This study was conducted in Boreda district, Gamo zone, Southern Ethiopia. Boreda is one of the districts in Gamo zone with high number of elephantiasis case. It is bordered on the southeast by Mirab Abaya, on the southwest by Chencha, on the west by Kucha, and on the north by the Wolayita Zone. There is about 1,084 lymphoedema cases reported in the study area.14
Study design and period
- A community based cross-sectional study design was employed from January 1, 2021 to March 30, 2021
- All individuals who have leg lymphoedema in Boreda district.
- Lymphedema cases in randomly selected kebeles (an aggregate of villages and the smallest administrative unit in Ethiopia).
Inclusion criteria: individuals who had leg lymphoedema in the study area were included
Exclusion criteria: individuals with leg lymphoedema other than podoconiosis and lymphatic filariasis, mental problems and severely ill during data collection period were excluded from the study.
Sample size and sampling procedure
Single population proportion formula was used to determine sample size and the following assumptions were used:
n= initial sample size
P= 50%, to get the highest sample size on practice of foot care among patients
d= margin of error (0.05)
Zα/2 = significance level at 95% confidence interval = 1.96
By considering non response rate 10%, the sample size would be 384+38 = 422.
Since total number of cases in the study area was 1084 which is less than 10,000, we used finite population correction formula as follows:
Nt= n0/1+n0/N= 422/1+422/1084= 422/1+0.3893=422/1.3893=304=304. Hence, the final estimated sample size was 304.
From total of 29 kebeles in Boreda district, 10 kebeles were endemic for podoconiosis. Six endemic kebeles were randomly selected for data collection. Then number of lymphedema cases in each kebele was identified by health extension workers. The sample size was allocated proportionally to the size of cases in the selected districts. Finally, the study subjects were selected by using systematic sampling technique and selected cases were interviewed based on the pretested structured questionnaire (Figure 1).
- Foot care practice (Good or Poor)
- Socio-demographic characteristics, economic factors, environmental factors, health related factors
Plan for data collection
Data was collected by using pretested structured interviewer administered questionnaire which was developed by reviewing different literatures. Eight data collectors and four supervisors having diploma and above holders with health background and have experience on any research undertakings were recruited for data collection. Each randomly selected patient was subjected to an interview by using a pretested structured questionnaire and asked how she/he dealt with lymphoedema particularly about the treatment, and regular foot care. Subsequently each patient was asked whether she/he practiced the identified foot care measures. We developed nine most commonly recommended foot care measures by reviewing available literatures.15 A patient was queried on each measure specifically and probed about different foot care practices in her/his daily life. The details of their socio-demographic, economic, personal hygiene and environmental factors, grade and duration of lymphoedema were recorded.
Lymphoedema: in this study lymphoedema was defined as lymphoedema of lower leg present for more than one year in a resident of an endemic area, for which other causes- e.g. onchocerciasis, leprosy, Milroy syndrome, heart and liver failures have been excluded.16
Data quality control
The data collection tool was reviewed by team members and then pretested on 5% of sample size outside actual study area. The tool was prepared in English then translated to local language by experienced translators and then back to English to check consistency. Data collectors and supervisors were trained on the tool and familiarized with it. Daily supervision and checking collected data for any missing values and inconsistency throughout data collection process was done by supervisors and investigators.
Data processing and analysis
After checking completeness of the collected data, entry of data was done by epi-info version 3.5.1 software and then exported to SPSS version 25 for cleaning, coding and analysis. For quantifying the level of foot care practice, we used nine most commonly recommended foot care measures and the correct answer was given 1 and 0 score for incorrect response. Patients who practice below the mean of practice question categorized as poor foot care practice and those patients who responded above the mean was considered as good foot care practice. Binary logistic regression analysis was employed to see association of independent variable with outcome variable. Factors which had p-value less than 0.25 during bivariate analysis were candidate for multivariate logistic analysis. Statistical significance was shown by 95% confidence interval and p-value<=0.05. Finally, the findings were presented in frequencies, graphs, tables and text.