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Research
Predicted distribution and burden of podoconiosis in Cameroon
  1. Kebede Deribe1,2,
  2. Jorge Cano3,
  3. Abdel Jelil Njouendou4,5,
  4. Mathias Esum Eyong4,5,
  5. Amuam Andrew Beng4,5,
  6. Emanuele Giorgi3,6,
  7. David M Pigott7,
  8. Rachel L Pullan3,
  9. Abdisalan M Noor8,9,
  10. Fikre Enquselassie2,
  11. Christopher J L Murray7,
  12. Simon I Hay7,10,
  13. Melanie J Newport1,
  14. Gail Davey1,
  15. Samuel Wanji4,5
  1. 1 Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
  2. 2 School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
  3. 3 Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
  4. 4 Parasites and Vector Biology Research Unit (PAVBRU), Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
  5. 5 Research Foundation for Tropical Diseases and the Environment (REFOTDE), Buea, Cameroon
  6. 6 Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
  7. 7 Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
  8. 8 Kenya Medical Research Institute–Wellcome Trust Collaborative Programme, Nairobi, Kenya
  9. 9 Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
  10. 10 Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
  1. Correspondence to Dr Kebede Deribe; kebededeka{at}yahoo.com

Abstract

Introduction Understanding 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.

Methods We 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.

Results A 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.

Conclusion In 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.

  • podoconiosis
  • non-filarial
  • elephantiasis
  • lymphedema
  • cameroon
  • mapping

This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjgh-2018-000730

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors Conceived and designed the experiments: KD, MJN, SIH, GD and SW. Performed the experiments: KD, AJN, MEE, AAB and SW. Analysed the data: KD, JC, EG. Contributed reagents/materials/analysis tools: KD, JC, EG, FE and DMP. Wrote the first draft of the manuscript: KD. Contributed to the writing of the manuscript: JC, EG, GD, MJN, SIH, JC, AJN, MEE, AAB, DMP, RLP, AMN, FE, CJLM and SW. Agree with the manuscript’s results and conclusions: KD, JC, AJN, MEE, AAB, EG, DMP, RLP, AMN, FE, CJLM, SIH, MJN, GD and SW. All authors have read and confirmed that they meet the ICMJE criteria for authorship.

    • Funding This work was primarily supported by a grant from the Wellcome Trust (grant no. 201900) to KD as part of his Intermediate Fellowship in Public Health and Tropical Medicine. SIH is funded by grants from the Bill & Melinda Gates Foundation (OPP1106023, OPP1093011, OPP1132415, OPP1159934 and OPP1176062), Wellcome Trust (grant no. 209142) and Fleming Fund.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The protocol used for this study received ethical approval from the Cameroon National Ethics Committee (CNEC) and Brighton and Sussex Medical School Research Governance and Ethics Committee (RGEC).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.