19 April 2017

East Africa: Volcanic Soils Causing Elephantiasis in Kamwenge, New Study Suggests

Podoconiosis elephantiasis outbreak has been confirmed in Kamwenge district and other parts of western Uganda after a new study by the ministry of Health and World Health Organisation (WHO).

Since 2015, ministry of health received reports on cases of people suffering from podoconiosis elephantiasis, characterised by severe swelling in the limbs, yet Kamwenge was not affected or at risk of the disease.

According to Dr Christine Kihembo, the senior epidemiologist at the ministry, podoconiosis is a form of elephantiasis which is not caused by the tiny small worms called microfilaria that are transmitted by mosquitoes; it is caused by volcanic minerals in the soils.

"The disease is as a result of chronic exposure of skin to irritant minerals in volcanic soils causing itching and pain. It is a disabling disease characterized by progressive swelling of the lower limbs, affecting one limb more than the other," she said.

Kihembo said according to the study conducted at the end of 2015, their investigation uncovered widespread cases of elephantiasis in Kamwenge district, consistent with podoconiosis elephantiasis.

"We identified 52 cases of people with podoconiosis elephantiasis who had this disease since 1980, because it takes long for someone to realize it due to lack of awareness. The risk of the disease increased with older age. Women were five times more affected than men because they move barefooted and spend more time in the farms touching the volcanic soils with minerals that cause this disease," she said.

Kihembo said they also found a big number of farmers affected by podoconiosis elephantiasis because they do not wear gumboots when tilling their land and the disease is associated with direct contact with the soils.

"Also, persons who did not wash their feet until bedtime were 11 times as likely to have the disease compared to those who washed their feet within two hours after work. This helped them to remove the soils with minerals... that spread this disease," she said.

According to Kihembo, podoconiosis elephantiasis has been spreading silently for more than 30 years, since its symptoms are not severe at the beginning.

Effects of Podoconiosis

Podoconiosis elephantiasis causes severe and permanent disability, reduced productivity, increased social stigma and isolation of the victims.

"Many people with this disease are neglected because of the swelling legs and feet, which give them a bad smell. The swelling eventually becomes so painful and they cannot help themselves," she said.

"Lack of awareness among local health workers on how to prevent the disease has also increased the epidemic and many victims were not reporting to health facilities."

"In Kamwenge, as many as five to 10 per cent [of those working with these volcanic soils] are currently living with the disease," she added.

Other places

Kihembo said this strain of elephantiasis is one of the neglected tropical diseases that affect about four million people, particularly in East and Central Africa, Ethiopia, South America, and Southeast Asia.

She said other cases have been reported on the slopes of Mt Elgon in Kapchorwa, another area rich in volcanic soils, and in the highlands of Kabale and Kisoro districts.

The ministry is now working with local health workers to sensitise communities on how to manage podoconiosis elephantiasis, which has no treatment currently, and also educate people on how to prevent it.

"There is no specific treatment currently. The only way to control the disease is through prevention such as improving foot hygiene and wearing protective shoes like gumboots to avoid stepping on volcanic soils directly. The disease has no cure, you can't reverse it but during early stages, the disease's progression can be halted by improving hygiene," she said.

"Unfortunately, many people living in endemic areas lack the money to buy shoes, nor do they have clean water to wash their feet frequently."

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