04010nas a2200433   4500000000100000008004100001653003900042653001700081653002300098653001300121653001500134100001300149700001200162700001100174700001600185700001400201700001200215700001300227700002300240700001300263700001300276700001400289700001300303700001100316700001900327700001300346700001400359700001000373700001300383700001400396700001200410700001200422245016700434856009800601300001300699490000700712520284300719022001403562       2018                            d10aNeglected tropical diseases (NTDs)10aPodoconiosis10aGeographic Mapping10aCameroon10aLymphedema1 aDeribe K1 aBeng AA1 aCano J1 aNjouendo AJ1 aFru-Cho J1 aAwah AR1 aEyong ME1 aChounna Ndongmo PW1 aGiorgi E1 aPigott D1 aGolding N1 aPullan R1 aNoor A1 aEnquselassie F1 aMurray C1 aBrooker S1 aHay S1 aEnyong P1 aNewport M1 aWanji S1 aDavey G00aMapping the geographical distribution of podoconiosis in Cameroon using parasitological, serological, and clinical evidence to exclude other causes of lymphedema.  uhttp://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0006126&type=printable  ae00061260 v123 a<p><strong>BACKGROUND: </strong>Podoconiosis is a non-filarial elephantiasis, which causes massive swelling of the lower legs. It was identified as a neglected tropical disease by WHO in 2011. Understanding of the geographical distribution of the disease is incomplete. As part of a global mapping of podoconiosis, this study was conducted in Cameroon to map the distribution of the disease. This mapping work will help to generate data on the geographical distribution of podoconiosis in Cameroon and contribute to the global atlas of podoconiosis.</p>

<p><strong>METHODS: </strong>We used a multi-stage sampling design with stratification of the country by environmental risk of podoconiosis. We sampled 76 villages from 40 health districts from the ten Regions of Cameroon. All individuals of 15-years old or older in the village were surveyed house-to-house and screened for lymphedema. A clinical algorithm was used to reliably diagnose podoconiosis, excluding filarial-associated lymphedema. Individuals with lymphoedema were tested for circulating Wuchereria bancrofti antigen and specific IgG4 using the Alere Filariasis Test Strips (FTS) test and the Standard Diagnostics (SD) BIOLINE lymphatic filariasis IgG4 test (Wb123) respectively, in addition to thick blood films. Presence of DNA specific to W. bancrofti was checked on night blood using a qPCR technique.</p>

<p><strong>PRINCIPAL FINDINGS: </strong>Overall, 10,178 individuals from 4,603 households participated in the study. In total, 83 individuals with lymphedema were identified. Of the 83 individuals with lymphedema, two were found to be FTS positive and all were negative using the Wb123 test. No microfilaria of W. bancrofti were found in the night blood of any individual with clinical lymphedema. None were found to be positive for W. bancrofti using qPCR. Of the two FTS positive cases, one was positive for Mansonella perstans DNA, while the other harbored Loa loa microfilaria. Overall, 52 people with podoconiosis were identified after applying the clinical algorithm. The overall prevalence of podoconiosis was found to be 0.5% (95% [confidence interval] CI; 0.4-0.7). At least one case of podoconiosis was found in every region of Cameroon except the two surveyed villages in Adamawa. Of the 40 health districts surveyed, 17 districts had no cases of podoconiosis; in 15 districts, mean prevalence was between 0.2% and 1.0%; and in the remaining eight, mean prevalence was between 1.2% and 2.7%.</p>

<p><strong>CONCLUSIONS: </strong>Our investigation has demonstrated low prevalence but almost nationwide distribution of podoconiosis in Cameroon. Designing a podoconiosis control program is a vital next step. A health system response to the burden of podoconiosis is important, through case surveillance and morbidity management services.</p>
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