DOCSLIB.ORG

Defining and Managing Acute Lymphangioadenitis in Podoconiosis Lymphoedema in Northern Ethiopia

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Defining and Managing Acute Lymphangioadenitis in Podoconiosis Lymphoedema in Northern Ethiopia DEFINING AND MANAGING ACUTE LYMPHANGIOADENITIS IN PODOCONIOSIS LYMPHOEDEMA IN NORTHERN ETHIOPIA HENOK NEGUSSIE SEIFU PhD 2017 1 DEFINING AND MANAGING ACUTE LYMPHANGIOADENITIS IN PODOCONIOSIS LYMPHOEDEMA IN NORTHERN ETHIOPIA HENOK NEGUSSIE SEIFU A thesis submitted in partial fulfillment of the requirements of the University of Brighton and the University of Sussex for a programme of study undertaken at Brighton and Sussex Medical School for the degree of Doctor of Philosophy JULY, 2017 2 This thesis was supervised by Prof Gail Davey, Professor of Global Health Epidemiology, Brighton and Sussex Medical Scholl, UK Prof. Melanie Newport, Professor of Global Health and Infection, Brighton and Sussex Medical Scholl, UK Prof Fikre Enquselassie, Professor of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Addis Ababa, University 3 Abstract Podoconiosis (endemic non-filarial elephantiasis) is a non-infectious disease arising in barefoot individuals in long-term contact with irritant red clay soil of volcanic origin. The condition is believed to be caused by the interplay between environmental factors and genetic susceptibility over a prolonged period of time. In the last decade significant progress had been made in research on podoconiosis. Acute dermatolymphangioadenitis (ADLA) is a common and disabling complication of podoconiosis lymphoedema and remain the most painful and distressing condition, with diverse health, social and economic ramifications, yet has been very little investigated to date. This PhD thesis is therefore, aimed at defining ADLA, validating this to measure the impact of ADLA, and to document the impact of a simple foot hygiene intervention on ADLA and quality of life among podoconiosis patients. The study utilized several steps. A Rapid Ethical Assessment (REA) was conducted at the outset to understand how best to approach the community for consent and develop context-relevant information sheet and consent format. A case definition of ADLA was adapted from that used for Lymphatic Filariasis (LF) based on discussion with podoconiosis experts and trial methodologists. This was followed by developing and testing a simple, patient-held ADLA diary. Acceptability, feasibility and accuracy of completion were checked. Subsequently, the incidence, duration and social impact of ADLA were measured. A total of 1339 patients were recruited, screened and mapped from 18 kebeles (smallest administrative unit) from Aneded woreda (district) in East Gojjam Zone, Amhara Regional State, from December 2014 to June 2015. Using randomized controlled design 321 and 329 patients were randomized to immediate and delayed treatment groups, respectively, were followed for a period of 12 months, from 2015-2016. Comparison of a simple foot hygiene intervention on ADLA and quality of life were made. Finally, a process assessment using qualitative techniques, Focus Group Discussions (FGDs) and In-depth Interviews (IDIs) were conducted to explore stakeholders’ perceptions of the treatment and its key elements for feasibility and impact. 4 The REA guided the development of information sheet and consent forms. The diary was found to be acceptable and feasible to be completed by patients and was used in the main study. Almost all patients (immediate 341 (98%), delayed 341 (99%)) had ever experienced ADLA. The median (Inter quartile range) experiences of ADLA in the past 30 days at baseline were 2 (IQR 2-3) and 3 (IQR 2-3) with an average duration (in days) of 3 (IQR, 3-5) in the intervention and control groups, respectively. No significant difference was found on the Incidence Rate Ratio (IRR) of number of ADLA in the past 30 days and sex (IRR=1.00, p=0.983, 95%CI=-0.90, 1.10), school attendance (IRR=0.96, p=0.53, 95%CI=-0.85, 1.08) at baseline. However, the number of ADLA episodes in the past 30 days were 13% higher among those aged 50 and over (IRR=-1.13, p=0.01, 95%CI=1.05, 1.25). Similarly, those with disease stage 3 and above had 39% and 37% higher rate of ADLA compared to those with stage 2 (p=0.02) and (p=0.03), for the left and right feet, respectively. Absence of inter-digital lesions was associated with significantly fewer episodes at baseline (p=0.04). Similarly, presence of wounds in both feet was associated with a higher rate of ADLA (p=0.001). Further, patients who washed their feet more than seven times per week had reduced number of episodes in the previous 30 days (p=0.002). On the other hand, severity of the most recent episode, absence of swollen lymph nodes and wounds on the feet were associated with longer duration of symptoms of ADLA (p=0.001). Poisson regression of Dermatology Quality Life Index (DLQI) scores with feet washing practices and intensity of the most recent ADLA indicated that the more severely the most recent ADLA was rated by patients, the higher the DLQI scores were compared to than those reporting mild attacks (Log OR=0.13, p=0.001, 95% CI=0.05, 0.21). Those who washed more than once scored significantly lower compared to patients who washed their feet once per day (Logs OR=-0.25, SE=0.04, p=0.001, 95%CI=0.30, -0.20). There were a total of 16,550 episodes of ADLA reported in the twelve months of observation, within 765.2 person years. The intervention group recorded 7,515 and delayed group 9,035 episodes within 387.1and 378.1 person years; incidence rates of 19.4 (95% CI 18.9, 19.9) and 23.9 (95% CI 23.4-24.4) episodes per person years respectively 5 (IRR) 0.81 (95% CI 0.69, 0.96, p<0.001). At 12 months follow up, patients who received the foot care and hygiene intervention had 1614 episodes and the delayed treatment group, 1935 episodes providing incidence rates of 18.5 (95% CI 17.6, 19.4) and 24.5 (95% CI 23.4, 25.6) for the two groups respectively (IRR= 0.76, 95% CI 0.62, 0.93) (p<0.001). Similarly, the total annual duration of symptoms of ADLA for the treatment group (95% CI) was 79 days (95% CI 78, 80), significantly lower than that of the control group at 107 days (95% CI 106, 108) (P<0.001). At 12 months, there was a significant difference in percentages of presence of mossy lesions in both legs between the two groups in favour of the immediate treatment group (32%) and (42%) control group (p= 0.008). Similarly, at twelve months follow up, DLQI scores were 11 (5-16) and 14 (11-19) for the treatment and control groups, a decrease by 10 and 7 points, respectively (p<0.001). Finally, the process assessment which explored patients’ perceptions of the intervention and its components showed that the foot care and hygiene intervention was acceptable to patients their families and service providers, simple and easy to conduct at home and thought to bring about health, social and economic improvements in patients’ lives. The thesis had clarified the clinical expression of ADLA in podoconiosis lymphoedema as well as documented the incidence, duration and social impact of ADLA. Based on a practical approach to the preparation and conduct of a RCT, it has made a significant scientific and policy contribution to scale up treatment as a disease recognition and management tool in settings where both LF and podoconiosis lymphoedema exist. The REA proved to be handy and practical in identifying approaches to communities with little experience in research such as in rural Gojjam in the context of preparing and launching a RCT among podoconiosis patients. The local term “michader” used to describe the symptoms of ADLA was understandable to patients in rural Gojjam. It would seem practical to be put to use in future intervention programs, for example, as a tool to monitor improvement in the incidence and duration of ADLA once treatment had been initiated. 6 The fact that absence of inter-digital lesions and wounds were associated with lower numbers of ADLA episodes in the past 30 days at baseline and that the foot care and hygiene intervention had significantly lowered the incidence and duration ADLA as well as DLQI scores compared to the controls (p<0.001), indicated the effectiveness of the hygiene intervention among podoconiosis patients. It also suggests the importance of educating patients in order to prevent, identify and promptly treat wounds and inter-digital lesions in the feet in order prevent recurrent episodes of ADLA. Accordingly, NGOs providing podoconiosis prevention and treatment services should be encouraged to adopt the treatment package as a safe, affordable and uniform package. However, from the process assessment it also appears that patients prefer treatment near where they live. Health Centres (HCs) seem to be far from remote villages and difficult to walk particularly for the elderly and visually impaired. On the other hand, consideration that the Health Extension Workers (HEWs) are already overburdened with many packages appears to make the Health Post (HP) as a less preferable option. Thus, the full spectrum of the feasibility of these options vis-à-vis other formats of integration need to be assessed carefully for several reasons including compliance with treatment. Future treatment provision in other contexts should give due attention to availability of and unrestricted access to water, local availability and affordability of treatment products and the all too important gender differences in designing footwear as participants of the study indicated. 7 Table of Contents Abstract .................................................................................................................................................... 4 List of Figures ......................................................................................................................................
Load more

Recommended publications
  • Districts of Ethiopia
    Region District or Woredas Zone Remarks Afar Region Argobba Special Woreda -- Independent district/woredas Afar Region Afambo Zone 1 (Awsi Rasu) Afar Region Asayita Zone 1 (Awsi Rasu) Afar Region Chifra Zone 1 (Awsi Rasu) Afar Region Dubti Zone 1 (Awsi Rasu) Afar Region Elidar Zone 1 (Awsi Rasu) Afar Region Kori Zone 1 (Awsi Rasu) Afar Region Mille Zone 1 (Awsi Rasu) Afar Region Abala Zone 2 (Kilbet Rasu) Afar Region Afdera Zone 2 (Kilbet Rasu) Afar Region Berhale Zone 2 (Kilbet Rasu) Afar Region Dallol Zone 2 (Kilbet Rasu) Afar Region Erebti Zone 2 (Kilbet Rasu) Afar Region Koneba Zone 2 (Kilbet Rasu) Afar Region Megale Zone 2 (Kilbet Rasu) Afar Region Amibara Zone 3 (Gabi Rasu) Afar Region Awash Fentale Zone 3 (Gabi Rasu) Afar Region Bure Mudaytu Zone 3 (Gabi Rasu) Afar Region Dulecha Zone 3 (Gabi Rasu) Afar Region Gewane Zone 3 (Gabi Rasu) Afar Region Aura Zone 4 (Fantena Rasu) Afar Region Ewa Zone 4 (Fantena Rasu) Afar Region Gulina Zone 4 (Fantena Rasu) Afar Region Teru Zone 4 (Fantena Rasu) Afar Region Yalo Zone 4 (Fantena Rasu) Afar Region Dalifage (formerly known as Artuma) Zone 5 (Hari Rasu) Afar Region Dewe Zone 5 (Hari Rasu) Afar Region Hadele Ele (formerly known as Fursi) Zone 5 (Hari Rasu) Afar Region Simurobi Gele'alo Zone 5 (Hari Rasu) Afar Region Telalak Zone 5 (Hari Rasu) Amhara Region Achefer -- Defunct district/woredas Amhara Region Angolalla Terana Asagirt -- Defunct district/woredas Amhara Region Artuma Fursina Jile -- Defunct district/woredas Amhara Region Banja -- Defunct district/woredas Amhara Region Belessa --
    [Show full text]
  • Midterm Survey Protocol
    Protocol for L10K Midterm Survey The Last 10 Kilometers Project JSI Research & Training Institute, Inc. Addis Ababa, Ethiopia October 2010 Contents Introduction ........................................................................................................................................................ 2 The Last Ten Kilometers Project ............................................................................................................ 3 Objective one activities cover all the L10K woredas: .......................................................................... 4 Activities for objectives two, three and four in selected woredas ...................................................... 5 The purpose of the midterm survey ....................................................................................................... 6 The midterm survey design ...................................................................................................................... 7 Annex 1: List of L10K woredas by region, implementation strategy, and implementing phase ......... 10 Annex 2: Maps.................................................................................................................................................. 11 Annex 3: Research questions with their corresponding study design ...................................................... 14 Annex 4: Baseline survey methodology ........................................................................................................ 15 Annex 5: L10K midterm survey
    [Show full text]
  • AMHARA REGION : Who Does What Where (3W) (As of 13 February 2013)
    AMHARA REGION : Who Does What Where (3W) (as of 13 February 2013) Tigray Tigray Interventions/Projects at Woreda Level Afar Amhara ERCS: Lay Gayint: Beneshangul Gumu / Dire Dawa Plan Int.: Addis Ababa Hareri Save the fk Save the Save the df d/k/ CARE:f k Save the Children:f Gambela Save the Oromia Children: Children:f Children: Somali FHI: Welthungerhilfe: SNNPR j j Children:l lf/k / Oxfam GB:af ACF: ACF: Save the Save the af/k af/k Save the df Save the Save the Tach Gayint: Children:f Children: Children:fj Children:l Children: l FHI:l/k MSF Holand:f/ ! kj CARE: k Save the Children:f ! FHI:lf/k Oxfam GB: a Tselemt Save the Childrenf: j Addi Dessie Zuria: WVE: Arekay dlfk Tsegede ! Beyeda Concern:î l/ Mirab ! Concern:/ Welthungerhilfe:k Save the Children: Armacho f/k Debark Save the Children:fj Kelela: Welthungerhilfe: ! / Tach Abergele CRS: ak Save the Children:fj ! Armacho ! FHI: Save the l/k Save thef Dabat Janamora Legambo: Children:dfkj Children: ! Plan Int.:d/ j WVE: Concern: GOAL: Save the Children: dlfk Sahla k/ a / f ! ! Save the ! Lay Metema North Ziquala Children:fkj Armacho Wegera ACF: Save the Children: Tenta: ! k f Gonder ! Wag WVE: Plan Int.: / Concern: Save the dlfk Himra d k/ a WVE: ! Children: f Sekota GOAL: dlf Save the Children: Concern: Save the / ! Save: f/k Chilga ! a/ j East Children:f West ! Belesa FHI:l Save the Children:/ /k ! Gonder Belesa Dehana ! CRS: Welthungerhilfe:/ Dembia Zuria ! î Save thedf Gaz GOAL: Children: Quara ! / j CARE: WVE: Gibla ! l ! Save the Children: Welthungerhilfe: k d k/ Takusa dlfj k
    [Show full text]
  • Integrated Morbidity Management For
    Lessons from the field Integrated morbidity management for lymphatic filariasis and podoconiosis, Ethiopia Kebede Deribe,a Biruck Kebede,b Mossie Tamiru,b Belete Mengistu,c Fikreab Kebede,c Sarah Martindale,d Heven Sime,e Abate Mulugeta,f Biruk Kebede,c Mesfin Sileshi,b Asrat Mengiste,g Scott McPhersonc & Amha Fentayeb Problem Lymphatic filariasis and podoconiosis are the major causes of tropical lymphoedema in Ethiopia. The diseases require a similar provision of care, but until recently the Ethiopian health system did not integrate the morbidity management. Approach To establish health-care services for integrated lymphoedema morbidity management, the health ministry and partners used existing governmental structures. Integrated disease mapping was done in 659 out of the 817 districts, to identify endemic districts. To inform resource allocation, trained health extension workers carried out integrated disease burden assessments in 56 districts with a high clinical burden. To ensure standard provision of care, the health ministry developed an integrated lymphatic filariasis and podoconiosis morbidity management guideline, containing a treatment algorithm and a defined package of care. Experienced professionals on lymphoedema management trained government-employed health workers on integrated morbidity management. To monitor the integration, an indicator on the number of lymphoedema-treated patients was included in the national health management information system. Local setting In 2014, only 24% (87) of the 363 health facilities surveyed provided lymphatic filariasis services, while 12% (44) provided podoconiosis services. Relevant changes To date, 542 health workers from 53 health centres in 24 districts have been trained on integrated morbidity management. Between July 2013 and June 2016, the national health management information system has recorded 46 487 treated patients from 189 districts.
    [Show full text]
  • Podoconiosis in Ethiopia: from Neglect to Priority Public Health Problem
    Podoconiosis in Ethiopia: from neglect to priority public health problem Article (Accepted Version) Deribe, Kebede, Kebede, Biruck, Mengistu, Belete, Negussie, Henok, Sileshi, Mesfin, Tamiru, Mossie, Tomezyk, Sara, Tekola-Ayele, Fasil, Davey, Gail and Fentaye, Amha (2017) Podoconiosis in Ethiopia: from neglect to priority public health problem. Ethiopian Medical Journal, 55. pp. 65-74. ISSN 0014-1755 This version is available from Sussex Research Online: http://sro.sussex.ac.uk/id/eprint/70009/ This document is made available in accordance with publisher policies and may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher’s version. Please see the URL above for details on accessing the published version. Copyright and reuse: Sussex Research Online is a digital repository of the research output of the University. Copyright and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable, the material made available in SRO has been checked for eligibility before being made available. Copies of full text items generally can be reproduced, displayed or performed and given to third parties in any format or medium for personal research or study, educational, or not-for-profit purposes without prior permission or charge, provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. http://sro.sussex.ac.uk Podoconiosis in Ethiopia: From neglect to priority public health problem KebedeDeribe1,2,3,4, Biruck Kebede1, Belete Mengistu1, Henok Negussie2, Biruk Kebede4,Mesfin Sileshi1,4 , Mossie Tamiru1, Sara Tomczyk5, Fasil Tekola-Ayele6, Gail Davey2, Amha Fentaye1 1.
    [Show full text]
  • English-Full (0.5
    Enhancing the Role of Forestry in Building Climate Resilient Green Economy in Ethiopia Strategy for scaling up effective forest management practices in Amhara National Regional State with particular emphasis on smallholder plantations Wubalem Tadesse Alemu Gezahegne Teshome Tesema Bitew Shibabaw Berihun Tefera Habtemariam Kassa Center for International Forestry Research Ethiopia Office Addis Ababa October 2015 Copyright © Center for International Forestry Research, 2015 Cover photo by authors FOREWORD This regional strategy document for scaling up effective forest management practices in Amhara National Regional State, with particular emphasis on smallholder plantations, was produced as one of the outputs of a project entitled “Enhancing the Role of Forestry in Ethiopia’s Climate Resilient Green Economy”, and implemented between September 2013 and August 2015. CIFOR and our ministry actively collaborated in the planning and implementation of the project, which involved over 25 senior experts drawn from Federal ministries, regional bureaus, Federal and regional research institutes, and from Wondo Genet College of Forestry and Natural Resources and other universities. The senior experts were organised into five teams, which set out to identify effective forest management practices, and enabling conditions for scaling them up, with the aim of significantly enhancing the role of forests in building a climate resilient green economy in Ethiopia. The five forest management practices studied were: the establishment and management of area exclosures; the management of plantation forests; Participatory Forest Management (PFM); agroforestry (AF); and the management of dry forests and woodlands. Each team focused on only one of the five forest management practices, and concentrated its study in one regional state.
    [Show full text]
  • Ethiopia: Amhara Region Administrative Map (As of 05 Jan 2015)
    Ethiopia: Amhara region administrative map (as of 05 Jan 2015) ! ! ! ! ! ! ! ! ! ! Abrha jara ! Tselemt !Adi Arikay Town ! Addi Arekay ! Zarima Town !Kerakr ! ! T!IGRAY Tsegede ! ! Mirab Armacho Beyeda ! Debark ! Debarq Town ! Dil Yibza Town ! ! Weken Town Abergele Tach Armacho ! Sanja Town Mekane Berhan Town ! Dabat DabatTown ! Metema Town ! Janamora ! Masero Denb Town ! Sahla ! Kokit Town Gedebge Town SUDAN ! ! Wegera ! Genda Wuha Town Ziquala ! Amba Giorges Town Tsitsika Town ! ! ! ! Metema Lay ArmachoTikil Dingay Town ! Wag Himra North Gonder ! Sekota Sekota ! Shinfa Tomn Negade Bahr ! ! Gondar Chilga Aukel Ketema ! ! Ayimba Town East Belesa Seraba ! Hamusit ! ! West Belesa ! ! ARIBAYA TOWN Gonder Zuria ! Koladiba Town AMED WERK TOWN ! Dehana ! Dagoma ! Dembia Maksegnit ! Gwehala ! ! Chuahit Town ! ! ! Salya Town Gaz Gibla ! Infranz Gorgora Town ! ! Quara Gelegu Town Takusa Dalga Town ! ! Ebenat Kobo Town Adis Zemen Town Bugna ! ! ! Ambo Meda TownEbinat ! ! Yafiga Town Kobo ! Gidan Libo Kemkem ! Esey Debr Lake Tana Lalibela Town Gomenge ! Lasta ! Muja Town Robit ! ! ! Dengel Ber Gobye Town Shahura ! ! ! Wereta Town Kulmesk Town Alfa ! Amedber Town ! ! KUNIZILA TOWN ! Debre Tabor North Wollo ! Hara Town Fogera Lay Gayint Weldiya ! Farta ! Gasay! Town Meket ! Hamusit Ketrma ! ! Filahit Town Guba Lafto ! AFAR South Gonder Sal!i Town Nefas mewicha Town ! ! Fendiqa Town Zege Town Anibesema Jawi ! ! ! MersaTown Semen Achefer ! Arib Gebeya YISMALA TOWN ! Este Town Arb Gegeya Town Kon Town ! ! ! ! Wegel tena Town Habru ! Fendka Town Dera
    [Show full text]
  • International Journal of Advanced Research in Biological Sciences
    Int. J. Adv. Res. Biol. Sci. (2019). 6(2): 110-117 International Journal of Advanced Research in Biological Sciences ISSN: 2348-8069 www.ijarbs.com DOI: 10.22192/ijarbs Coden: IJARQG(USA) Volume 6, Issue 2 - 2019 Research Article DOI: http://dx.doi.org/10.22192/ijarbs.2019.06.02.013 A Cross Sectional Study on the Prevalence and Possible Risk Factors of Bovine Schistosomiasis in and Around Gozamen District, Northwest Ethiopia Yezina Mengist1 and Nigussie Yilak2* 1 Gozamen Agricultural Office , East Gojjam, ETHIOPIA 2Shewa Robit Municipal Abattoir, Shewa Robit, ETHIOPIA *Corresponding author: Nigussie Yilak; email: [email protected] Abstract A cross sectional study was conducted from April, 2017 to July 2017 in and around Gozamen district to estimate the prevalence and possible risk factors of bovine Schistosomiasis. Simple random sampling was used to select the study animals and sedimentation technique. Out of 384 faecal samples examined 101(26.3%) were found positive for bovine Schistosomiasis. The prevalence of bovine Schistosomiasis was higher in local breed cattle (29.3%) than cross breed cattle (16.1%). Similarly, the prevalence of the disease in male and female cattle was 26.2% and 26.4%, respectively. Cattle having less than 2 years, 2-5years and greater than 5 years old had (18.8%), (28.7%) and (26.0%) disease prevalence, respectively without significant statistical difference (p>0.05). The highest prevalence of Schistosoma infection was observed in poor body conditioned animals (35.5%) followed by medium body conditioned animals (21.1%). Whereas, the lowest prevalence of the disease was observed in good body conditioned animals (11.4%).
    [Show full text]
  • An Under-Recognized Non-Filarial Cause of Lower Extremity Lymphedema
    An under-recognized non-filarial cause of lower extremity lymphedema Angie Koriakos, DO, MPH South Texas Dermatology Residency Case A 14-year-old boy presents with bilateral lower extremity elephantiasis with lichenification of the overlying skin and a mossy appearance of the toes. The lesions began 5 years ago and were accompanied by edema and pruritus. The boy is from the Guraghe zone of Ethiopia and because of poor socioeconomic conditions has been barefoot throughout his entire life. He works in the fields and has no significant medical history. Causes of lower extremity lymphedema Deep vein thrombosis Neurofibromatosis Hypoalbuminemia Sclerema neonatorum Renal failure Idiopathic edema Lipedema Congestive heart failure Postoperative complications Venous insufficiency Baker cyst Cellulitis Differential diagnosis Lymphedema secondary to systemic disease (cardiac, renal) Vascular causes Lymphangioma Mycetoma Kaposi sarcoma Leprotic lymphedema Elephantiasis verrucosa nostra Filarial elephantiasis PODOCONIOSIS What is podoconiosis? Podoconiosis is a non-infectious, non-filarial, geochemical lymphedema Derived from Greek terms podos and konos, meaning foot and dust, respectively Elephantiasis dates back to second millennium BC. Until 1924, all forms of elephantiasis were considered infectious until the 1960’s and 1970’s, when non filarial elephantiasis in Ethiopia termed podoconiosis Affects farmers mainly in tropical parts of Africa and is caused by long term barefoot exposure to red clay soil of volcanic origin Epidemiology At least 4 million people globally with podoconiosis Affects people in more than 20 countries Tropical Africa Central and South America Northern India Countries where podoconiosis is endemic or has been described Geographical distribution of podoconiosis in Ethiopia, results from historical maps and recent surveys conducted on podoconiosis.
    [Show full text]
  • Establishing Rights and Duties in the Prevention And
    HHr Health and Human Rights Journal A Human Right to Shoes? Establishing RightsHHR_final_logo_alone.indd 1 10/19/15 10:53 AM and Duties in the Prevention and Treatment of Podoconiosis arianne shahvisi, enguday meskele, and gail davey Abstract Podoconiosis is a debilitating chronic swelling of the foot and lower leg caused by long-term exposure to irritant red volcanic clay soil in the highland regions of Africa, Central America, and India. In this paper, we consider the human rights violations that cause, and are caused by, podoconiosis in Ethiopia. Specifically, we discuss the way in which the right to an adequate basic standard of living is not met in endemic regions, where the following basic necessities are not readily available: appropriate footwear, health education, and affordable, accessible health care. Those living with podoconiosis experience disablement, stigma and discrimination, and mental distress, contributing to greater impoverishment and a reduced quality of life. We suggest that while identifying rights violations is key to characterizing the scale and nature of the problem, identifying duties is critical to eliminating podoconiosis. To this end, we describe the duties of the Ethiopian government, the international community, and those sourcing Ethiopian agricultural products in relation to promoting shoe-wearing, providing adequate health care, and improving health literacy. Arianne Shahvisi is a lecturer in ethics and medical humanities at Brighton and Sussex Medical School, Brighton, UK. Enguday Meskele is a lecturer in human rights law at Wolaita Sodo University, Ethiopia. Gail Davey is a professor of global health epidemiology at Brighton and Sussex Centre for Global Health Research, Brighton, UK.
    [Show full text]
  • Mycetoma: a Clinical Dilemma in Resource Limited Settings Pembi Emmanuel1,2,3, Shyam Prakash Dumre1, Stephen John4, Juntra Karbwang5* and Kenji Hirayama1
    Emmanuel et al. Ann Clin Microbiol Antimicrob (2018) 17:35 Annals of Clinical Microbiology https://doi.org/10.1186/s12941-018-0287-4 and Antimicrobials REVIEW Open Access Mycetoma: a clinical dilemma in resource limited settings Pembi Emmanuel1,2,3, Shyam Prakash Dumre1, Stephen John4, Juntra Karbwang5* and Kenji Hirayama1 Abstract Background: Mycetoma is a chronic mutilating disease of the skin and the underlying tissues caused by fungi or bacteria. Although recently included in the list of neglected tropical diseases by the World Health Organization, strategic control and preventive measures are yet to be outlined. Thus, it continues to pose huge public health threat in many tropical and sub-tropical countries. If not detected and managed early, it results into gruesome deformity of the limbs. Its low report and lack of familiarity may predispose patients to misdiagnosis and delayed treatment initia- tion. More so in situation where diagnostic tools are limited or unavailable, little or no option is left but to clinically diagnose these patients. Therefore, an overview of clinical course of mycetoma, a suggested diagnostic algorithm and proposed use of materials that cover the exposed susceptible parts of the body during labour may assist in the prevention and improvement of its management. Furthermore, early reporting which should be encouraged through formal and informal education and sensitization is strongly suggested. Main text: An overview of the clinical presentation of mycetoma in the early and late phases, clues to distinguish eumycetoma from actinomycetoma in the feld and the laboratory, diferential diagnosis and a suggested diagnostic algorithm that may be useful in making diagnosis amidst the diferential diagnosis of mycetoma is given.
    [Show full text]
  • Wound Practice and Research
    Wound Practice and Research Journal of Wounds Australia Volume 25 Number 3 September 2017 Limited access to resources: Facing the universal issues takes a ‘village’. Featuring Editorial: Low resources and traditional medicine: Addressing global practice changes Resources for optimising wound outcomes in low-resource settings Care of oedematous skin in a resource-poor environment: A commentary of practice strategies to address a global community need Minimising wound-related pain: A discussion of traditional wound dressings and topical agents used in low-resource communities Establishing a lymphatic fi lariasis morbidity plan for Haiti Lessons learnt following my volunteer work in low-resource communities Good things happen when you put people first The ALLEVYN™ Range ALLEVYN LIFE ALLEVYN Gentle Border The next generation in multifoam layer dressing, A gentle silicone adhesive for fragile skin. designed with the human body in mind. ALLEVYN Non-Adhesive ALLEVYN Adhesive A versatile dressing for compromised skin.1 A secure adhesive when security is paramount. The non-sensitising adhesive2 helps keep the dressing securely in place without adhering to the wound.3,4 We find that good things happen when you put people first: improved wellbeing, greater concordance and all the system efficiencies that derive from that.5 Getting you closer to zero delays in wound healing www.closertozero.com Supporting healthcare professionals References: 1. Denyer J. Wound management for children with Epidermolysis Bullosa. Dermatol Clin 2010; 28(2): 257-264. 2. Walton G. Claims support for ALLEVYN adhesive. Data on file; 2015: report PSS185. 3. Avanzi A, et al. An adhesive hydrocellular dressing versus a hydrocolloid dressing in the treatment of 2nd and 3rd degree pressure sores.
    [Show full text]