LAUSR

Twenty years ago, podoconiosis was hidden in the bookshelves and the suffering of people with the disease was a private matter that was not dealt with by the formal heath sector. For many health workers in endemic countries, podoconiosis was a mystifying dead end. However, with improved research, advocacy and demonstration projects, the disease came out of the ‘Dark Age’. Podoconiosis, which causes massive swelling of the lower leg, is caused by exposure to particles common in soils of volcanic origin and is second only to lymphatic filariasis as the leading cause of tropical lymphoedema. An estimated 4 million people live with podoconiosis globally in 32 potentially endemic countries. The control and elimination of podoconiosis rely on consistent footwear use from an early age and regular foot hygiene to avoid exposure to the type of soil responsible for the disease. For those already affected by the disease, the main strategy is hygiene-based management which includes foot hygiene, foot care, wound care, compression, exercises, elevation of the legs and treatment of acute infections. Today, podoconiosis is a disease of significant clinical and public health importance in several endemic countries. Over the last 15 years there has been remarkable progress in research, advocacy and implementation of podoconiosis inteventions. In 2011 the World Health Organization (WHO) recognized podoconiosis as one of the neglected tropical diseases (NTDs) under the category of ‘other tropical conditions’. Subsequently Ethiopia, Rwanda and Cameroon recognized podoconiosis as a priority NTD and included it in their long-term health plans. Mapping of podoconiosis has been completed in Cameroon, Ethiopia and Rwanda and evidence supporting the effectiveness of hygiene-based morbidity management has been established. As a consequence, morbidity management services have been integrated within the national health system in some countries such as Ethiopia. Progress over recent years has been impressive, but much remains to be done. There are several remaining challenges ahead to be addressed. First, there is the challenge of recognition of podoconiosis as an important public health problem. The disease is one of the most disabling tropical diseases and is linked to significant stigma, discrimination and comorbid mental health problems. The disease has a significant impact in reducing the economic productivity of affected individuals and their families. All these justify the need for recognition of podoconiosis as a public health challenge and the development of a comprehensive and adequately resourced global health strategy towards elimination of podoconiosis. Advocacy is critical to increase awareness of the disease by decision makers. Identifying public figures as podoconiosis champions is important to achieve this goal. The use of different media outlets, including social media and newsletters, to increase public awareness is important. International podoconiosis initiative should be at the forefront of these efforts. The first international conference on podoconiosis will be held on 23 September 2018 in Addis Ababa, Ethiopia. The overall theme for the conference is ‘Research to Implementation: A Call for Global Action’. The conference should reach out to donors, policymakers and programme planners. Second, in the constantly changing global health architecture, sustainable financing of podoconiosis research and intervention is a continuing challenge. Simple hygiene-based management for the treatment of podoconiosis has been shown to work. In a recent randomized controlled trial in Ethiopia, the intervention reduced the incidence of acute dermatolymphangioadenitis (one of the major sequela) by 20% in those treated. Scaling up these interventions is critical to alleviate the suffering of people with podoconiosis and improve their productivity and quality of life. Primary prevention interventions are also crucial. Empowering endemic communities to use footwear and undertake proper foot hygiene is important. Proven health messaging approaches and addressing practical and logistical challenges in accessing these interventions are needed. Sustainable financing is required to scale-up effective intervention. Donor funding for the scale-up intervention is needed, but to sustain the delivery of interventions it is critical to have domestic financing by endemic country governments.