An estimated 7,000 people in Rwanda are affected by podoconiosis, a non-infectious form of elephantiasis caused by long-term contact with irritant red clay soil of volcanic origins, according to the World Health Organisation (WHO).
The neglected tropical disease is responsible for an estimated four million cases of leg swelling (lymphedema) in highland tropical and sub-tropical areas of 17 countries in Africa, Central and South America, and South and South-East Asia.
WHO noted that out of the 17 countries in which there is evidence of Podoconiosis, 12 are in Africa, three are in Latin America, and two are in Asia.
“Tropical African countries bear the highest disease burden with about 1.5 million people living with podoconiosis in Ethiopia, a further 40,000 in Cameroon, 9,000 in Kenya, and 7,000 in Rwanda,” WHO’s report read.
The disease mostly affects poor, remote, subsistence farming communities.
It causes avoidable disability through swollen, deformed feet and lower legs and painful acute attacks that render patients bedbound for 3-5 days each episode.
Podoconiosis is both preventable and treatable. “Prevention is through avoiding contact with irritant soil by wearing footwear, covering house floors, and paving roads,” the WHO said.
“Treatment using a holistic lymphedema management package has been demonstrated to decrease swelling, disability, and incidence of acute attacks, improve quality of life, and can be readily mainstreamed into government community health services,” it added.
According to the WHO, the average age at first noticing leg swelling is 25 years, and the disease is common up to the sixth decade.
The disease is more common in women; a recent meta-analysis concluded that the likelihood of Podoconiosis among women was 1.15 times greater than among men.
Early symptoms of the disease include a burning sensation and itching on the back of the feet. Skin thickening is accompanied by some growths around the sides of the feet and the heel.
“Reversible foot and lower leg oedema (swelling) later becomes fixed and gradually progresses up the leg. Swelling is bilateral but often asymmetrical and the swelling is mostly limited to below the knees. Nodules and maceration between toes are common,” the WHO says.
Treatment and care
Treatment of Podoconiosis is currently based on lymphedema management (foot hygiene, compression, exercises, and elevation), psychosocial and mental health support, and the use of shoes to reduce exposure to irritant soil, according to the WHO.
Surgical removal of large nodules can be achieved with satisfactory healing rates, allowing patients to use custom-designed shoes. The effectiveness and cost-effectiveness of a holistic physical and mental health care package for people with lymphedema caused by lymphatic filariasis, leprosy, or podoconiosis (mainstreamed into routine primary health care services in Ethiopia) have been demonstrated.
“Expert patients (patients who have been trained to successfully manage their condition and assist others in doing so) can be trained to guide treatment for uncomplicated lymphedema,” the WHO notes.
The main challenge faced in podoconiosis control, according to the WHO, is a lack of awareness that the condition exists and that it is different from lymphatic filariasis and other main causes of lymphedema in the tropics, requiring different prevention and control strategies.
Treatment is most effective when the disease is diagnosed early. Podoconiosis takes longer to identify than it should through lack of diagnostic tools that can be used in the community,” the WHO’s statement reads.