HARAMAYA UNIVESTY SCHOOL OF GRAAUATE STUDIES

Theses done on fFactors associated with podoconisis patients in Age between

15-64 years, Guliso woreda, West Wolega, Oromia Region, Western Ethiopia:
community based case control study.

MPH Research theses

Submitted by Muleta Olana

College of Health Science ,General Public Health Department

Program General Science

Major Adviser Bezatu Mengistie (PhD)

Co Adviser Tadese Alemayehu (PhD)

September, 2018

Harar,Ethiopia
Acknowledgment

I would like to express my deepest gratitude to my adiviser Dr Bezatu Mengistie (PhD) associate
professor of public health and Education development center coordinator college of Health
and Medical Sciences of Haramaya University and Dr Tadese Alemayehu (PhD) Haramaya
University,Guiding me in developing and preparing this theses for the fulfillment of masters
of post graduate in MPH program .
 Table of contents

Acknowledgment....................................................................................................................................i

Table of contents...................................................................................................................................ii

List of tables.........................................................................................................................................iv

Abbreviations........................................................................................................................................v

Abstract................................................................................................................................................vi

1 Introduction.......................................................................................................................................1

1.1 Back Ground...............................................................................................................................1

1.2 Statement of the problem.............................................................................................................3

1:3 Significance of the study..............................................................................................................5

1.4 Objectives.....................................................................................................................................6

1.4.1 General Objective................................................................................................................6

1.4.2 Specific Objectives...............................................................................................................6

2. Literature review...............................................................................................................................7

2.1 Factors associated with podoconosis...........................................................................................7

2.1.1 Geographical factors...............................................................................................................7

2.1.2 .Socio demographic factors………………………………………………………………..…………………………………11

2.1.3.Social and economic factors…………………………………………………………………….…………………………11.

2.1.4 Cultural factors……………………………………………………………………………….……………………………………12

2.2 Conceptual framework.............................................................................................................13

3. Methods and Materias…………………………………………………………………………………….……………………………14

3.1 Study area and Study period...................................................................................................14

 3.2. Study Design.............................................................................................................................15

3.3. Source Population.....................................................................................................................15

3.5 Inclusion Criteria.....................................................................................................................15

3.6 Exclusion Criteria.....................................................................................................................15

3.7 Sample size and procedure........................................................................................................15

3.8 Sample size determination........................................................................................................15

3.9 Sampling procedure...................................................................................................................16

3.10 Data collection method...........................................................................................................16

3.11. Variables of the study..............................................................................................................17

3.12 Operational Definition.............................................................................................................18

3.13 Plan for data processing and analysis......................................................................................18

3.14 Data Quality control...............................................................................................................19

3.15 Pre-testing the Questionnaire..................................................................................................19

3.16. Ethical considerations.............................................................................................................19

3.17 Posible out comes.....................................................................................................................20

3.18 Dissemination of the results………………………………………………………………………………………………..20

4 Result………………………………………………………………………………………………………………………………………….29

4.1 Socio demographic characteristics of podoconosis………………………………………………..………………...29

4.2 Familyrelationshipdue to the presence of podoconiosis………………………………………………….……..…30

Respondents believe about podoconiosis diseases………...…………………………………33

Factors associated with podoconiosis respondents…………………………………………..33

4.3 Discussion………………………………………………………………………………………………………………….…. 35
4.4Concluton…………………………………………………………………………………………………………………….…36

Recommendation…………………………………………………………………………………………………………………
37REFERENCE……………………………………………………………………………................
38
Curriculumvite…………………………………………………………………………………46

APPROVAL SHEET……………………………………………………………………………… 47
LIST OF TABLES
Table 1: Socio demographic characteristics of podoconisis patients’ case-control study Guliso
woredas, West Wolega, Oromia Region, Western Ethiopia, 2018

Table 2: Daily base practices of podoconisis respondents’ case-control study Guliso woredas,
West Wolega, Oromia Region, Western Ethiopia, 2018

Table 3: Factors associated with podoconiosis respondents’ case-control study Guliso woredas,
West Wolega, Oromia Region, Western Ethiopia, 2018

Figure1: Sex of respondent about the podoconosis cases

Figure 2: Sex of respondent about the podoconosis controlls

Abbreviations
ETB Ethiopian Birr

GC Gregorian calendar

HEW Health Extension Workers

HO Health Officer

LF Lymphatic Filariasis

NTD Neglected Tropical Diseases

PPP Podoconiosis Prevention Project

QOL Quality of Life

SPSS Statistical Package for Social Sciences

USD United States Dollar

WHO World Health Organization

Abstract

Background: Podoconiosis is a non-infectious geochemical disease arising in barefoot farmers

who are in long-term contact with irritant red clay soil of volcanic origins. It is caused by
prolonged exposure to red clay soils of volcanic origins when tiny silica crystals appear to be
absorbed through the feet and it is believed to be mineral particles absorbed through skin are
taken up into the lymphatic system and result in an inflammatory process leading to blockage of
the lymph vessels. It is a neglected tropical disease resulting in progressive bilateral swelling of
the lower legs in barefoot individuals exposed to red-clay. It is a considerable public health
problem in countries across tropical Africa, including Ethiopia. Even though studies done on the
problem in the area but does not showed the factors to cause the disease

Objective: To identify associate factors with podoconosis patients’ age group 15-64 in Guliso
woredas, community based case control study from May 30 to October 30, 2018.

Methods: A community based case control study design employed. The data was collected using
structured questionnaire quantitative methods. Five kebeles selected from the 29 kebeles of the
woredas. Patients previously identified as having podoconiosis and a healthy comparative
(control) group of households with the same aged in the same Kebeles selected to be included in
the study. Data were collected, coded and entered into EpiData 3.1 and analyzed by Statistical
Package for Social Science (SPSS) 23.0. Logistic regression analysis was used and dependants
and independents variables was measured using 95% CI and the p< 0.05was considered as
statistically significant. Descriptive statistics used and presented by frequency tables, graphs and
charts.
Result: A total of 200 participants (100 cases, 100 controls) completed the study questionnaire
by making 100% response rate. The mean age of the study participants for the case was 42.94
years (SD 11.42 years) and 40.40 years (SD 11.89years) for the controls. Level of education,
elementary (p=0.001; AOR=6.37, 95%CI(2.163-18.782), high school and above(p=0.005;
AOR=3.89, 95% CI (1.507-10.054), history of farming (p=0.004;COR=.316, 95%CI(.143-.698),
family relationship with podoconiosis patient (p=0.001; AOR 0.132: 95% CI 0.061-0.287),
income(P= 0.018; AOR 0.234; 95% CI: 0.070-0.783), age for first shoe(p=0.001; AOR .362:
95% CI .196 - .669) and curability of the Podoconiosis (p=0.001,AOR=.334, 95%CI(.179-.624)
were statistically significant predictors for podoconiosis.
Conclusion: However, the onset of diseases is not limited on age as well as sex but which is
based on prolonged soil-foot exposure this finding identified that educational level, occupation
(being farmer), family relationship, income, age of first shoes wearing, curability about
podoconiasis was strongly associated with Podoconiosis which need control measurements for
these predictors.
 1. Introduction

1.1 Back Ground

In highland areas of trop ical Africa, Central America and northern India. It is considered to be a
considerable public health problem in more than ten African countries including Uganda ,
Tanzania ,Kenya , Rwanda, Burundi, Sudan, Ethiopia, Cameroon, and Equatorial Guinea.It was
conclude that podoconiosis imposes a huge burden in west Ethiopia (Getahun A,etl, 2011)
Podoconiosis is caused by prolonged exposure to red clay soils of volcanic origin when tiny
silica crystals are absorbed through the feet ( Fikresilasie et al, 2015)

Podoconiosis is a chronic, progressive, disabling and disfiguring disease exclusively affecting the
lower limbs. It is a type of lower limb tropical elephantiasis distinct from lymphatic filariasis
(LF). Podoconiosis is also known as “mossy foot” due to the moss-like disfigurement of the
lower limb.The prevalence of podoconiosis in the population of 1197/392556 was 3.05%.The
podoconoisis was significantly higher among women than men (3.67% vs 2.4%). Most (92.2%)
people with podoconiosis were in the economically active age group (15–64 years) ( Gail.
D,2010)

Podoconiosis is caused by prolonged exposure to red clay soils of volcanic origin when tiny
silica crystals are absorbed through the feet ( Fikresilasie et al, 2015)

In Africa, it is widely prevalent in countries associated with rift valley geological complex
including Ethiopia, Kenya, Tanzania, Rwanda and Burundi. Common features of endemic areas
are high altitude above 1250m , annual rainfall above 100mm , average annual temperature of
200c, and soils of volcanic origin (Kenate .Bet al 2016)

In Ethiopia , the basalt area covers more than 200,000 km 2, approximately one-fifth of the land
surface. High soil fertility in these areas attracts an agricultural population of 20.5 million
people. (Fikresilasie ,etal 2015)

Climatic conditions, primarily altitude, rainfall, precipitation and temperature, influence the
weathering of rocks and determine the type of soil generated, which in turn probably influences
the distribution of podoconiosis. High altitude areas >5% are characterized avarege mean >1500
mm, temperature between 19–21oC, mean annual rainfall>1500 mm and mean annual
precipitation >130 mm. The distribution of podoconoisis is limited under certain environmental
conditions, presumably those conditions favorable for the weathering of rock to produce specific
types of soil (Tekola et al. 2006).

Guliso woreda is one of the affected areas in western party of West Wollega zone, Oromia region of
Ethiopia . The Woreda is located 500 km west of Addis Ababa, the capital city of Ethiopia, and has an
altitude of 1,500–1,800 m above sea level. The population of the woreda is 69,856, of which 88.7% live
in 26 rural kebeles. The economic base for most of population is agriculture, which allows prolonged
contact with the local soil and are subsistence farmers producing coffee as a cash crop. The area is known
for the presence of podoconiosis for a long time. Most of the studies on podoconiosis in Ethiopia were
done in this area. According to the most recent prevalence survey, which was done in the Woreda
in 2011, it is estimated that there are about 1935 podoconiosis patients in the woreda were
registered (Getahun, A.et al )

The socio-demographic and other characteristics of controls living in the three different levels of
podoconiosis endemicity were compared to assess existence of basic differences among these
groups. Comparing the average income, there was no statistically significant difference between
controls living in ‘high’ and ‘low’ endemicity areas (mean difference = 21.8, t = 1.2, p = 0.231),
whereas a significant difference in income was observed after adjusting for sex. In general,
controls living in the ‘medium’ endemicity area earned less than controls living in ‘high’ or ‘low’
endemicity areas.(AOR = 0.5, 95% CI = 0.4–0.7) (Yordanos .B,etal).

A community-based cross-sectional study done to burden assessment of podoconiosis in Wayu

Tuka woreda, The experience and attitudes of respondents towards footwear and personal
hygiene were assessed and majority 348 (94.1%) of people with podoconiosis had no problem
finding enough water and took an average of 22 min to reach a water source. (Bekele K, et
al.2016).

The majority 315 (85.1%) of people with podoconiosis washed their feet at least once per day
(mean 1.4±0.086), and 79 (21.4%) washed their feet with soap daily. Almost all (345, 94.3%)
had washed their feet on the night before the interview was conducted. Foot washing behaviour
did not change in 97 (26.2%) people with podoconiosis after their leg started to swell (Bekele K,
et al.2016).
The experience of wearing shoes did not vary between males and females. However, the type and
quality of shoe worn varied, more males than females wearing the better quality and more
expensive leather shoes (19.6% vs. 8.7%, χ2 = 7.4, p = 0.007) ( Alemu .G,et al, 2011)

The mean age at first shoes wearing was 25.94±13.83 (range 4–95) years. During the interview,
162 (43.8%) were wearing closed plastic shoes, while 32 (8.6%) were barefoot. A small but
important subset (21, 5.7%) had never worn shoes. (Bekele K, et al.2016)

Although the social consequences of the disease are indicated at different times, there is no
concrete evidence that fully describe the problem to attract the attention of responsible parties.
Even if podoconiosis is a preventable disease by simply wearing a protective shoe, it can be said
that it is a neglected public health problem by the Minister of Health, the regional health bureau
and even by the World Health Organization. Hence the objective of this study is to investigate
the awareness and knowledge of people on associate factors and social consequence of the
disease and to fulfill the gap.
 1.2Statement of the problem

Globally, it is estimated that there are at least four million people with podoconiosis. The disease
has been reported in more than 20 countries, of which ten had high burden of the disease. In
endemic highland areas of these countries podoconiosis is more prevalent than commonly
known diseases such as HIV/AIDS, tuberculosis, malaria, or filarial elephantiasis (Davey et
al. 2007).
Podoconosis is highest in Cameroon and Ethiopia. In Ethiopia,9.1% of podoconiosis cases live in areas
with irritant red clay soil (Gail .D, 2010 )

The prevalence of podoconiosis in the population of 1197/392556 was 3.05%.The podoconoisis

was significantly higher among women than men (3.67% vs 2.4%). Most (92.2%) people with
podoconiosis were in the economically active age group (15–64 years) ( Gail. D,2010)

Study conducted in northern Ethiopia,A community based case control case-control study carried
out in six kebeles (the lowest governmental administrative unit) shows three endemicity levels:
‘low’ (prevalence <1%), ‘medium’ (1–5%) and ‘high’ (>5%). A total of 142 (30.7%) households
had two or more cases of podoconiosis. It is estimated that up to 1 million cases of podoconiosis
(i.e. 25% of the global total case load) exist in Ethiopia. The ‘at-risk’ population for podoconiosis
is made up of all the people who live and farm on irritant soil. The soil is estimated to cover 18%
of the surface area of Ethiopia, on which estimated 22–25% of Ethiopia’s population (19.3
million) lives. In endemic areas of Ethiopia, the prevalence of podoconiosis is high: 9.1% in
Illubabor Zone, Oromia Region; 6% in the Pawe resettlement area, northwest Ethiopia; 5.5% in
Wolayta zone, SNNPR; 2.8% in GullisoWoreda, West Wollega zone, Oromia region, 7.4% in
Midakegni, West Shewa Oromia region, 3.3% in Debreelias and Dembecha, East and West
Gojjam, Amhara region (Tekola et al. 2006)

Across-sectional quantitative study was conducted Bedele Zuria woreda, west Ethiopi in 2011
and involved a house-to-house survey in all 2285 households shows the prevalence of
podoconiosis was 5.6% (379/6710) (95% CI 5.1–6.2%) and was significantly greater among
women than men (6.6% vs 4.7%; p = 0.001). A total of 311 (16.9%) households had at least one
member with podoconiosis, and 128 (33.8%) study participants reported having a blood relative
with podoconiosis. Two hundred and forty-three (76.4%) podoconiosis patients were in the
economically productive age group of 15–64 years. On average, a patient experienced at least six
episodes of adenolymphangitis per year resulting in a loss of 25 working days per year (Fasil.T,et
al,2011).

Podoconiosis has severe health, social and economic consequences. According to a study in
Ethiopia, the annual economic cost of podoconiosis in an area with 1.7 million residents was
more than 16 million United States dollars (US$) (Kebede.D, 2015).

When extrapolated to the national population, this result indicates a corresponding cost of more
than US$ 200 million. Some studies suggested that the total direct cost of podoconiosis is
amounted to the equivalent of US$ 143 per patient per a year (Fikresilasie,etal .2015).

Most people with podoconiosis in Ethiopia experience an episode of acute inflammation that
may be triggered by bacterial, viral or fungal infection. Patients experienced an average of 5.5
ALA episodes annually, each of average 4.4 days, thus 24 working days were lost annually.Since
podoconiosis patients become bedridden during such attacks, it leads to loss of producti vity
(Deribe K, et al. 2015). Some studies suggested that the total direct cost of podoconiosis is
amounted to the equivalent of US$ 143 per patient per a year (Fikresilasie,etal .2015)

From a total of 128 patients (40.8% [64/157] of men and 28.9% [64/222] of women; χ2 = 4.6; p =
0.028) reported having a blood relative with podoconiosis. Of these, 97 (75.8%) reported having
one or more affected close relatives (sibling, parent or grandparent). There was at least one
member with podoconiosis in 311 households (16.9%) and 70 of these households (22.5%) had
two or more podoconiosis-affected members. Of the households reporting two or more affected
members, 32 (45.7%) included an affected couple (Fasil,T.et al 2011)

Podoconosis disease leads to social exclusion of individuals and their families. The most
Pronounced social stigma in endemic areas are often unable to marry, excluded from school,
church, and social events (Tekola et al. 2006).

The social impact of podoconiosis is also substantial. In endemic areas of southern Ethiopia, the
disease is considered to be the most stigmatizing health problem. Affected people may be
excluded from school, denied participation in local meetings, Churches and mosques and
excluded from marriage with unaffected individuals. In northern Ethiopia,People with
podoconiosis were found to have lower quality-of-life scores, in all domains of quality of life,
compared to healthy people from the same neighborhoods. (Kebede,D.2015 ).

Social stigma related to podoconiosis has a major impact on the psycho-social well being of
patients and their children. The disease leads to social exclusion of individuals and their families.
Patients commonly reported that they had considered suicide in response to discrimination and
prejudice, particularly in interpersonal interactions. Unable to marry, forced divorce, dissolution
of marriage plan, insults and exclusion from school and social events were some of the most
commonly mentioned forms of enacted stigma reported patients (Fikresilasie,T, 2015)

Recently, podoconiosis and other NTDs have been receiving attention in Ethiopia. The Federal
Ministry of Health of Ethiopia endorsed inclusion of podoconiosis in the National Master Plan
for Neglected Tropical Diseases in 2011, and nationwide mapping of podoconiosis and lymphatic
filariasis was conducted in 2013 (Gail. D, 2010).

Inthis study factors associated which predispose to podoconoisis was identified. The study was
conducted because there was knowledge gap in terms of what factors are contribute to the
problem. Addressing the gap in turn helps in the improvement of awareness on the community.
The recommendations made by this study may play a role towards improving effective planning
healthy services. In addition,it may be useful to other studies as reference while conducting
further studies on the problems.

1:3 Significance of the study

The findings of the study is helpful for community, stake holders , local governmental health
planners, and other organizations working on health areas to consider these community health
problems during planning and designing an intervention strategies, monitoring and evaluation of
their activities with active participation of the community. It can also provide supplementary
baseline information for researchers who want to further investigate and intervene on the
podoconiosis and other neglected tropical disease.
1.4 Objectives

1.4.1 General Objective

To identify associate factors with podoconosis patients age group 15-64 in Guliso woreda,
community based case control study from May 30 to October 30. 2018

1.4.2 Specific Objectives

To identify factors associated with podoconosis
2. Literature review

2.1 Factors associated with podoconosis

2.1.1 Geographical factor.

A case–control study was done in Kamwenge District, Western Uganda, September 2015 ,
tested the hypothesis that the disease was caused by prolonged foot skin exposure to irritant
soils, using 40 probable case-persons and 80 asymptomatic village control-persons, individually
matched by age and sex. The suspected cases (40) with onset from 1980 to 2015. Prevalence
rates increased with age; annual incidence (by reported onset of disease) was stable over time
at 2.9/100,000 and resulted that 93% (37/40) of cases and 68% (54/80) of controls never wore
shoes at work ( AOR) = 7.7; 95% [confidence interval] CI = 2.0–30); 80% (32/40) of cases and
49% (39/80) of controls never wore shoes at home (AOR) = 5.2; 95% CI = 1.8–15); and 70%
(27/39) of cases and 44% (35/79) of controls washed feet at day end (versus immediately after
work) (AOR = 11; 95% CI = 2.1–56) (Christine ,et al, 2015).

2.1.2 Socio demographic Factors.

According to study done in Ethiopia in ,2015,individual and environmental factors were found
to be risk factors for podoconiosis. Thus, individual-level factors associated with an increased
risk for podoconiosis included female gender (odds ratio [AOR] = 1.3; 95%% BCI; ( 1.2–1.4),
age (AOR = 1.02; 95% BCI; 1.02–1.03), unmarried status (AOR = 1.4; 95% BCI; 1.3–1.5),
religion; factors associated with a decreased risk included secondary or higher education,
increased foot hygiene, employment, housing with covered floor (OR = 0.3; 95% BCI; 0.3–0.4).
(Kebede D, etl,2015)

According to study done in Soddo Zuria Woreda, Wolaita Zone South Ethiopia,Eighty (5.4%) of study
participants were affected by podoconosis disease. And the significantly contributed factors for
Prevalence of podoconiosis in the study area were age above 26 years (AOR=4.15, 95% CI=1.50-11.51),
washing practice only by water (AOR=1.86, 95% CI=1.08-3.81)(Alemtsehay E,etal2016)

According to this study done in Soddo Zuria District, Wolaita Zone, South Ethiopia , January 25-
February 20, 2015Community-based cross-sectional study was conducted on 703 households
(1483 Participants) in selected 3 kebeles and participated. Age, educational status, age of first
shoes wearing, feet washing practice, regular walking on bare foot and time spent on farming on
barefoot were the independent variables which found in this study as predictors of Podoconiosis.
80(5.4%) of study participants had affected by the disease. The significant contributed factors for
prevalence of Podoconiosis in study area were age above 26 years (AOR=4.15, 95% CI=1.50-
11.51), (Alemtsehay E,etal2016)

Washing practice in Soddo Zuria Woreda, Wolaita Zone South Ethiopia ,only by water (AOR=1.86,
95% CI=1.08-3.81), regular walking on barefoot for different social purpose (AOR=4.18, 95%
CI=1.84-9.46), time spent on farming on barefoot who travelled above mean hour (AOR=2.23,
95% CI=1.31-3.80),the educational status who were illiterate (AOR=9.74, 95% CI=1.29-73.53)
and primary level (AOR=2.23, 95% C=1.33-3.73) and age of first shoes wearing (AOR=8.14,
95% CI=2.61-25.40) (Alemtsehay E,etal2016)

People those who have dirty and cracked status of feet in Soddo Zuria Woreda, Wolaita Zone South
Ethiopia ,were 2.77 times more likely to develop Podoconiosis than those who have clean and
intact feet status (COR=2.77, 95% CI=1.75-4.37, p=0.00). On other hand the participants
washing practice dependent on only by water were 1.73 times more likely to develop
Podoconiosis than who washed by water and soap (COR=1.73, 95%CI= 1.06-2.84, p=0.03). The
participant who travelled regularly for social purpose were 3.44 times more likely to develop
Podoconiosis than those who not travelled (COR=3.44, 95% CI=1.68-7.02, p=0.01). (Alemtsehay
E,etal,2016)

A case control study conducted in the northern Ethiopia shows the majority of the cases,
especially women, were less educated (AOR = 1.7, 95% CI = 1.3 to 2.2), were unmarried (AOR = 
3.4, 95% CI = 2.6–4.6) and had lower income (t = −4.4, p<0.0001). On average, age started
wearing shoes ten years later than controls. Among cases, age of first wearing shoes was
positively correlated with age of onset of podoconiosis (r = 0.6, t = 12.5, p<0.0001). Among all
study participants average duration of shoe wearing was less than 30 years (Yordanos .B,etal,2015
).

A case-control study conducted in East Gojam zone ,2015, with more than 2.1 million
inhabitants in northern Ethiopia households had two or more cases of podoconiosis compared to
controls, the majority of the cases, especially women, were less educated Odds Ratio = 6.74,
95% CI (1.3 - 2.2) (Yordanos ,B,et al,2015)

2.1.3 . Social and economical factors

A comparative cross-sectional study was conducted in Dembecha woreda (district) in northern

Ethiopia,2012, Among 346 clinically confirmed adult patients with podoconiosis, and 349
healthy adult on the impact of podoconiosis on quality of life shows patients with podoconiosis
had significantly lower mean overall QoL than the controls (52.05 versus 64.39), and this was
also true in all four sub domains (physical, psychological, social and environmental). Controls
were 7 times more likely to have high (above median) QoL(AOR = 6.74, 95% Confidence
Interval 4.62 - 9.84) than cases (Elizabeth M, et al, 2012).

According to crossectional study in Wayu Tuka Woreda 2015,the prevalence was significantly
higher among women than men (3.67% vs 2.4%) and most (92.2%) people with podoconiosis
were in the economically active age group (15–64 years. On average, people with podoconiosis
had 23.3 episodes of ALA/year and each person with podoconiosis lost 149.5 days of
activity/year. Never walking barefoot associated with decreased odds of ALA (AOR=0.23; 95%
CI 0.06 -0.80 and daily foot washing (AOR 0.09; 95% CI 0.01 to 0.75) (Kenate B, etal 2016).

According to study done in Ethiopia ,2017, total of 1113 study participants (379 cases and 734
controls) were included giving for a response rate of 96.95%. Positive family history (AOR, 2.81
[95% CI: 1.7–4.64]), bare foot (AOR, 3.26 [95% CI: 2.03–5.25]), poor foot hygiene (AOR, 2.68
[95 CI: 1.72 – 4.19]) increase the risk of Podoconiosis. Female gender (AOR, 0.26 [95% CI:
0.15–0.44]), good housing condition (AOR, 0.17 [95% CI: 0.1–0.3]), medium income (AOR,
0.12 [95 % CI: 0.07– 0.22]) and primary education (AOR, 0.02 [95% CI: 0.01–0.04]) decrease
the risk of Podoconiosis.
2.1.4 .Cultural factor.

According to crossectional study in Wayu Tuka Woreda 2015 ,marital status of people was
assessed between cases and controls were compared and classified into married and unmarried
(single, divorced, separated or widowed), and unmarried people had three times greater odds of
disease than married people (AOR = 3.4, 95% CI = 2.6–4.6, p<0.0001) Stratified analysis by sex
among cases and control assessed, showed that affected women had greater odds of being
unmarried than affected men (AOR = 3.7, 95% CI 2.4 - 5.5, p<0.0001) (Kenate B, etal 2016).

In a study conducted in Sodo Zuria Woreda, Ethiopia never walking barefoot and daily foot
washing were associated with lower odds of ALA. People with podoconiosis who never walked
barefoot had one-quarter the odds of ALA as those who walked barefoot at times (AOR=0.23,
95% CI 0.06 to 0.80, p=0.025). People with podoconiosis who washed their feet daily had one-
twelfth the odds of ALA as those who did not (AOR=0.09, 95% CI 0.01 to 0.75, p=0.023)
(Kenate B, etal 2016)

Acording to study done in Soddo Zuria Woreda, Wolaita Zone South Ethiopia regular walking
for different social purpose on barefoot (AOR=4.18, 95% CI=1.84-9.46), time spent on farming
above mean hour in farming on barefoot (AOR=2.23, 95% CI=1.31-3.80) , educational level of
being illiterate (AOR=10.14, 95% CI=1.3777.00) and age of first shoes wearing (AOR=8.14,
95% CI=2.61-25.40) of the participants were associated with podoconosis.(Alemtsehay
E,etal,2016)
 2.2. Conceptual framework

Geographical factor
Economical factor
Location
Income
Weather
Productivity
Accessibility healthy facility

Podoconoisis
Socio demographic factors
mmmmmmmm
Age, sex,ethnicity,religion,
marital status, educational
status, ,
Social factor
Cultural factor
Poverty
Stigmatizing
Distance from health
Isolation
service
Access to water supply

Figure 1: Conceptual frame work adopted and modified from malnutrition and Environmental
Health: (Mikko K.Paunio anAnjali Achary)
 3 Methods and Materials

3.1 Study area and Study period.

The study was conducted from May 30 to October 30. 2018 in West Wollega zone, Guliso
woreda located in Oromia Regional state .West wollega is located at about 521kms from the
capital city of the countery Ethiopia. Guliso woreda is one of the 26 woredas in west wolega
zone Oromiya region western party of Ethiopia The major area central to this study is Guliso
woreda. The Woreda is located 500 km west of Addis Ababa, the capital city of Ethiopia, and has
an altitude of 1,500–1,800 m above sea level. The population of the woreda is 69,856, of which
88.7% live in 26 rural kebeles. The economic base for most of population is agriculture and are
subsistence farmers producing coffee as a cash crop.The woreda has 26 rural kebeles and 3
urban kebeles totaly 29 kebeles .The area is 42688km2 and the topography is characterized by
combination of high lands low lands that are mostly covered with forest ( Alemu G,et al, 2011).

The area is also has combination of tropical, sub tropical and temperate climate. Both live stock
rearing and crop cultivation (mixed farming) is product of the area. For many decades the
population in the area has had access to well functioning health services though near-by hospital
and clinics run by non-governmental organizations. The population has also had above-average
primary and secondary education resulting in a relatively higher literacy rate than the national
average for rural areas in Ethiopia. Majority of the woredas ethnic group are represented the
largest groups include the oromo (99.1%) and (09%) otheres like amhara and gurage and
Languages spoken is oromiffa.

The religion with the most believers in the area is Orthodox with 10% of the population, while
2.5% are Muslim, the rest (87.5%) are protestants.( Guliso woreda health office ,2017)
3.2. Study Design
A community based case control study design was employed and supplemented with quantitative
methods.

3.3. Source Population

All podoconosis patient age between 15-64 years (Cases) Guliso woreda and All non
podoconosis individual with the same age and geographical location (controls).
3.4 Study population
All podoconosis patiant (cases )and All non podoconosis people (controls) age between 15-64
years in Guliso woreda.

3.5 Inclusion Criteria

The study involved podoconosis patient cases age group 15-64 years and controls who were not
diseased and similar with same age and geographical area.

3.6 Exclusion Criteria

Who were travelled out for greater than 6 months.Those who did not provide written consent and
those who were severely sick and could not respond?

3.7 Sample size and procedure

3.8 Sample size determination

The sample size for this particular study was calculated using formula for case control proportion
considering the following assumptions. Proportion of podoconosis among control to be 33.7%
with confidence level 95%, 80 % power case to control ratio 1:1 and 10 % non respondent rate.
Accordingly 251 cases and 251Controls required for the study.

Sample size=r+1 SD2(Z1-Z2)2 = 1+1 (0.33-0.33)2 = 250.88= 251

r d2 1 (0.25)2

SD - standard deviation , d- Expected mean difference case and control

Z1 +Z2- Proportion expected case and proportion of control exposed.

R - Ratio of control to case

3.9 Sampling procedure

Structured questionnaire was developed and podoconoisis patient were interviewed.The
Ethiopian administrative structure is organized hierarchically, with multiple zones in each region.
Each zone contains multiple woredas (equivalent to districts). The woreda contains kebeles and
each kebele contains villages with multiple households.

A list of kebeles in Guliso woreda known for the presence of podoconiosis, based on a previous
podoconiosis survey has been obtained. The study was a case control quantitative research
design. The 5 kebeles were randomly selected by simple random sampling method. Individuals
with podoconiosis over 15 years of age were selected from the registration list generated. The
patients were selected based on accessibility of their homes for data collectors. House hold with
podoconiosis cases and house hold without cases were randomly selected from each of the five
podoconiosis kebeles. For each participant with podoconiosis were selected those controls with
out Podoconiosis were matched with age and sexwere randomly selected and who were
caregivers to non school-aged children will be passed over for the study.

3.10 Data collection method.

Structured questionnaire was employed and podoconoisis patient and compared group were
interviewed. Data collection was done by trained HEWs supervised by health professionals
working in the respective health center. Before performing data collection, all HEWs were
received orientation from the research coordinator on techniques and approaches for obtaining
information. They advised patients on proper and regular use of footwear, daily foot washing and
replacing earth floors with concrete or covering floor at the end of every interview. The data
collection process was be supervised by the study investigators
3.11. Variables of the study
Independent variable

Age

Sex

Ethnicity

Religion

Marital status

Family podoconiosis status

Educational status

Occupation

Family size

Family relationships

Income

Productivity

Distance from Healthy facility

Days of visit health facility

Age started wearing shoes

3.12 Operational Definition
A person with podoconiosis: An individual in an endemic area diagnosed by a trained nurse or a
health extension worker who fulfils all of the following diagnostic criteria: history of burning
sensation in the feet when the swelling started; visible swelling that started at the feet and
progressed upwards; with at least stage one of the five clinical stages of podoconiosis; and with
no known clinical signs or symptoms of leprosy or lymphatic filariasis.

ALA: Acute adenolymphangitis - Acute infection, occurs on average 5 times per year. Patients
become pyretic with a warm, painful limb, necessitating on average of 4.5 days off work for each
episode (Fikresilasie,etal ,2015). These episodes appear to be related to progression to a hard,
fibrotic leg, a reddish, hot, swollen leg with a painful groin.

Dorsal foot:The part of the foot opposite the sole.

Pedigree: A chart that containing the list of an individual ancestor across different generation.
Planter foot:The sole of the foot.
Moss = tiny, rough lesions like moss on the foot.
Enacted stigma: A stigma imposed by others towards the individual.
Felt stigma: A stigma that the individual with podoconiosis perceives from the behavior of others
and how they themselves feel..
Economically active age: Anyone between the ages of 15 and 65 years.

3.13 Plan for data processing and analysis.

After the data collected, data was checked manually for its completeness and consistency,
entered in to epi data version 3.1, Dupilicated, validated and exported to SPSS for analysis
using the Statistical Package for Social Sciences (SPSS) software v.20.0. BIvaiate and
Multivariate analysis used to know the relation of podocoinsis cases and control to identify the
determinant factors by controlling the confounder. The results was presented by frequency tables
and graphs as needed. In this study, the associate factors of podoconosis disease was identified
and the statistical association between the outcome variables having knowledge about associated
factors related to podpconosis disease and the variables was tested to control confounding
effects were measured using 95% CI and the p.values below 0.05 was considered as statistically
significant.
3.14 Data Quality control.
The quality of data was ensured on tool development, collection, coding, entry and analysis. The
questionnaire was translated to Afan Oromo language and retranslated to English before data
collection. Different translators were used to keep the consistence of the questionnaire and
necessary correction was taken.

Data collectors were trained about the purpose of the study and how to administer the
questionnaire. Role play by trainees were done to strengthen their skills in administering the
questionnaire and how to approach participants in the field.

During data collection, questionnaires were checked for completeness on a daily basis by the
immediate supervisors. Incorrectly filled or missed questionnaires were sent back to the
respective data collectors for correction and checked by supervisor’s sent and submitted to the
principal investigator after checking its consistency and completeness. The investigators also
recheck the completed questionnaires to maintain the quality of data.

There were discussion with data collectors and supervisors accordingly if there was a problem
encountered during data collection. Data quality was ensured during data coding, cleaning, entry
to computer and during analysis.

3.15 Pre-testing the Questionnaire

Pretest of the questionnaire was carried out on 5% of respondents a head of a week in kebele that
have similar socio demographic characteristics as the podoconiosis patients in the study area.
During pre-test, the interviewers and supervisors were assessed clarity, understandability and
completeness of questions, correction and changes,

3.16. Ethical considerations

After approval of the proposal, ethical clearance was obtained from the Institutional Healthy
Research Committee (IHRERC) of the College of Healthy and Medical Science,Haramaya
University.Aformal letter was obtained from the College of Health and Medical Science,
Haramaya University. The necessary permission was obtained from Guliso administrative Office,
health office and Kebeles administrative office. Informed consent was obtained from the study
participants (podoconiosis and non-podoconiosis patients) after explaining the purpose of the
study. Participants assured that their name would not be stated, data would be kept confidential
and anonymous and it was only to be used for research purposes. They were also informed that
they would not be forced to answer the entire questionnaire if they do not choose to and they
could withdraw from participation at any time. At the end of each interview health education was
given about the causes, prevention and the locally available of treatment of podoconiosis for both
patients and healthy individuals.

3.17 Possible outcomes.

The purpose of the study can be of paramount importance for the woreda health office to plan
intervention on improving planning specially prevention of podoconoisis and improving health
services care for podoconoisis patients in the area and recommendations will be to the planner,
health facility, and community.

3.18 Dissemination of the results

The finding of the research was submitted to department of College of Healthy and Medical
Sciences Institutional Healthy Research Ethics Review Committee (IHRERC) College of Health
and Medical science,Haramaya Unuversty,General public health department and Guliso woreda
health Office will be presented at SPH organized seminars and appropriate conferences. Besides,
the findings will be also published and disseminated through different journals and scientific
publications.
Result
Socio-demographic characteristic of podoconiosis participants
In this community based survey of household study a total of 200 (100 cases, 100 controls)
participants answered the questionnaire making 100% response rate. Table 1 shows the
Sociodemographic information of the respondents.
The majorities (57%) of the respondents were females in the cases and 51% of the male were
controls. The mean age of the study participants for the case was 42.94 years (SD 11.42 years)
and 40.40years (SD 11.89years) for the controls. In the age category 31 of the cases and 27 of
the controls were in between the ages group ofbetween 35-44 years old. And more than half (59)
of the cases and (50) of the controls level of education was at elementary (primary school) leve
and almost all of them were living in rural areas. Seventy –seven respondents of the cases and
89 of the controls were married and majority of them 90 cases and 74 (cases and controls) were
farmers. respectively.

Table 1: Sociodemographic characteristics of podoconisis patients’ case-control study Guliso woredas,

West Wolega, Oromia Region, Western Ethiopia, 2018
Variables Cases Controls
Sex
Male 42 51
Female 57 49
Age
15-24 7 11
25-34 17 22
35-44 31 27
45-54 26 26
55-64 19 14

Residence
Urban 1 0
Rural 99 100
Educational status
Can’t write and read 33 17
Elementary 59 50
Secondary school 7 23
Diploma(level I-IV) 1 9
University and above 0 1
Marital status
Single 15 15

Married 77 89
Widowed 6 5
Divorced 2 0
Occupation
Farmer 90 74
Daily laborer 5 4
Government 0 12
employee
Others 5 10

Religion
Protestant 100 98
Orthodox 0 2
Ethnicity
Oromo 100 99
Amhara 0 1

Daily income
Yes 4 16
No 96 84

Family relationship due to the presence of podoconiosis

From the study finding, 54(58.5%) of the participants who had podoconiosis cases responded
that as they have had about one to four family size and 46(41.5%) had five and above family but
the controls have responded that 63(58.5%) had one to four and 37(41.5%) have had five and
above family size. According to this finding about 4(10.5%) of family had showed very poor
relationship due the presence of podoconiosis and 7(23.5%) of them had poor relationship. In the
contrary about 47(41.7%) and 42(24.5%) of the family had showed good and very good
relationship with their family who infected with podoconiosis respectively.
 Daily bases practices on hygiene of foot care about podoconiosis

As shown on table 2 below from 100 cases 68 of them responded as they wear shoes daily and
about 62 from the controls did the same. But when asked the time point for wearing shoes
majority of them responded during adult and almost all of them wore shoes when interviewed
about podoconiosis. Almost both cases and controls responded that as there is the availability of
water for washing their foot and about 50% of them can access(get) this water with a short
distance of not more than within 10 minutes walking distance to fetch the water. People The
proportion of with bare foot among cases and controls was ere 92.0% and 87.0% respectively.
Table 2: Daily base practices of podoconisis respondents’ case-control study Guliso woredas, West
Wolega, Oromia Region, Western Ethiopia, 2018

Variables Cases Controls

Wear shoes daily
Yes 68 62
No 32 38
Wearing shoes started
At childhood 4 25
At school age 20 24
At toddler age 19 17
At adulthood 57 34
Wore shoes during interview

Yes 97 95
No 3 5
Availability of water for Washing foot
Yes 99 99
No 1 1
Distance in time to get water
<10minutes 55 45
15-30minutes 45 54
>30minutes 0 1
Barefoot
Yes 92 87
No 8 13
Time of barefoot
During farming 5 7
In the field 0 2
At home 52 46
At anytime 43 45
Nearby health facility
Yes 100 99
No 0 1
Distance of health facility
<5km 69 51
5-10km 36 33
>10km 3 8

Respondents believe about podoconiosis diseases

According to this study finding, from 100 cases of podoconiosis patients 66 of podoconiosis
patients them believed that they have been experienced isolation by different people. As reported
by the podoconios these patients this case had effect on individual daily activity and so on in the
community. Again about 53 and 89 of them reported that as podoconiosis is a curable and
preventable disease respectively. As tThe respondents of the control groups responded 68 of
them believed there is isolation and 82 of them assumed as podoconiosis has effect on
individuals. But only 32 of them believed as podoconiosis is curable disease and 85 responded as
it can be prevented.

Factors associated with podoconiosis respondents

Variable assignment during regression was coded as 0, 1 and 2. Those assigned under 0 were
cannot write and read, other occupation, poor/very poor relationship, no response, childhood age.
And 1 represented elementary (primary school), farmers, good/very good response, yes response,
and adulthood age response while 2 represented high school and above for educational status
only. Bivariate and multivariablte logistic regression was performed in order to identify the
strength of association and to assess factors associated with the podoconiosis. The variables that
showed less than 0.25 of p-value were reanalyzed in the multivariablte logistic regression and
some predictors were identified by controlling confounding factors. Comparing male and female
cases and controls there was no statistically significant difference.

The study subjects who found under elementary school were 6.37 times more likely to know
about Podoconiosis than those who didn’t get formal education (can’t write and read)
(p=0.001;AOR=6.37,95%CI(2.163-18.782)

The study subjects who found under high school and above were 3.89 times more likely to know
about Podoconiosis than those who were below school and didn’t get formal education level
(p=0.005; AOR=3.89, 95% CI (1.507-10.054).
The participants, who work on farm, were 31.6% lessmore likely to develop Podoconiosis than
those
work other activities (p=0.004;COR=.316, 95%CI(.143-.698)
 The odds of Podoconiosis was 86.8% lower among persons relationship on the family living with
podoconiosis in the family (p=0.001; AOR 0.132: 95% CI 0.061-0.287). Not wearing shoes
during childhood increases decreases the risk of Podoconiosis by 63.8% (p=0.001; AOR .362:
95% CI .196 - .669). The odd of Podoconiosis was 76.6% higher lower among people with low
income (P= 0.018; AOR 0.234; 95% CI: 0.070-0.783) than those???.
The participants, who responded yes on the cure about podoconiosis, were 66.6% less likely to
know about Podoconiosis curability than those who responded no (p=0.001, AOR=.334, 95%CI
(.179-.624).

Table 3: Factors associated with podoconiosis respondents’ case-control study Guliso woredas, West
Wolega, Oromia Region, Western Ethiopia, 2018

Variables Cases Controls COR(95%CI) AOR(95%CI)

Educational level

Can’t write and read 33 17 1 1

Elementary 59 50 8.007(3.038- 6.373(2.163-18.782)
21.102)
High school and above 8 33 4.867(2.061- 3.892(1.507-10.054)
11.496)
Occupation
Farmers 90 74 .316(.143-.698) .605(.224-1.631))
Others 10 26 1 1
Family relationship
Very poor/poor 11 57 1 1
Good/very good 89 43 .093(.044-.196) .132(.061-.287)
Income
Yes 4 16 .219(.070-.680) .234(.070-.783)
No 96 84 1 1
Age for Wearing shoes
Childhood 43 66 1 1
Adulthood 57 34 .389(.219-.689) .362(.196-.669)
Cure
Yes 53 32 .417(.235-.742) .334(.179-.624)
No 47 68 1 1

NB: AOR-Adjusted Odds Ratio; OR-Crude Odds Ratio; CI-Confidence Interval

All are statistically significant p<0.05, except occupation () not statistically significant)

Discussions

In this study, there are factors that have been affecting podoconios respondents both in case and
controls. The mean age of the cases was 42.94 years while the mean age of controls was 40.40
years which indicated that the cases were about two years older than the controls. Age and sex
were grouped under potential factors for the development of Podoconiosis in different studies
and significant factor but in this study they are not significant which might be due to the time of
the study and sampling technique. The experience of wearing shoes did not vary between males
and females in this study which is inconsistent with the previous study. Level of education,
history of farming (occupation), family relationship with podoconiosis patient, income, age for
first shoe and curability of the Podoconiosis were statistically significant predictors for
podoconiosis.

The study subjects who found under elementary school were 6.37 times more likely to know
about Podoconiosis than those who didn’t get formal education (can’t write and read) (p=0.001;
AOR=6.37, 95%CI (2.163-18.782). This finding agrees with previous finding done in Ethiopia(.
The study subjects who found under high school and above were 3.89 times more likely to know
about Podoconiosis than those who were below school and didn’t get formal education level
(p=0.005; AOR=3.89, 95% CI (1.507-10.054). Educational level is a prior risk factor and
outcome of Podoconiosis. This means, when educational level of an individual showed a gap
there is the chance of getting the disease that increases and people tend to stop their education
after the disease onset.
Age of wearing first shoe was significantly associated with the age of onset of Podoconiosis and
one predictor for not wearing during early childhood age. Not wearing shoes during childhood
increases decreases the risk of Podoconiosis by 63.8% (p=0.001; AOR .362: 95% CI .196 - .669).
This finding is consistent with the previous finding on west Ethiopia, East and West Gojam
indicating that most patients might have started wearing shoe after the development of
Podoconiosis that they didn’t do before.
Income is a predictor for podoconiosis and this study assessed the household income however
the study acknowledge that the reported income may be biased because of different cultural and
other barriers including estimation of the income made by the subjects.
Conclusion

Podoconiosis is the disease of all age groups and both sex but it showed significant difference in
educational level, occupation, family relationship, income, age of wearing shoes and curability of
podoconiosis. However, the onset of diseases is not limited on age as well as sex but which is
based on prolonged soil-foot exposure on both factors. According to this finding, educational
level, occupation (being farmer), family relationship, income, age of first shoes wearing,
curability about podoconiasis was strongly associated with podoconiosis.
Strength and Limitations of the study

Community based household survey identified that the problem of the podoconiosis cases in the
five randomly selected Kebeles for the future intervention and might be the generalizability for
the zonal health bureau that they can react on the case with the regional and federal health
bureau. The main limitation of this study is recall bias because to make it more clear for the
respondents the interviewer asked them repeatedly.

Recommendation

Advocacy for shoes as a health intervention and effort should focus to address the community,
the policy makers and other concerned bodies on education & awareness creation. For those
individuals who cannot afford to buy shoes, support financially distribution – possibly by means
of collaboration with shoe companies be supposed to be considered. Extending similar
collaborations to other shoe companies would be beneficial. By using as opportunity on
observed increased shoe wearing practice educating of the community is needed. Effective
prevention could be possible based on early age shoe wearing, foot washing practice and
appropriate utilization of shoes. Podoconiosis control and prevention programmes should involve
the low income and uneducated populations. Establishing anti-Podoconiosis, doing with
woredas, zonal, regional and federal health bureaus as needed for the community.
Finally, continued research should focus on the development of good point-of-care diagnostic
tests for podoconiosis, which are needed both to detect new cases and, ultimately, to verify
elimination and Scholars should test the effect of all these variables with further longitudinal
studies.

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DATA COLLECTION INSTRUMENT ENGLISH QUESTIONNAIRE

English questionnaire to assess associated factors of podoconoisis patient among 15-64 age
group,Kebele -------------------------------- Interviewer No. ------------------------Interviewee No.
-------Woreda/Town------------------------ Date of interview----------------

PARTI.QUESTION TO ASSESS DEMOGRAPHIC CHARACTERSTICS AMONG STUDY PARTICIPANTS.

S.No Questionns Responed Skip

1 Sex Male

Female

2 Age at interview in completed year? 15-24

25-34

35-44

45-54

55-64

>65+

3 Where do you live/ Area of residence/? Urban

Rural

4 What is your level of education? Cannotread and write

Elementery(1-8)

Secondary(9-12)

Diploma (level1-4)

Higher education(BSc and above)

5 What is your marital status? Single

Marired

Widowed

Divorced

Separated

Others

6 What is your occupation? Farmer

Merchant

Daily laborer

Government employee
 Other

7 What is your religion Orthodox

Protestant

Muslim

Catholic

Others

8 What is your Ethinicity Amhara

Oromo

Gurage

Tigrai
Others
9 Family size 1-4

>5

10 Family podoconosis status Eiither father or mother have

Father and Mother have

Only One Child have

More than one children have

11 How is Family relationships with you Very poor

because of podoconiosis ?
Poor

Neither poor nor good

Good

Very good

Changed for the better

Changed for the worse

12 Do you know your daily income? Yes

 No

II Questions associated with on daily bases practices of podoconoisis patients on

hygien of foot care.

S.N Questions Responed Skip

o
1 Do you wear Shoses daily? Yes

No
2 If yes at what age did you started to wear At child hood/5/years
shoes?

At school age/6-7/ years

At todler age /7-13/ years

At adult hood >15 years

3 Does the patient worn shoes at interview time? Yes

No
4 Do you have access to get water for washing Yes
your foot/Leg/?

No
5 How long you walk to get water from water <10 munits
source?

15-30 munits

>30 munits
6 Do you have experience of walking bare foot Yes
before ?

No
7 If yes when did you have experienced walking During ploughing/farming/
bare foot?

In the field
 At home

At any time

8 Do you have access of healthy services at your Yes

near-by local area when you get sick ?

No
9 If yes,How far your house from healthy facility <5 km
in km ?
5-10 km
>10km

III Questions related to podoconoisis patient’s belive on Podoconosis

S.N Questions Responed Skip

o
1 Do you think that you have experienced of Yes
isolation by people before?
No
2 Do you think that being podoconosis patient Yes
can have effect on the individual?
No
3 Do you think that podoconosis disease is Yes
curable?
No
4 Do you think that podoconoisis disease is Yes
preventable? No
Gaafilee afaan oromoon.
Gaafilee afaan oromoon sakatainsa waantota dhibee miila dhiitaa(podoconoisis)
qaban namoota umurii(15-64) Omishtumaa keessa jiraniif.

GAREE I Amaloota sociodemoraphic hirmaatota.

T Gaafilee Deebii Bira darbi

Lakk
1 Saala Dhiira
Dhalaa
2 Umurii yeroo gaaffin kun guutamu 15-24
25-34
35-44
45-54
55-64
>65+
3 Bakka jireenyaa kee eessa? Magaala
 Baadiyaa
4 Sadarkaa barnoota kee meeqa ? Barresuu fi dubbisuu hidanda’u.

Sadarkaa tokkoffaa(1-8)

Sadarkaa lamaffaa (9-12)

Diplomaaa (Sadarkaa I-V)

Barnoota olaanaa (BSC fi isaa oli)

5 Haala bultii ijaarachuu kee? Hinfuune

Fuudheera

Kan irraa du’e/duute

kan hike

Addaan ba’anii jiru.

Knan biro
6 Hojiin kee maali? Qotee bulaa

Daldalaa
Hojjetaa guyyaa
Hojjetaa mootumaa
7 Amantiin kee maali? Orthodoksii

Protestants
Musliima

kaatolikii
kan biro
8 Lammumaan kee maali? Amaara
Oromooo
Guragee

Tigiraay

kan biro
9 Baayina maatii keessanii hoo? 1-4
 >5
10 Haala dhibee miila dhiitaa / Abbaan ni qaba
podoconiosis/ maatii keeti? Haati ni qabdi
Lammanuu qabu
,Abbaa Haadha fi ijoollee keesa tokko

11 Sababa dhibee podoconiosis tiif /qabani.

Baayyee gadi bu’aa dha.
walitti dhufeenya maatii waliin qabu?
Gadi bu’aa dha.
Gadi bu’aas, gaariis miti
Gaarii dha
Baayyee gaarii
12 Sababa dhibee podoconiosis tiif walitti Jijiiramnni hinjiru.
dhufeenya maatii jijjiramnni maatii
keessati yoo jiraate?
Jijjiirama waan gaariif ta’e
Jijjiiram waan gaaarii hintaaneef
13 Galii kee guyyaa beektaa? Eeyyee
Lakki
Garee II Gaaffilee waantota dhibamaan dhibee podoconosis ta’e tokko guyyaa
guyyaan raawwatu qulqulinq miila isaaf

T/L Gaafilee Deebii Bira darbi

akk
1 Yeroo hunda Kophee ni ka’ataa? Eeyyee

Lakki
2 Yoo deebbiin kee eeyyee ta’e umurii meeqatti Yeroo mucumaat waggaa
kophee ka’achuu eegalte? <5
Yeroo umurii barnootaa
Waggaa 6-7
Yeroo saafilummaa 7-13

Yeroo dargagumaa >15

years
3 Yeroo gaaffiin kun gaafatameti kophee ka’ate Eeyyee
jira?
Lakki
4 Miilla kee dhiqachuuf bishaan ga’a Eeyyee
argataayoo?

Lakki
5 Fageenya hagam deemta bishaan argachuufi? <10 daqiiqaa

15-30 daqiiqaa
>30 daqiiqaa

6 Shaakala miilla qullaa deemuu qabdaayoo kana Eeyyee

dura?

Lakki
7 Yoo deebiinkee eeyyee ta’e gaafii lakk 6 Yeroo hojii qottisaa
fyoomfa’a miilla qullaa deemta turte?
Dirree keessa

Yeroo mana turu

Yeroo kamlee
8 Tajaajila fayyaa naannoo keettii ni arggataa Eeyyee
yeroo si dhukkubu?
Lakki
9 Yoo gaafii lakk 9 f deebiinkee eeyyee ta’e <5 km
fageenya hagamii km ta’a?
5-10km
>10km
Garee III gaafii dhibamaa dhibee podoconoisis ilaalatu.

T/L Gaafilee Deebii Bira darbi

a
1 1 Namootaan adda qoodinsi sirra ga’e beektaa Eeyyee
kana dura?
Lakki
2 Dhibamaa dhibee miillaa /podoconosis/ ta’uun Eeyyee
dhiibbaa qaba jettee hinyaadda? Lakki
3 Dhibeen miillaa /podoconosis/ irra fayyuun ni Eeyyee
danda’ama jettee hin yaadda?
Lakki
4 Dhibeen miillaa /podoconosis/ ittisuun ni Eeyyee
danda’ama jettee ni yaadda?
Lakki
 Curriculum vita
Personal information

Name Muleta Olana Tolasaa

Sex Male

Birth of place West Wolega Aira

Address West Wolega, Aira

Date Jannuary 21,1974 GC

Nationality Ethiopian

Phone No 0912053339

E-mail muleteolana@gmail.com

Educational and Training

Education Elementary School Ifa Suchi 1979-1983EC

Secondary School Lalo Aira Secondary School 1983EC

Desie Health Assistant School 1984 EC

Diploma Nurse at Nekemte Health Science college 1998 EC

BSc in public Health from Jima University 2003 EC

Work Experience 20 years

Worked at Lalo kile Woreda at Clinic level from1986-1997 EC

At Guliso Woreda /Guliso Health center from march 1998-1099EC

At Aira Woreda vice health office 2000-2001EC

Aira health center up to now

Training Participatory project planning and Management Nov 20-December 02 2006at adama ci

TOT Long term famil planning

Skills

Languages speaking Listening writhing

Amaharic perfect perfect perfect

English perfect perfect perfect

Oromifa perfect perfect perfect

 APPROVAL SHEET

HARAMAYA UNIVESTY

POSTGARADUATE POROGRAM DIRECTORATE

Title:factors associated podoconisis in Guliso woreda, West Wolega, Oromia Region, Western Ethiopia :
community based case control study .

Submitted by

___________________________ ___________________________ _______________

Name of student signature Date

Approved by

1_____________________ _______________ _________________

Major Advisor signature Date

2 ________________________ _________________________ _________________

Co-Advisor signature Date

3________________________ __________________________ _________________

Research Thematic Area Leader signature Date

4 ________________________ ____________________________ _______________

Chairman, ,DGS/SGS signature Date

5________________________ _____________________________ _______________

PGPD signature Date