Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis).
OBJECTIVE
To develop and test a robust clinical staging system for podoconiosis, a geochemical disease in individuals exposed to red clay soil.


METHODS
We adapted the Dreyer system for staging filarial lymphoedema and tested it in four re-iterative field tests conducted in an area of high-podoconiosis prevalence in Southern Ethiopia. The system has five stages according to proximal spread of disease and presence of dermal nodules, ridges and bands. We measured the 1-week repeatability and the inter-observer agreement of the final staging system.


RESULTS
The five-stage system is readily understood by community workers with little health training. Kappa for 1-week repeatability was 0.88 (95% CI 0.80-0.96), for agreement between health professionals was 0.71 (95% CI 0.60-0.82), while that between health professionals and community podoconiosis agents without formal health training averaged 0.64 (95% CI 0.52-0.78).


CONCLUSIONS
This simple staging system with good inter-observer agreement and repeatability can assist in the management and further study of podoconiosis.
Tekola
Fasil
F
Brighton and Sussex Medical School, Brighton, UK.
Ayele
Zewdu
Z
Mariam
Dereje Haile
DH
Fuller
Claire
C
Davey
Gail
G
D000293:Adolescent; D000328:Adult; D000538:Aluminum Silicates; D000077215:Clay; D004604:Elephantiasis / Q000473:pathology*; D005002:Ethiopia; D005260:Female; D005534:Foot Diseases / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012987:Soil
D000538:Aluminum Silicates; D012987:Soil; D000077215:Clay