'Volcanic soils, not worms causing elephantiasis in Kamwenge'

PIC: Affected people have painful, swollen limbs with sores, symptoms often associated with elephantiasis.

Scientists have uncovered a chronic neglected tropical disease that has afflicted people in the western Uganda district of Kamwenge for over 30 years.

In a new study published in the American Journal of Tropical Medicine and Hygiene, scientists established that a type of elephantiasis reported in Kamwenge district two years ago is not caused by parasitic worms but by walking barefoot.

Dr. Christine Kihembo, a fellow at the Makerere University School of Public Health in conjunction with experts from Ministry of Health, World Health Organisation and the U.S. Centre for Disease Control and Prevention (CDC) conducted the study after an NGO reported what they suspected to be an outbreak of elephantiasis in Kamwenge in August 2015.

Affected people have painful, swollen limbs with sores, symptoms often associated with elephantiasis. However medical tests on the 52 identified cases showed no evidence of filarial worms, the common cause of elephantiasis. Instead victims were found to be suffering from a form of elephantiasis called podoconiosis.

Podoconiosis is a non-infectious type of elephantiasis that is triggered by long-term foot exposure to irritating minerals in volcanic soils.

 According to Footwork, The International Podoconiosis Initiative, going barefoot in volcanic soils sparks off an inflammatory reaction within the lymph system in the legs causing swelling which causes elephantiasis after years of exposure.

According to the WHO, this type of elephantiasis is usually associated with farming and years of working barefoot in freshly dug up soil.

Scientists also found that not wearing shoes was strongly associated with developing podoconiosis.

Scientists had never documented the disease in the Toro - Ankole region of Uganda though it has been reported on the slopes of Mt Elgon in Kapchorwa in northeastern Uganda (areas rich in volcanic soils), and in the highlands of Kabale and Kisoro districts in southwestern Uganda.

In a press release, Kihembo, a senior field epidemiologist with Ministry of Health and the lead author of the study said many of the people affected in Western Uganda probably had been suffering silently without help for more than 30 years.

She explained that people can suffer from podoconiosis for years before it becomes obvious that they are developing elephantiasis.

According to the journal article, ‘Risk Factors for Podoconiosis: Kamwenge District, Western Uganda,' podoconiosis affects about 4 million people globally with at least a million of them in Ethiopia. India, Uganda, and Cameroon are the other countries with a high prevalence of the disease.

Victims experience burning sensations and repeated episodes of itching of the skin of the forefoot. They can develop secondary infections due to the sores on the skin, compromising their health and productivity.

"People end up being isolated and stigmatized by the disease," Kihembo said.

According to District Health Officer of Kamwenge, William Mucunguzi, many children drop out of school due to stigma from the disease. It also impoverishes the already poor families the more as most of the patients are economically excluded.

Edith Twamusiima, a middle aged woman from Kyakatooma village in Busiriba sub county lost her marriage as a result of the disease.

 "I have moved back to my mother so she can take care of me. After trying the hospital and herbs with no success, my husband told me to go back to my parents. I could no longer do anything on my own," she narrated.

In Kamwenge, women were more at risk of getting the disease. Reasons for this are unknown though researchers suspect it could be due to the fact that they are more likely than men to be engaged in agriculture activities and spend longer periods in the fields exposed to irritant soils. Also in rural settings, men are more likely to own shoes than women.

Mucunguzi says they have not yet established the exact number of people suffering from the condition which affects planning for appropriate interventions.

"There should, however, be no cause for alarm. It is a preventable condition and we are currently empowering the communities with necessary information on both prevention and management," Mucunguzi said, adding that they have had incidents where people expect health workers to give them shoes.

The easiest way to prevent the disease is for people to wear shoes, regularly and quickly wash their feet after soil exposure and covering floor surfaces inside traditional huts.

Mucunguzi explains that to treat the disease requires daily foot-washing with soap, water and antiseptic, use of a simple soothing balm, bandaging in selected patients, elevation of the leg, controlled exercises and use of socks and shoes.

The programme manager in charge of neglected diseases at the Vector Control Division of the health ministry, Dr. Edridah Tukamuheki explained that podoconiosis has no vector to eliminate but soil to deal with.

"It's quite challenging to tell a predominantly farming community to stop contact with soil other than promoting the use of shoes. And as a ministry, we can't provide shoes," she said.

Kihembo pointed out the need to identify early signs of the disease because proper foot care can arrest the disease before it reaches a "point of no return where the swelling cannot be reversed".

She said there was an effort in the region, to conduct a public health education campaign on the importance of better foot hygiene.

The publication comes a week ahead of a summit in Geneva, Switzerland to celebrate the fifth anniversary of the London Declaration on NTDs.

Five years ago, a diverse group of NGOs, private and public partners meeting in London committed to eliminate or eradicate 10 NTDs by 2020. They mobilised the drugs, tools and resources to support countries with a heavy burden to combat the diseases.

As a result of the programme, the number of people at-risk for NTDs globally has been cut by approximately half a billion.

Elephantiasis is a largely predominant condition in tropical Africa at a 10% prevalence. It has been eliminated in North Africa and Europe.

(Additional reporting by Gloria Nakajubi and Godwin Oulanya)