title: Measuring elimination of podoconiosis, endemicity classifications, case definition and targets: an international Delphi exercise.
abstract: BACKGROUND
  Podoconiosis is one of the major causes of lymphoedema in the tropics. Nonetheless, currently there are no endemicity classifications or elimination targets to monitor the effects of interventions. This study aimed at establishing case definitions and indicators that can be used to assess endemicity, elimination and clinical outcomes of podoconiosis.
  
  
  METHODS
  This paper describes the result of a Delphi technique used among 28 experts. A questionnaire outlining possible case definitions, endemicity classifications, elimination targets and clinical outcomes was developed. The questionnaire was distributed to experts working on podoconiosis and other neglected tropical diseases in two rounds. The experts rated the importance of case definitions, endemic classifications, elimination targets and the clinical outcome measures. Median and mode were used to describe the central tendency of expert responses. The coefficient of variation was used to describe the dispersals of expert responses.
  
  
  RESULTS
  Consensus on definitions and indicators for assessing endemicity, elimination and clinical outcomes of podoconiosis directed at policy makers and health workers was achieved following the two rounds of Delphi approach among the experts.
  
  
  CONCLUSIONS
  Based on the two Delphi rounds we discuss potential indicators and endemicity classification of this disabling disease, and the ongoing challenges to its elimination in countries with the highest prevalence. Consensus will help to increase effectiveness of podoconiosis elimination efforts and ensure comparability of outcome data.
authors.affiliation: Brighton and Sussex Medical School, Falmer, Brighton, UK School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia kebededeka@yahoo.com.
authors.forename: Kebede
authors.initials: K
authors.lastname: Deribe
authors.affiliation: Research Foundation for Tropical Diseases and Environment, Buea, Cameroon Department of Microbiology and Parasitology , University of Buea, Buea, Cameroon.
authors.forename: Samuel
authors.initials: S
authors.lastname: Wanji
authors.affiliation: Federal Ministry of Health, Addis Ababa, Ethiopia.
authors.forename: Oumer
authors.initials: O
authors.lastname: Shafi
authors.affiliation: Vector Control Division, Ministry of Health, Kampala, Uganda.
authors.forename: Edridah
authors.initials: E
authors.lastname: Muheki Tukahebwa
authors.affiliation: Malaria and OPD Division, Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Irenee
authors.initials: I
authors.lastname: Umulisa
authors.affiliation: Brighton and Sussex Medical School, Falmer, Brighton, UK.
authors.forename: Gail
authors.initials: G
authors.lastname: Davey
mesh_terms: D003697:Delphi Technique; D060740:Disease Eradication / Q000379:methods*; D004604:Elephantiasis / Q000453:epidemiology*; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000592:standards; D015995:Prevalence; D014330:Tropical Medicine
keywords: Delphi; Elephantiasis; Elimination; Endemicity; Non-filarial elephantiasis; Podoconiosis