Deribe, Kebede; Mbituyumuremyi, Aimable; Cano, Jorge; Jean Bosco, Mbonigaba; Giorgi, Emanuele; Ruberanziza, Eugene; Bayisenge, Ursin; Leonard, Uwayezu; Bikorimana, Jean Paul; Rucogoza, Aniceth; +12 more... Turate, Innocent; Rusanganwa, Andre; Pigott, David M; Pullan, Rachel L; Noor, Abdisalan M; Enquselassie, Fikre; Condo, Jeanine U; Murray, Christopher JL; Brooker, Simon J; Hay, Simon I; Newport, Melanie J; Davey, Gail; (2019) Geographical distribution and prevalence of podoconiosis in Rwanda: a cross-sectional country-wide survey. LANCET GLOBAL HEALTH, 7 (5). e671-e680. DOI: https://doi.org/10.1016/S2214-109X(19)30072-5
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Abstract
BACKGROUND: Podoconiosis is a type of tropical lymphoedema that causes massive swelling of the lower limbs. The disease is associated with both economic insecurity, due to long-term morbidity-related loss of productivity, and intense social stigma. Reliable and detailed data on the prevalence and distribution of podoconiosis are scarce. We aimed to fill this data gap by doing a nationwide community-based study to estimate the number of cases throughout Rwanda. METHODS: We did a population-based cross-sectional survey to determine the national prevalence of podoconiosis. A podoconiosis case was defined as a person with bilateral, asymmetrical lymphoedema of the lower limb present for more than 1 year, who tested negative for Wuchereria bancrofti antigen (determined by Filariasis Test Strip) and specific IgG4 (determined by Wb123 test), and had a history of any of the associated clinical signs and symptoms. All adults (aged ≥15 years) who resided in any of the 30 districts of Rwanda for 10 or more years were invited at the household level to participate. Participants were interviewed and given a physical examination before Filariasis Test Strip and Wb123 testing. We fitted a binomial mixed model combining the site-level podoconiosis prevalence with continuous environmental covariates to estimate prevalence at unsampled locations. We report estimates of cases by district combining our mean predicted prevalence and a contemporary gridded map of estimated population density. FINDINGS: Between June 12, and July 28, 2017, 1 360 612 individuals-719 730 (53%) women and 640 882 (47%) men-were screened from 80 clusters in 30 districts across Rwanda. 1143 individuals with lymphoedema were identified, of whom 914 (80%) had confirmed podoconiosis, based on the standardised diagnostic algorithm. The overall prevalence of podoconiosis was 68·5 per 100 000 people (95% CI 41·0-109·7). Podoconiosis was found to be widespread in Rwanda. District-level prevalence ranged from 28·3 per 100 000 people (16·8-45·5, Nyarugenge, Kigali province) to 119·2 per 100 000 people (59·9-216·2, Nyamasheke, West province). Prevalence was highest in districts in the North and West provinces: Nyamasheke, Rusizi, Musanze, Nyabihu, Nyaruguru, Burera, and Rubavu. We estimate that 6429 (95% CI 3938-10 088) people live with podoconiosis across Rwanda. INTERPRETATION: Despite relatively low prevalence, podoconiosis is widely distributed geographically throughout Rwanda. Many patients are likely to be undiagnosed and morbidity management is scarce. Targeted interventions through a well coordinated health system response are needed to manage those affected. Our findings should inform national level planning, monitoring, and implementation of interventions. FUNDING: Wellcome Trust.
Item Type | Article |
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Faculty and Department | Faculty of Infectious and Tropical Diseases > Dept of Disease Control |
PubMed ID | 30926303 |
Elements ID | 127295 |