02591nas a2200253   4500000000100000008004100001260003400042653001700076653002300093100001300116700001400129700001400143700001200157700001200169700001300181700001300194700001400207700001100221700001200232700001100244245009400255856008800349520190000437       2020                            d  bCold Spring Harbor Laboratory10aPodoconiosis10aPopulation at risk1 aDeribe K1 aSimpson H1 aPullan RL1 aBosco M1 aWanji S1 aWeaver N1 aMurray C1 aNewport M1 aHay SI1 aDavey G1 aCano J00aPredicting the Environmental Suitability and Population at Risk of Podoconiosis in Africa  uhttps://www.biorxiv.org/content/biorxiv/early/2020/03/05/2020.03.04.977827.full.pdf3 a<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Podoconiosis is a type of tropical lymphedema that causes massive swelling of the lower limbs. The disease is associated with both economic insecurity, due to long-term morbidity-related loss of productivity, and intense social stigma. The geographical distribution and burden of podoconiosis in Africa is uncertain.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We applied statistical modelling to the most comprehensive database compiled to date to predict the environmental suitability of podoconiosis in the African continent. By combining climate and environmental data and overlaying population figures, we predicted the suitability and human population at risk.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In Africa, environmental suitability for podoconiosis was predicted in 29 countries. By 2020, the total population in areas suitable for podoconiosis was estimated at 114.5 million people, (95% confidence interval: 109.4-123.9) with 16.9 million in areas suitable for both lymphatic filariasis and podoconiosis. Of the total 5,712 implementation units defined by WHO in Africa, 1,655 (29.0%) were found to be environmentally suitable for podoconiosis. The majority of IUs with high environmental suitability are located in Angola (80 IUs), Cameroon (170 IUs), the DRC (244 IUs), Ethiopia (495 IUs), Kenya (217 IUs), Uganda (116 IUs) and Tanzania (112 IUs). Of the 1,655 environmental suitable IUs, 960 (58.0%) require more detailed community-level mapping</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our estimates provide key evidence of the population at risk and geographical extent of podoconiosis in Africa, which will help decision-makers to better plan more integrated intervention programmes.</jats:p></jats:sec>