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    Rights statement: © 2013 Molla et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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

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  • Yordanos Molla
  • Jennifer Le Blond
  • Nicola A. Wardrop
  • Peter Baxter
  • Peter M. Atkinson
  • Melanie J. Newport
  • Gail Davey
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Article numbere2554
<mark>Journal publication date</mark>5/12/2013
<mark>Journal</mark>PLoS Neglected Tropical Diseases
Issue number12
Volume7
Number of pages11
Publication StatusPublished
<mark>Original language</mark>English

Abstract

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 =24.4, 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.

Bibliographic note

M1 - 12 © 2013 Molla et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.