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Individual correlates of podoconiosis in areas of varying endemicity: a case-control study

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posted on 2023-06-08, 17:09 authored by Yordanos B Molla, Jennifer S Le Blond, Nicola Wardrop, Peter Baxter, Peter M Atkinson, Melanie NewportMelanie Newport, Gail DaveyGail Davey
BACKGROUND Podoconiosis is a non-filarial form of elephantiasis resulting in lymphedema of the lower legs. Previous studies have suggested that podoconiosis arises from the interplay of individual and environmental factors. Here, our aim was to understand the individual-level correlates of podoconiosis by comparing 460 podoconiosis-affected individuals and 707 unaffected controls. METHODS/PRINCIPAL FINDINGS This was a case-control study carried out in six kebeles (the lowest governmental administrative unit) in northern Ethiopia. Each kebele was classified into one of three endemicity levels: 'low' (prevalence <1%), 'medium' (1-5%) and 'high' (>5%). A total of 142 (30.7%) households had two or more cases of podoconiosis. Compared to controls, the majority of the cases, especially women, were less educated (OR?=?1.7, 95% CI?=?1.3 to 2.2), were unmarried (OR?=?3.4, 95% CI?=?2.6-4.6) and had lower income (t?=?-4.4, p<0.0001). On average, cases started wearing shoes ten years later than controls. Among cases, age of first wearing shoes was positively correlated with age of onset of podoconiosis (r?=?0.6, t?=?12.5, p<0.0001). Among all study participants average duration of shoe wearing was less than 30 years. Between both cases and controls, people in 'high' and 'medium' endemicity kebeles were less likely than people in 'low' endemicity areas to 'ever' have owned shoes (OR?=?0.5, 95% CI?=?0.4-0.7). CONCLUSIONS Late use of shoes, usually after the onset of podoconiosis, and inequalities in education, income and marriage were found among cases, particularly among females. There were clustering of cases within households, thus interventions against podoconiosis will benefit from household-targeted case tracing. Most importantly, we identified a secular increase in shoe-wearing over recent years, which may give opportunities to promote shoe-wearing without increasing stigma among those at high risk of podoconiosis.

Funding

MRC; MR/J012343/1

History

Publication status

  • Published

File Version

  • Published version

Journal

PLoS Neglected Tropical Diseases

ISSN

1935-2735

Publisher

Public Library of Science

Issue

12

Volume

7

Article number

e2554

Department affiliated with

  • Global Health and Infection Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2014-05-12

First Open Access (FOA) Date

2014-06-09

First Compliant Deposit (FCD) Date

2014-06-09

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