Kebede Deribe1,2, Lyndsey Florence3, Abebe Kelemework4, Tigist Getaneh4, Girmay Tsegay5, Jorge Cano6, Emanuele Giorgi7, Melanie J Newport1, Gail Davey1,2. 1. Brighton and Sussex Centre for Global Health Research, Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK. 2. School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, PO Box 9086, Ethiopia. 3. King's College Hospital NHS Foundation Trust, Denmark Hill SE5 9RS, London, UK. 4. International Orthodox Christian Charities, PO Box 495 Bahir Dar, Ethiopia. 5. College of Medicine and Health Sciences, Debre Markos University, PO Box 269, Debre Markos, Ethiopia. 6. Department of Disease Control, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK. 7. CHICAS Research Group, Lancaster Medical School, Lancaster University, Bailrigg, LA1 4YW, Lancaster, UK.
Abstract
BACKGROUND: Difficulties in reliably diagnosing podoconiosis have severely limited the scale-up and uptake of the World Health Organization-recommended morbidity management and disability prevention interventions for affected people. We aimed to identify a set of clinical features that, combined into an algorithm, allow for diagnosis of podoconiosis. METHODS: We identified 372 people with lymphoedema and administered a structured questionnaire on signs and symptoms associated with podoconiosis and other potential causes of lymphoedema in northern Ethiopia. All individuals were tested for Wuchereria bancrofti-specific immunoglobulin G4 in the field using Wb123. RESULTS: Based on expert diagnosis, 344 (92.5%) of the 372 participants had podoconiosis. The rest had lymphoedema due to other aetiologies. The best-performing set of symptoms and signs was the presence of moss on the lower legs and a family history of leg swelling, plus the absence of current or previous leprosy, plus the absence of swelling in the groin, plus the absence of chronic illness (such as diabetes mellitus or heart or kidney diseases). The overall sensitivity of the algorithm was 91% (95% confidence interval [CI] 87.6 to 94.4) and specificity was 95% (95% CI 85.45 to 100). CONCLUSIONS: We developed a clinical algorithm of clinical history and physical examination that could be used in areas suspected or endemic for podoconiosis. Use of this algorithm should enable earlier identification of podoconiosis cases and scale-up of interventions.
BACKGROUND: Difficulties in reliably diagnosing podoconiosis have severely limited the scale-up and uptake of the World Health Organization-recommended morbidity management and disability prevention interventions for affected people. We aimed to identify a set of clinical features that, combined into an algorithm, allow for diagnosis of podoconiosis. METHODS: We identified 372 people with lymphoedema and administered a structured questionnaire on signs and symptoms associated with podoconiosis and other potential causes of lymphoedema in northern Ethiopia. All individuals were tested for Wuchereria bancrofti-specific immunoglobulin G4 in the field using Wb123. RESULTS: Based on expert diagnosis, 344 (92.5%) of the 372 participants had podoconiosis. The rest had lymphoedema due to other aetiologies. The best-performing set of symptoms and signs was the presence of moss on the lower legs and a family history of leg swelling, plus the absence of current or previous leprosy, plus the absence of swelling in the groin, plus the absence of chronic illness (such as diabetes mellitus or heart or kidney diseases). The overall sensitivity of the algorithm was 91% (95% confidence interval [CI] 87.6 to 94.4) and specificity was 95% (95% CI 85.45 to 100). CONCLUSIONS: We developed a clinical algorithm of clinical history and physical examination that could be used in areas suspected or endemic for podoconiosis. Use of this algorithm should enable earlier identification of podoconiosis cases and scale-up of interventions.
Authors: Fasil Tekola Ayele; Adebowale Adeyemo; Chris Finan; Elena Hailu; Paul Sinnott; Natalia Diaz Burlinson; Abraham Aseffa; Charles N Rotimi; Melanie J Newport; Gail Davey Journal: N Engl J Med Date: 2012-03-29 Impact factor: 91.245
Authors: Cathy Steel; Allison Golden; Joseph Kubofcik; Nicole LaRue; Tala de Los Santos; Gonzalo J Domingo; Thomas B Nutman Journal: Clin Vaccine Immunol Date: 2013-06-05
Authors: Gary J Weil; Kurt C Curtis; Lawrence Fakoli; Kerstin Fischer; Lincoln Gankpala; Patrick J Lammie; Andrew C Majewski; Sonia Pelletreau; Kimberly Y Won; Fatorma K Bolay; Peter U Fischer Journal: Am J Trop Med Hyg Date: 2013-05-20 Impact factor: 2.345
Authors: Samuel Wanji; Jonas A Kengne-Ouafo; Fabrice R Datchoua-Poutcheu; Abdel Jelil Njouendou; Dizzel Bita Tayong; David D Sofeu-Feugaing; Nathalie Amvongo-Adjia; Bridget A Fovennso; Yolande F Longang-Tchounkeu; Fasil Tekola-Ayele; Peter A Enyong; Melanie J Newport; Gail Davey Journal: BMC Public Health Date: 2016-09-20 Impact factor: 3.295
Authors: Louise A Kelly-Hope; Mohammad Jahirul Karim; Asm Sultan Mahmood; Abdullah Al Kawsar; Abul Khair; Hannah Betts; Janet Douglass; Armelle Forrer; Mark J Taylor Journal: J Clin Med Date: 2021-05-25 Impact factor: 4.241