What is Podoconiosis 1 Noninfectious elephantiasis swelling of

What is Podoconiosis? - 1 • Non-infectious elephantiasis (“swelling of limb like an elephant’s”) caused by long term exposure of bare feet to irritant soil. SIS PODOCONIO The most neglected tropical disease?

What is podoconiosis? (1) Non-filarial elephantiasis • Non-infectious • Caused by long term exposure of bare feet to irritant soil The most neglected tropical disease?

What is podoconiosis? (2) ‘Gene + soil exposure = disease’ Susceptible people who go barefoot have high risk

Differential diagnosis Filarial lymphedema • Asymmetrical • Also upperleg (and elsewhere) • Lowland

Why is it important in Ethiopia? At least one million people affected in Ethiopia 5% prevalence in areas of irritant soil & subsistence farming Profound social stigma

Countries where podoconiosis is endemic or has been described. Deribe K, Tomczyk S, Tekola-Ayele F (2013) Ten Years of Podoconiosis Research in Ethiopia. PLo. S Negl Trop Dis 7(10): e 2301. doi: 10. 1371/journal. pntd. 0002301 http: //www. plosntd. org/article/info: doi/10. 1371/journal. pntd. 0002301

Podoconiosis: an issue across tropical Africa Other countries known to be affected: • • • Uganda Kenya Tanzania Rwanda Congo (east) Cameroon (north-west)

What can be done about podoconiosis? Podoconiosis is • Preventable (if shoes are worn consistently) • Treatable (using good foot hygiene, bandages, socks and shoes) People with podoconiosis can return to a full role in society.

Prevention To PREVENT podoconiosis • education through schools, kebeles, churches, mosques, events • from young childhood: shoes

What is Podoconiosis? - 1 Non-infectious elephantiasis (“swelling of limb like an elephant’s”) caused by long term exposure of bare feet to irritant soil. The most neglected tropical disease?

Treatment To TREAT people with podoconiosis • foot hygiene, soap, antiseptic, ointment, pressure bandages, socks and shoes • different clinics different programs

Foot Hygiene Wash feet with soap and soak in clean, cool water with antiseptic berekina (bleach), aceto, eucalyptus, neem, gentianviolet, salt which is the best antiseptic/antifungal ? ? ?

Skin care Keep skin soft and flexible: Rub small piece of Whitfield ointment or local oil into skin of lower legs after washing and drying. Oil may be clean cooking oil with eucalyptus extract.

Medische behandeling • Antibiotica: alleen bij erysipelas • Chirurgie: alleen evt. nodulectomie (dun-gesteelde noduli : afbinden)

Elevation & Movement • Ankle circles & calf raises to improve lymphatic circulation • Raise end of bed with a brick • Elevate leg on small stool when sitting

Zwachtels/kousen Doel: in sokken/schoenen passen Patientenselectie: • schoon, moeten schoenen (kunnen) dragen • moeten het zelf kunnen/willen doen • wegdrukbaar oedeem? Instructie: • • startmeting, maandelijks vervolgen moet strak voelen, geen pijn voor de nacht af, voor de dag om bij problemen (pijn) onmiddellijk af en retour kliniek

Zwachtels? Ethiopische zwachtels (firma Asmi): • te veel stretch, maar toch wel resultaat • duur: € 3, 32 per 4 (1 persoon) • nog niet in Nekemte? Nederlandse zwachtels: • nadeel: persoonlijke import, te weinig • voordeel: “gratis” • juxta fit/lite: makkelijk? ?

Simple Treatment is Effective Before After

Summary • Podoconiosis is NOT INFECTIOUS – no virus, bacterium or parasite is responsible • Podoconiosis is PREVENTABLE – by avoiding contact with irritant soil, primarily by wearing shoes • Podoconiosis is TREATABLE – using simple measures, for which patients can take responsibility

Simple Treatment is Effective Before After