Podoconiosis: observations from clinical field work in Ethiopia.

Abstract

Abstract Background: Podoconiosis is an incurable, but preventable and treatable, neglected tropical disease (NTD). Mineral particles and pathogens found in alkaline, volcanic soil enter plantar skin via breaches causing an inflammatory reaction, skin oedema and damage to superficial lymphatics. It has a severe impact on quality of life. Following inclusion in the World Health Organization (WHO) list of NTDs in 2011, podoconiosis became a health priority for the Ethiopian Government. The Second Morbidity Management and Disability Prevention Programme 2016 for filariasis and podoconiosis targeted 100 woredas (districts) with a high prevalence of podoconiosis to try to eliminate or reduce the impact of the disease by 2020. The Ministry of Health’s subsequent Third National Neglected Tropical Disease Strategic Plan 2021– 2025 set further targets for podoconiosis. Objectives: To visit Ethiopian health centres in areas with a high prevalence of podoconiosis and capture the experiences of health centre staff and patients and compare observations with Government guidelines. Methods: Observational visits were made by a clinician with a nursing background to four Ethiopian health centres over 2 days in a high prevalence region of the Boreda District. Informal interviews with staff and patients were held at the two health centres with the highest registered numbers of patients with podoconiosis. Results: The two health centres with the most patients with podoconiosis were caring for 300 and 163 patients, respectively. Five healthcare staff were interviewed (one health officer who covered all four of the centres; three health officers from one of the two centres and one from the other). They identified issues accessing treatment materials that limited their ability to educate patients to undertake the correct podoconiosis treatment. Twelve patients with podoconiosis with an age range of 24–87 years were interviewed over the 2 days. Patients were mainly subsistence farmers (n=10) who reported that they could not afford to purchase treatment materials and they struggled to travel the long distances needed to access clean water for limb washing. These factors adversely had an impact on attainment of Government targets. Conclusions: The Ethiopian Government guidelines on podoconiosis are very challenging as all the patients seen in the study were unable to afford, or easily access, the products required to prevent and treat the disease. Health centres require a consistent stock of all the materials required to teach and demonstrate podoconiosis prevention and treatment. Supplying free soap, disinfectant and emollients to individuals with the disease would be helpful. Lack of affordability of protective shoes was also an issue. Key learning points • The Ethiopian Third National Neglected Tropical Disease Strategic Plan 2021–2025 contains challenging targets for the prevention and treatment of podoconiosis. • Poverty affects patients’ ability to access the materials required to prevent and treat the disease. • Walking long distances to access clean water and health centres is a further disincentive for patients. • Consistent supplies to health centres of the materials required to demonstrate treatment and educate patients are essential