Neglected tropical diseases (NTD) affected more than one billion people globally and World Health Organization (WHO) African Region accounts about half of this global burden, which are greatly predominant in tropical and subtropical regions and affect mainly the low income and impoverished communities. Neglected tropical diseases are identified by their slowly evolving symptoms that often lead to devastating complications. By impairing the physical and intellectual capacities of the affected persons, these diseases perpetuate the cycle of poverty and negatively affect socioeconomic development1.
Podoconiosis, endemic non-filarial elephantiasis, is one of the neglected tropical diseases which is caused by prolonged exposure of barefoot to red clay soil of volcanic origin2. It affects the poorest community in the world, but it is easily preventable and treatable by using simple practical measures like regular and consistent wearing of proper shoes and washing their feet/foot hygiene making it as a norm 3.
The disease affects men and women equally in most societies. Most of the community based studies had shown that the onset of clinical signs and symptoms happen in the first and second decades and gradual increase in the podoconiosis prevalence up to the sixth decades. People who do not wear shoes regularly due to poverty or other cultural reasons are at higher risk for podoconiosis4.
Podoconiosis causes bilateral yet asymmetrical leg swelling with lie on top firm nodules. Early onset symptoms may include itching, tingling, widening of the forefoot, and swelling which then advance to soft edema, skin fibrosis, papillomatosis, and nodule formation resembling moss, giving rise to the disease's alternate name of "mossy foot" in some regions of the world. As with other form of lymphedema, chronic disease can lead to rigid toes, ulceration, and bacterial super infection. During acute episodes of adenolymphangitis, patients may develop fevers, extremity warmth, redness, and pain. These episodes are extremely debilitating and account for many days of activity and productivity loss each year5.
Endemic non-filarial elephantiasis or podoconiosis has severe social, economic and health consequences. According to the study conducted in Ethiopia, Wolayta zone revealed that the annual economic cost of the disease in an area with 1.7 million people was more than 16 million US dollars. When extrapolated to the national population, this finding reflects a corresponding cost of more than 200 million US dollars. People affected with podoconiosis were found to lose 45% of their economically productive time because of illness associated with the disease. Majority of people living with podoconiosis in Ethiopia experience an episode of acute inflammation that may be triggered by bacterial, viral or fungal infection, at least once per year. Such type of acute attacks is characterized by hot, painful and reddened swelling. Since podoconiosis patients become bedridden during such attacks, it leads to loss of productivity6.
More recently a systemic review on global epidemiology on podoconiosis conducted by Kebede Derib and his colleagues reported that the overall podoconiosis prevalence ranges from 0.10–8.08% globally. The highest prevalence was in African region with substantially higher in adults than in children and adolescents. Their report showed that the prevalence of podoconiosis in Cameroon is 8.08%, 7.45% in Ethiopia, 4.52% in Uganda, 3.87% in Kenya and 2.51% in Tanzania7.
Although podoconiosis has severe social stigma, physical disability and economic unproductivity, the disease is neglected by global community. Most studies shown that podoconiosis is the common public health problem in African regions which affects mostly poorest community of the tropics with the highest prevalence. Majority of studies conducted, indicates that podoconiosis remains unrecognized in most governmental and non-governmental organizations8.
Even though the public health importance and prevalence of podoconiosis, there are few control and prevention initiatives exist in Ethiopia. These initiatives are limited in certain parts of Ethiopia. In Wolayta zone, the Mossy Foot Treatment and Prevention Association (MFTPA) has been documented as effective continuing podoconiosis community program model since 1998 as compared to the WHO Innovative Care for Chronic Conditions (ICCC) Framework9. The MFTPA program involves prevention (distribution of shoes to children, adult shoemaking), treatment (shoe wearing education integrated into clinics/hygiene), and rehabilitation (microcredit, training) activities at the community-level across one zone. In June 2010, the first podoconiosis program in Northern Ethiopia was started in Debre Markos, East Gojam Zone in an effort to take the experiences of MFTPA and develop a program specific to the context of Northern Ethiopia. The program in Debre Markos aims to address podoconiosis prevention, awareness, and care and support activities10.
Ethiopia also developed a guideline for lymphatic filariasis and podoconiosis morbidity management and disability prevention that contribute its part in the control and elimination of podoconiosis. The guideline is helpful for general medical practitioners, health officers, nurses and other mid-level health practitioners in their efforts to reduce morbidity and disability of podoconiosis10.
Despite the above mentioned efforts made by government of Ethiopia, there was no scientific data that show level of knowledge, attitude and practices of health professionals towards podoconiosis in the study area. Therefore the aim of this study was to assess the knowledge, attitude, practices and associated factors of health professionals towards podoconiosis in Gamo zone, Southern Ethiopia.