Study of lymphoedema of non-filarial origin in the northwest region of Cameroon: spatial distribution, profiling of cases and socio-economic aspects of podoconiosis

Wanji, Samuel; Kengne-Ouafo, Jonas A.; Deribe, Kebede; Tembei, Ayok M.; Njouendou, Abdel Jélil; Tayong, Dizzel Bita; Sofeu-Feugaing, David Denis; Datchoua-Poutcheu, Fabrice R.; Cano, Jorge; Giorgi, Emanuele; Longang-Tchounkeu, Yolande F.; Enyong, Peter; Newport, Melanie J.; Davey, Gail

doi:10.1093/inthealth/ihy028

Cited by 7 publications

(8 citation statements)

References 27 publications

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“…51 In a survey conducted in the North West region, only a handful of interviewees reported wearing shoes during farm-related activities such as planting, harvesting and working on a rice farm. 22 This is likely to have contributed to the continued presence of the disease in environmentally suitable areas. The lack of attention by national agencies and international partners, and difficulties in ensuring access to preventive methods, such as shoes, 52 are listed among the major challenges for podoconiosis elimination.…”

Section: Discussionmentioning

confidence: 99%

“…The sampling design and findings of this survey are detailed in a separate publication. 22 Briefly, at least 50% of the communities from all the health areas in each of the 19 health districts of the region were screened for lymphoedema of the lower limbs. Preliminary community screening was carried out by trained community health implementers, and final confirmation of podoconiosis was done by expert research assistants and health personnel following a standardised clinical diagnosis algorithm.…”

Section: Methodsmentioning

confidence: 99%

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Predicted distribution and burden of podoconiosis in Cameroon

et al. 2018

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IntroductionUnderstanding the number of cases of podoconiosis, its geographical distribution and the population at risk are crucial to estimating the burden of this disease in endemic countries. We assessed each of these using nationwide data on podoconiosis prevalence in Cameroon.MethodsWe analysed data arising from two cross-sectional surveys in Cameroon. The dataset was combined with a suite of environmental and climate data and analysed within a robust statistical framework, which included machine learning-based approaches and geostatistical modelling. The environmental limits, spatial variation of predicted prevalence, population at risk and number of cases of podoconiosis were each estimated.ResultsA total of 214 729 records of individuals screened for podoconiosis were gathered from 748 communities in all 10 regions of Cameroon. Of these screened individuals, 882 (0.41%; 95% CI 0.38 to 0.44) were living with podoconiosis. High environmental suitability for podoconiosis was predicted in three regions of Cameroon (Adamawa, North West and North). The national population living in areas environmentally suitable for podoconiosis was estimated at 5.2 (95% CI 4.7 to 5.8) million, which corresponds to 22.3% of Cameroon’s population in 2015. Countrywide, in 2015, the number of adults estimated to be suffering from podoconiosis was 41 556 (95% CI, 1170 to 240 993). Four regions (Central, Littoral, North and North West) contributed 61.2% of the cases.ConclusionIn Cameroon, podoconiosis is more widely distributed geographically than was initially expected. The number of cases and the population at risk are considerable. Expanding morbidity management and follow-up of cases is of utmost necessity. Promotion of footwear use and regular foot hygiene should be at the forefront of any intervention plan.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Predicted distribution and burden of podoconiosis in Cameroon

et al. 2018

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“…A few studies report low prevalence of microfilaremia, not exceeding 1% [6, 7]. The presence of clinical disease, especially lymphedema, is considered to be a poor indicator for LF in Cameroon, because podoconiosis associated lymphedema is common in some areas [8–10]. In Africa, LF is exclusively caused be the filarial parasite Wuchereria bancrofti and detection of circulating W .…”

Section: Introductionmentioning

confidence: 99%

Mapping of lymphatic filariasis in loiasis areas: A new strategy shows no evidence for Wuchereria bancrofti endemicity in Cameroon

et al. 2019

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Background Mapping of lymphatic filariasis (LF) caused by Wuchereria bancrofti largely relies on the detection of circulating antigen using ICT cards. Several studies have recently shown that this test can be cross-reactive with sera of subjects heavily infected with Loa loa and thus mapping results in loiasis endemic areas may be inaccurate. Methodology/Principal findings In order to develop an LF mapping strategy for areas with high loiasis prevalence, we collected day blood samples from 5,001 subjects residing in 50 villages that make up 6 health districts throughout Cameroon. Antigen testing using Filarial Test Strip (FTS, a novel platform that uses the same reagents as ICT) revealed an overall positivity rate of 1.1% and L . loa microfilaria (Mf) rates of up to 46%. Among the subjects with 0 to 8,000 Mf/ml in day blood, only 0.4% were FTS positive, while 22.2% of subjects with >8,000 Mf/ml were FTS positive. A Mf density of >8,200 Mf/ml was determined as the cut point at which positive FTS results should be excluded from the analysis. No FTS positive samples were also positive for W . bancrofti antibodies as measured by two different point of care tests that use the Wb123 antigen not found in L . loa . Night blood examination of the FTS positive subjects showed a high prevalence of L . loa Mf with densities up to 12,710 Mf/ml. No W . bancrofti Mf were identified, as confirmed by qPCR. Our results show that high loads of L . loa Mf in day blood are a reliable indicator of FTS positivity, and Wb123 rapid test proved to be relatively specific. Conclusions/Significance Our study provides a simple day blood-based algorithm for LF mapping in loiasis areas. The results indicate that many districts that were formerly classified as endemic for LF in Cameroon are non-endemic and do not require mass drug administration for elimination of LF.

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“…In this study, we focused on determining the presence or absence of podoconiosis at the country level. From previous work, the distribution of podoconiosis within a country has proven to be heterogeneous and we recognize the need for detailed (finer spatial resolution) information for in-country planning and intervention[51, 52]. Ongoing work with endemic countries such as India and Burundi is aimed at providing subnational administrative unit prevalence levels that are relevant to decision making for podoconiosis.…”

Section: Discussionmentioning

confidence: 99%

Mapping the global distribution of podoconiosis: Applying an evidence consensus approach

et al. 2019

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BackgroundPodoconiosis is a type of elephantiasis characterised by swelling of the lower legs. It is often confused with other causes of tropical lymphedema and its global distribution is uncertain. Here we synthesise the available information on the presence of podoconiosis to produce evidence consensus maps of its global geographical distribution.Methods and findingsWe systematically searched available data on podoconiosis in SCOPUS and MEDLINE from inception, updated to 10 May, 2019, and identified observational and population-based studies reporting podoconiosis. To establish existence of podoconiosis, we used the number of cases reported in studies and prevalence data with geographical locations. We then developed an index to assess evidence quality and reliability, assigning each country an evidence consensus score. Using these summary scores, we then developed a contemporary global map of national-level podoconiosis status.There is evidence of podoconiosis in 17 countries (12 in Africa, three in Latin America, and two in Asia) and consensus on presence in six countries (all in Africa). We have identified countries where surveillance is required to further define the presence or absence of podoconiosis. We have highlighted areas where evidence is currently insufficient or conflicting, and from which more evidence is needed.ConclusionThe global distribution of podoconiosis is not clearly known; the disease extent and limits provided here inform the best contemporary map of the distribution of podoconiosis globally from available data. These results help identify surveillance needs, direct future mapping activities, and inform prevention plans and burden estimation of podoconiosis.

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Study of lymphoedema of non-filarial origin in the northwest region of Cameroon: spatial distribution, profiling of cases and socio-economic aspects of podoconiosis

Abstract: This study provides an insight into the geographical distribution and epidemiology of podoconiosis in the North West region of Cameroon, yet management is limited. Evidence-informed targeted interventions are needed to manage people with lymphoedema.

Cited by 7 publications

References 27 publications

Predicted distribution and burden of podoconiosis in Cameroon

Predicted distribution and burden of podoconiosis in Cameroon

Mapping of lymphatic filariasis in loiasis areas: A new strategy shows no evidence for Wuchereria bancrofti endemicity in Cameroon

Mapping the global distribution of podoconiosis: Applying an evidence consensus approach

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