associated symptoms: skin itching, burning sensation, plantar edema, lymph ooze, prominent skin markings, rigid toes, or mossy papillomata. A probable case was a suspected case with negative microfilaria antigen immunochromatographic card test (ruling out filarial elephantiasis). We conducted active case-finding. In a case–control investigation, we tested the hypothesis that the disease was caused by prolonged foot skin exposure to irritant soils, using 40 probable case-persons and 80 asymptomatic village control-persons, individually matched by age and sex. We collected soil samples to characterize irritants. We identified 52 suspected (including 40 probable) cases with onset from 1980 to 2015. Prevalence rates increased with age; annual incidence (by reported onset of disease) was stable over time at 2.9/100,000. We found that 93% (37/40) of cases and 68% (54/80) of controls never wore shoes at work (Mantel–Haenszel odds ratio [ORMH] = 7.7; 95% [confidence interval] CI = 2.0–30); 80% (32/40) of cases and 49% (39/80) of controls never wore shoes at home (ORMH = 5.2; 95% CI = 1.8–15); and 70% (27/39) of cases and 44% (35/79) of controls washed feet at day end (versus immediately after work) (OR = 11; 95% CI = 2.1–56). Soil samples were characterized as rich black-red volcanic clays. In conclusion, this reported elephantiasis is podoconiosis associated with prolonged foot exposure to volcanic soil. We recommended foot hygiene and universal use of protective shoes.

Author Notes

* Address correspondence to Christine Kihembo, Uganda Public Health Fellowship Program, Makerere University School of Public Health, Kampala 7072, Uganda. E-mail: jckihembo@yahoo.com

Financial support: This investigation was financially supported by the World Health Organization, Uganda Office. Christine Kihembo and Ben Masiira are fellows of the Uganda Public Health Fellowship Program, Field Eidemiology Track, financially and technically supported by the U.S. Centers for Diseases Control and Prevention.

Authors' addresses: Christine Kihembo and Ben Masiira, Public Health Fellowship Program, and Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda, E-mails: jckihembo@yahoo.com and ben.masiira@musph.ac.ug. William Z. Lali and Miriam Nanyunja, Disease Prevention and Control, World Health Organization Country Office for Uganda, Kampala, Uganda, E-mails: laliw@who.int and nanyunjam@who.int. Gabriel K. Matwale, Vector Control Division, Ministry of Health, Kampala, Uganda, E-mail: gkmatwale@gmail.com. Joseph K. B. Matovu and Frank Kaharuza, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda, E-mails: jmatovu@musph.ac.ug and fkaharuza@musph.ac.ug. Alex R. Ario, Uganda Public Health Fellowship Program, Makerere University School of Public Health, Kampala, Uganda, E-mail: riolexus@musph.ac.ug. Immaculate Nabukenya and Monica Musenero, Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda, E-mails: lennfaith@yahoo.com and mmusenero@gmail.com. Issa Makumbi, Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda, E-mail: issamakumbi@gmail.com. Bao-Ping Zhu, Workforce and Institute Development Branch/Division of Global Health Protection/Center for Global Health, U.S. Centers for Diseases Prevention and Control, Kampala, Uganda, E-mail: bxz3@cdc.gov.

  • 1.

    Korevaar DA, Visser BJ, 2012. Podoconiosis, a neglected tropical disease. Neth J Med 70: 210214.

  • 2.

    Davey G, Bockarie M, Wanji S, Addiss D, Fuller C, Fox L, 2012. Launch of the international podoconiosis initiative. Lancet 379: 1004.

  • 3.

    Price E, 1976. The association of endemic elephantiasis of the lower legs in east Africa with soil derived from volcanic rocks. Trans R Soc Trop Med Hyg 4: 288295.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Uganda Beaureau of Statistics, 2015. National Population and Housing Census 2014: Preliminary Report. Kampala, Uganda: UBOS.

  • 5.

    Ministry of Health Uganda, 2011. National HIV AIDS Indicator Survey. Kampala, Uganda: Ministry of Health.

  • 6.

    Uganda Beaureau of Statistics, 2016. National Population and Housing Census 2014: Main Report. Kampala, Uganda: UBOS.

  • 7.

    Phantana S, Sensathein S, Songtrus J, Klagrathoke S, Phongnin K, 1999. ICT filariasis test: a new screening test for Bancroftian filariasis. Southeast Asian J Trop Med Public Health 30: 4751.

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

    El-Moamly AA-R, El-Sweify MA, Hafez MA, 2012. Using the AD12-ICT rapid-format test to detect Wuchereria bancrofti circulating antigens in comparison to Og4C3-ELISA and nucleopore membrane filtration and microscopy techniques. Parasitol Res 111: 13791383.

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

    Oliveira P, Braga C, Alexander N, Brandao E, Silva A, Wanderley L, Aguiar AM, Diniz G, Medeiros Z, Rocha A, 2014. Evaluation of diagnostic tests for Wuchereria bancrofti infection in Brazilian schoolchildren. Rev Soc Bras Med Trop 47: 359366.

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

    Veil GJ, Lammie PJ, Weiss N, 1997. The ICT Filariasis Test: a rapid-format antigen test for diagnosis of bancroftian filariasis. Parasitol Today 13: 401404.

  • 11.

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

  • 12.

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

  • 13.

    Deribe K, Davey G, 2014. How ‘the association of endemic elephantiasis of the lower legs in east Africa with soil derived from volcanic rocks’ has underpinned progress in podoconiosis research. Trans R Soc Trop Med Hyg 108: 528529.

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

    Deribe K, Wanji S, Shafi O, Tukahebwa EM, Umulisa I, Davey G, 2015. Measuring elimination of podoconiosis, endemicity classifications, case definition and targets: an international Delphi exercise. Health 7: 306316.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Desta K, Ashine M, Davey G, 2007. Predictive value of clinical assessment of patients with podoconiosis in an endemic community setting. Trans R Soc Trop Med Hyg 101: 621623.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    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
  • 17.

    Yakob B, Deribe K, Davey G, 2010. Health professionals' attitudes and misconceptions regarding podoconiosis: potential impact on integration of care in southern Ethiopia. Trans R Soc Trop Med Hyg 104: 4247.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

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

  • 19.

    Davey G, 2009. Recent advances in podoconiosis. Ann Trop Med Parasitol 103: 377382.

  • 20.

    Kloos H, Kello AB, Addus A, 1992. Podoconiosis (endemic non-filarial elephantiasis) in two resettlement schemes in western Ethiopia. Trop Doct 22: 109112.

  • 21.

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

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

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

  • 23.

    Wanji STN, Esum M, Che JN, Mand S, Tanga Mbi C, 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
  • 24.

    Alemu G, Ayele FT, Takele D, Ahrens C, Davey G, 2011. Burden of podoconiosis in poor rural communities in Gulliso woreda, west Ethiopia. PLoS Negl Trop Dis 5: e1184.

  • 25.

    Geshere Oli G, Tekola Ayele F, Petros B, 2012. Parasitological, serological, and clinical evidence for high prevalence of podoconiosis (non-filarial elephantiasis) in Midakegn district, central Ethiopia. Trop Med Int Health 17: 722726.

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

    Molla YB, Amberbir T, Tamiru A, Davey G, 2012. Podoconiosis in east and west Gojam zones, northern Ethiopia. PLoS Negl Trop Dis 6: e1744.

  • 27.

    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 Dis 52: 111115.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Dwek P, Yuan-Kong L, Wafer M, Cherniak W, 2015. Case report and literature review: podoconiosis in southwestern Uganda. Int J Trop Dis Health 9: 17.

  • 29.

    Smith EL, Mkwanda SZ, Martindale S, 2014. Lymphatic filariasis morbidity mapping: a comprehensive examination of lymphoedema burden in Chikwawa district, Malawi. Trans R Soc Trop Med Hyg 108: 751758.

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

    Yordanos BM, 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: e2554.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

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

  • 32.

    Deribe K, Brooker SJ, Pullan RL, Hailu A, Enquselassie F, Reithinger R, Newport M, Davey G, 2013. Spatial distribution of podoconiosis in relation to environmental factors in Ethiopia: a historical review. PLoS One 8: e68330.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Ayele TF, 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
  • 34.

    Davey G, Gebrehanna E, Adeyemo A, Rotimi C, Newport M, Desta K, 2007. Podoconiosis: a tropical model for gene environment interactions? Trans R Soc Trop Med Hyg 101: 9196.

  • 35.

    Abrahams PW, 2002. Soils: their implications to human health. Sci Total Environ 291: 132.

  • 36.

    Price E, 1974. The relationship between endemic elephantiasis of the lower legs and the local soils and climate. Trop Geogr Med 26: 225230.

  • 37.

    Kamwenge District Government, 2009. Higher Local Government Statistical Abstract: Kamwenge District. Kampala, Uganda.

  • 38.

    Odada EO, Olago DO, 2002. The East African Great Lakes: Limnology, Palaeolimnology and Biodiversity. Dordrecht, MA: Kluwer Academic Publishers.

  • 39.

    Head EM, Maclean AL, Carn SA, 2013. Mapping lava flows from Nyamuragira volcano (1967–2011) with satellite data and automated classification methods. Geomat Nat Haz Risk 4: 119144.

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

    Uwe R, 2008. Extreme uplift of the Rwenzori Mountains, Uganda, East African Rift: Structural framework and possible role of glaciations. Tectonics 27: 119.

  • 41.

    Muravyeva NS, Belyatsky BV, 2009. Petrology and geochemistry Toro Ankole kamafugite magmas: isotopic Constraints. Geophys Res Abstr 11: 12651.

  • 42.

    Schager M, 2016. Soda Lakes of East Africa. Cham, Switzerland: Springer International Publishing.

  • 43.

    Joint Research Centre European Soil Portal—Soil Data and Information Systems, 2012. Available at: http://eusoils.jrc.ec.europa.eu/library/maps/africa_atlas/. Accessed January 15, 2017.

    • PubMed
    • Export Citation
  • 44.

    Mwesigye F, Matsumoto T, 2013. Rural- Rural Migration and Land Conflicts: Implications on Agricultural Productivity in Uganda. Tokyo, Japan: National Graduate Institute for Policy Studies, Discussion paper 1317.

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

    Kebede D, Brooker J, Pullan RL, Sime H, Gebretsadik A, Assefa A, Kebede A, Hailu A, Rebollo MP, Shafi O, Bockarie MJ, Aseffa A, Reithinger R, Cano R, Enquselassie F, Newport MJ, Davey G, 2015. Epidemiology and individual, household and geographical risk factors of podoconiosis in Ethiopia: results from the first nationwide apping. Am J Trop Med Hyg 92: 148158.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Gerusa Dreyer RL, Norões J, Rizzo JA, Figueredo-Silva J, 2008. Sensitivity of the immunochromatographic card test relative to detection of adult Wuchereria bancrofti worms by Ultrasound. Am J Trop Med Hyg 78: 2834.

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

    World Health Organization, 2016. Podoconiosis: Endemic Non-Filarial Elephantiasis. Available at: http://www.who.int/lymphatic_filariasis/epidemiology/podoconiosis/en/. Accessed March 20, 2016.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 48.

    Sime H, Deribe K, Assefa A, 2014. Integrated mapping of lymphatic filariasis and podoconiosis: lessons learnt from Ethiopia. Parasit Vectors 7: 397.

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