Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis)

Tekola, Fasil, Ayele, Zewdu, Mariam, Dereje Haile, Fuller, Claire and Davey, Gail (2008) Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis). Tropical Medicine and International Health, 13 (10). pp. 1277-83. ISSN 1365-3156

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To develop and test a robust clinical staging system for podoconiosis, a geochemical disease in individuals exposed to red clay soil.


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.


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).


This simple staging system with good inter-observer agreement and repeatability can assist in the management and further study of podoconiosis.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Global Health and Infection
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0440 Study and teaching. Research
R Medicine > RC Internal medicine > RC0251 Constitutional diseases (General)
Depositing User: Gail Davey
Date Deposited: 09 Jun 2014 12:54
Last Modified: 02 Jul 2019 18:48

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