Podoconiosis research to implementation: a call for global action
Authors: Kebede Deribe, Nebiyu Negussu, Mbonigaba Jean Bosco, Gail Davey
Journal: The Lancet Global Health (2018)

Podoconiosis is a form of tropical lymphoedema caused by exposure to volcanic soils in people who do not use footwear.1WHONeglected tropical diseases: Podoconiosis: endemic non-filarial elephantiasis.http://www.who.int/lymphatic_filariasis/epidemiology/podoconiosis/en/Date: Jan 17, 2018Google Scholar, 2Price E Podoconiosis: non-filarial elephantiasis. Oxford Medical Publications, Oxford1990Google Scholar The past fifteen years have seen substantial progress in podoconiosis research.3Deribe K Cano J Newport MJ et al.The global atlas of podoconiosis.Lancet Glob Health. 2017; 5: e477-e479Summary Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 4Deribe K Tomczyk S Tekola-Ayele F Ten years of podoconiosis research in Ethiopia.PLoS Negl Trop Dis. 2013; 7: e2301Crossref PubMed Scopus (24) Google Scholar We are now entering a crucial time marked by the need for increased funding both for research and for translation of this research into implementation. Together, research and its translation will shape a global strategy for podoconiosis control and elimination.5Deribe K Kebede B Tamiru M et al.Integrated morbidity management for lymphatic filariasis and podoconiosis, Ethiopia.Bull World Health Organ. 2017; 95: 652-656Crossref PubMed Scopus (19) Google Scholar, 6Deribe K Wanji S Shafi O et al.The feasibility of eliminating podoconiosis.Bull World Health Organ. 2015; 93: 712-718Crossref PubMed Scopus (37) Google Scholar There have been several encouraging developments in the fight against podoconiosis in recent years. National or local programmes for the control and elimination of podoconiosis have been initiated in four endemic countries (Ethiopia, Uganda, Rwanda, and Cameroon). Nationwide mapping of podoconiosis has been completed in three countries,6Deribe K Wanji S Shafi O et al.The feasibility of eliminating podoconiosis.Bull World Health Organ. 2015; 93: 712-718Crossref PubMed Scopus (37) Google Scholar and at least three countries have achieved impressive improvements in surveillance systems. Morbidity management services have also been expanded in Ethiopia.5Deribe K Kebede B Tamiru M et al.Integrated morbidity management for lymphatic filariasis and podoconiosis, Ethiopia.Bull World Health Organ. 2017; 95: 652-656Crossref PubMed Scopus (19) Google Scholar Substantial progress has also been made in terms of research. Genome wide association studies have identified genetic susceptibility loci.7Tekola Ayele F Adeyemo A Finan C et al.HLA class II locus and susceptibility to podoconiosis.N Engl J Med. 2012; 366: 1200-1208Crossref PubMed Scopus (107) Google Scholar Mineralogical studies have linked specific minerals (smectite, mica, and quartz) within the soil with a high prevalence of podoconiosis.8Molla YB Wardrop NA Le Blond JS et al.Modelling environmental factors correlated with podoconiosis.Int J Health Geogr. 2014; 13: 24Crossref PubMed Scopus (39) Google Scholar Social and economic studies have quantified the stigma,9Tora A Davey G Tadele G A qualitative study on stigma and coping strategies of patients with podoconiosis in Wolaita zone, Southern Ethiopia.Int Health. 2011; 3: 176-181Summary Full Text Full Text PDF PubMed Scopus (59) Google Scholar discrimination, and economic impact of the disease.10Tekola F HaileMariam D Davey G Economic costs of endemic non-filarial elephantiasis in Wolaita Zone, Ethiopia.Trop Med Int Health. 2006; 11: 1136-1144Crossref PubMed Scopus (103) Google Scholar Developments in geostatistical and machine learning approaches have facilitated disease distribution mapping and estimation of the burden of disease.11Deribe K Cano J Newport MJ et al.Mapping and modelling the geographical distribution and environmental limits of podoconiosis in Ethiopia.PLoS Negl Trop Dis. 2015; 9: e0003946Crossref PubMed Scopus (47) Google Scholar Additionally, the effect of a simple lymphoedema management package on the frequency of acute attacks has been documented.12Negussie H Molla M Ngari M et al.Lymphoedema management to prevent acute dermatolymphangioadenitis in podoconiosis in northern Ethiopia (GoLBeT): a pragmatic randomised controlled trial.Lancet Glob Health. 2018; 6: e795-e803Summary Full Text Full Text PDF PubMed Scopus (41) Google Scholar Despite this progress in generating evidence, translation into policy and practice at the global level is poor. Four clear barriers exist. First, at present no global strategy for the control or elimination of podoconiosis exists. Countries are implementing interventions based on experience from pilot projects. Normative guidance about the implementation of podoconiosis interventions with clear end goals must be provided by WHO. Although podoconiosis is mentioned on the WHO website,1WHONeglected tropical diseases: Podoconiosis: endemic non-filarial elephantiasis.http://www.who.int/lymphatic_filariasis/epidemiology/podoconiosis/en/Date: Jan 17, 2018Google Scholar the lack of clear global strategies for podoconiosis has significantly limited advocacy and resource mobilisation. Second, podoconiosis is one of the least financed neglected tropical diseases.13Hotez JP Ten failings in global neglected tropical diseases control.PLoS Negl Trop Dis. 2017; 11: e0005896PubMed Google Scholar To accelerate progress in the control and elimination of podoconiosis, increased investment is needed. While resources provided by donors and philanthropic organisations are critical, domestic financing of podoconiosis intervention should also be encouraged. Of the 32 countries considered endemic for podoconiosis, 22 are categorised as middle-income countries. These countries could ensure domestic resource allocation for sustainable financing of the prevention and treatment of podoconiosis. The elimination of podoconiosis aligns well with attainment of the UN's Sustainable Development Goals (SDG).14UNThe Sustainable Development Goals report 2017.https://unstats.un.org/sdgs/files/report/2017/TheSustainableDevelopmentGoalsReport2017.pdfDate: 2017Date accessed: May 22, 2018Google Scholar Podoconiosis interventions are a perfect example of health services requiring universal health coverage (SDG3). Responsive health systems with financial risk protection for affected individuals is critical. Nonetheless, the elimination of podoconiosis depends on the progress of other SDG goals. Determinants and drivers of podoconiosis are directly linked with other goals such as addressing poverty and social protection (SDG1), universal access to safe and affordable water and hygiene (SDG6), working and living conditions (SDG8), and inequalities (SDG10).14UNThe Sustainable Development Goals report 2017.https://unstats.un.org/sdgs/files/report/2017/TheSustainableDevelopmentGoalsReport2017.pdfDate: 2017Date accessed: May 22, 2018Google Scholar Third, there is insufficient innovation in respect to new and better tools for podoconiosis prevention, control, and elimination.6Deribe K Wanji S Shafi O et al.The feasibility of eliminating podoconiosis.Bull World Health Organ. 2015; 93: 712-718Crossref PubMed Scopus (37) Google Scholar Point-of-care diagnosis, innovations which improve the outcome of morbidity management, and new tools for personal protection from soil exposure, including work-friendly and season-friendly footwear, are all important. To realise the elimination of podoconiosis, innovation that is faster and smarter than the current trend is crucial, as well as using multi-disciplinary approaches to develop tools. Fourth, reliable data for decision making is essential for effective use of available resources. Investment in distribution mapping and burden estimation in all endemic countries is crucial.3Deribe K Cano J Newport MJ et al.The global atlas of podoconiosis.Lancet Glob Health. 2017; 5: e477-e479Summary Full Text Full Text PDF PubMed Scopus (26) Google Scholar Well-powered surveys will enable estimation of national disease burdens, but countries should also invest in surveillance systems and integrate indicators for podoconiosis into national health data platforms. The first international conference on podoconiosis will take place on September 23, 2018, in Addis Ababa, Ethiopia. The overall theme of the conference is “Research to implementation: a call for global action”, and the meeting aims to delineate a clear direction for podoconiosis intervention in endemic countries. The following outcomes are expected from the conference; first, the conference will be an important advocacy forum to showcase the key research and implementation advances achieved so far. Policy makers and programme planners will have the opportunity to share experiences. Second, resource mobilisation and domestic financing will be discussed. Third, a written commitment to global podoconiosis implementation will be generated. This will outline the guiding principles for the implementation and financing of podoconiosis programmes. Elimination of podoconiosis is achievable within one generation. To achieve this goal, resources for translation of the available evidence into practice, for innovation and development of new tools, and for development of a comprehensive global strategy and case for investment are essential. KD and GD are members of the steering group of Footwork, the International Podoconiosis Initiative. NN and MJB declare no competing interests. KD is funded by a Wellcome Trust Intermediate Fellowship in Public Health and Tropical Medicine (201900).