Podoconiosis is a form of tropical lymphoedema caused by exposure to volcanic soils
in people who do not use footwear.1,2 The past fifteen years have seen substantial
progress in podoconiosis research.3,4 We are now entering a crucial time marked by
the need for increased funding both for research and for translation of this research
into implementation. Together, research and its translation will shape a global strategy
for podoconiosis control and elimination.5,6
There have been several encouraging developments in the fight against podoconiosis
in recent years. National or local programmes for the control and elimination of podoconiosis
have been initiated in four endemic countries (Ethiopia, Uganda, Rwanda, and Cameroon).
Nationwide mapping of podoconiosis has been completed in three countries,6 and at
least three countries have achieved impressive improvements in surveillance systems.
Morbidity management services have also been expanded in Ethiopia.5
Substantial progress has also been made in terms of research. Genome wide association
studies have identified genetic susceptibility loci.7 Mineralogical studies have linked
specific minerals (smectite, mica, and quartz) within the soil with a high prevalence
of podoconiosis.8 Social and economic studies have quantified the stigma,9 discrimination,
and economic impact of the disease.10 Developments in geostatistical and machine learning
approaches have facilitated disease distribution mapping and estimation of the burden
of disease.11 Additionally, the effect of a simple lymphoedema management package
on the frequency of acute attacks has been documented.12
Despite this progress in generating evidence, translation into policy and practice
at the global level is poor. Four clear barriers exist. First, at present no global
strategy for the control or elimination of podoconiosis exists. Countries are implementing
interventions based on experience from pilot projects. Normative guidance about the
implementation of podoconiosis interventions with clear end goals must be provided
by WHO. Although podoconiosis is mentioned on the WHO website,1 the lack of clear
global strategies for podoconiosis has significantly limited advocacy and resource
mobilisation.
Second, podoconiosis is one of the least financed neglected tropical diseases.13 To
accelerate progress in the control and elimination of podoconiosis, increased investment
is needed. While resources provided by donors and philanthropic organisations are
critical, domestic financing of podoconiosis intervention should also be encouraged.
Of the 32 countries considered endemic for podoconiosis, 22 are categorised as middle-income
countries. These countries could ensure domestic resource allocation for sustainable
financing of the prevention and treatment of podoconiosis. The elimination of podoconiosis
aligns well with attainment of the UN’s Sustainable Development Goals (SDG).14 Podoconiosis
interventions are a perfect example of health services requiring universal health
coverage (SDG3). Responsive health systems with financial risk protection for affected
individuals is critical. Nonetheless, the elimination of podoconiosis depends on the
progress of other SDG goals. Determinants and drivers of podoconiosis are directly
linked with other goals such as addressing poverty and social protection (SDG1), universal
access to safe and affordable water and hygiene (SDG6), working and living conditions
(SDG8), and inequalities (SDG10).14
Third, there is insufficient innovation in respect to new and better tools for podoconiosis
prevention, control, and elimination.6 Point-of-care diagnosis, innovations which
improve the outcome of morbidity management, and new tools for personal protection
from soil exposure, including work-friendly and season-friendly footwear, are all
important. To realise the elimination of podoconiosis, innovation that is faster and
smarter than the current trend is crucial, as well as using multi-disciplinary approaches
to develop tools.
Fourth, reliable data for decision making is essential for effective use of available
resources. Investment in distribution mapping and burden estimation in all endemic
countries is crucial.3 Well-powered surveys will enable estimation of national disease
burdens, but countries should also invest in surveillance systems and integrate indicators
for podoconiosis into national health data platforms.
The first international conference on podoconiosis will take place on September 23,
2018, in Addis Ababa, Ethiopia. The overall theme of the conference is “Research to
implementation: a call for global action”, and the meeting aims to delineate a clear
direction for podoconiosis intervention in endemic countries. The following outcomes
are expected from the conference; first, the conference will be an important advocacy
forum to showcase the key research and implementation advances achieved so far. Policy
makers and programme planners will have the opportunity to share experiences. Second,
resource mobilisation and domestic financing will be discussed. Third, a written commitment
to global podoconiosis implementation will be generated. This will outline the guiding
principles for the implementation and financing of podoconiosis programmes.
Elimination of podoconiosis is achievable within one generation. To achieve this goal,
resources for translation of the available evidence into practice, for innovation
and development of new tools, and for development of a comprehensive global strategy
and case for investment are essential.