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Association between footwear use and neglected tropical diseases: a systematic review and meta-analysis.

Tomczyk S, Deribe K, Brooker SJ, Clark H, Rafique K, Knopp S, Utzinger J, Davey G - PLoS Negl Trop Dis (2014)

Bottom Line: No significant association between footwear use and podoconiosis (OR=0.63; 95% CI: 0.38-1.05) was found and no data were available for mycetoma, myiasis, and snakebite.Our results show that footwear use was associated with a lower odds of several different NTDs.Access to footwear should be prioritized alongside existing NTD interventions to ensure a lasting reduction of multiple NTDs and to accelerate their control and elimination.

View Article: PubMed Central - PubMed

Affiliation: Institute of Tropical Medicine, Antwerp, Belgium.

ABSTRACT

Background: The control of neglected tropical diseases (NTDs) has primarily focused on preventive chemotherapy and case management. Less attention has been placed on the role of ensuring access to adequate water, sanitation, and hygiene and personal preventive measures in reducing exposure to infection. Our aim was to assess whether footwear use was associated with a lower risk of selected NTDs.

Methodology: We conducted a systematic review and meta-analysis to assess the association between footwear use and infection or disease for those NTDs for which the route of transmission or occurrence may be through the feet. We included Buruli ulcer, cutaneous larva migrans (CLM), leptospirosis, mycetoma, myiasis, podoconiosis, snakebite, tungiasis, and soil-transmitted helminth (STH) infections, particularly hookworm infection and strongyloidiasis. We searched Medline, Embase, Cochrane, Web of Science, CINAHL Plus, and Popline databases, contacted experts, and hand-searched reference lists for eligible studies. The search was conducted in English without language, publication status, or date restrictions up to January 2014. Studies were eligible for inclusion if they reported a measure of the association between footwear use and the risk of each NTD. Publication bias was assessed using funnel plots. Descriptive study characteristics and methodological quality of the included studies were summarized. For each study outcome, both outcome and exposure data were abstracted and crude and adjusted effect estimates presented. Individual and summary odds ratio (OR) estimates and corresponding 95% confidence intervals (CIs) were calculated as a measure of intervention effect, using random effects meta-analyses.

Principal findings: Among the 427 studies screened, 53 met our inclusion criteria. Footwear use was significantly associated with a lower odds of infection of Buruli ulcer (OR=0.15; 95% CI: 0.08-0.29), CLM (OR=0.24; 95% CI: 0.06-0.96), tungiasis (OR=0.42; 95% CI: 0.26-0.70), hookworm infection (OR=0.48; 95% CI: 0.37-0.61), any STH infection (OR=0.57; 95% CI: 0.39-0.84), strongyloidiasis (OR=0.56; 95% CI: 0.38-0.83), and leptospirosis (OR=0.59; 95% CI: 0.37-0.94). No significant association between footwear use and podoconiosis (OR=0.63; 95% CI: 0.38-1.05) was found and no data were available for mycetoma, myiasis, and snakebite. The main limitations were evidence of heterogeneity and poor study quality inherent to the observational studies included.

Conclusions/significance: Our results show that footwear use was associated with a lower odds of several different NTDs. Access to footwear should be prioritized alongside existing NTD interventions to ensure a lasting reduction of multiple NTDs and to accelerate their control and elimination.

Protocol registration: PROSPERO International prospective register of systematic reviews CRD42012003338.

No MeSH data available.


Related in: MedlinePlus

Forest plot of studies showing the association between footwear use and podoconiosis.**Adjusted effect estimate: Molla et al. [38]. *Inverted Log [odds ratio] and standard error (SE) from effect estimate of barefoot exposure: Deribe et al. [81] and Molla et al. [38]. *Log [odds ratio] and SE calculated from raw data: Price et al. [82], Kloos et al. [35], and Yakob et al. [83].
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pntd-0003285-g008: Forest plot of studies showing the association between footwear use and podoconiosis.**Adjusted effect estimate: Molla et al. [38]. *Inverted Log [odds ratio] and standard error (SE) from effect estimate of barefoot exposure: Deribe et al. [81] and Molla et al. [38]. *Log [odds ratio] and SE calculated from raw data: Price et al. [82], Kloos et al. [35], and Yakob et al. [83].

Mentions: As shown in Table 3, footwear use was mostly measured by self-report. The median proportion of footwear use was: Buruli ulcer (80% for both cases and those without infection), leptospirosis (cases: 40%; without infection: 50%), strongyloidiasis (cases: 25%; without infection: 40%), any STH infection (cases; 60%; without infection: 97%), hookworm infection (cases: 30%; without infection: 50%), podoconiosis (cases: 55%; without disease: 50%), and tungiasis (cases: 30%; without disease: 60%). Our meta-analyses showed that footwear use was significantly associated with a lower odds of Buruli ulcer (OR = 0.15; 95% CI: 0.08–0.29), CLM (OR = 0.24; 95% CI: 0.06–0.96), leptospirosis (OR = 0.59; 95% CI: 0.37–0.94), strongyloidiasis (OR = 0.56; 95% CI: 0.38–0.83), any STH infection (OR = 0.57; 95% CI: 0.39–0.84), hookworm infection (OR = 0.48; 95% CI: 0.37–0.61), and tungiasis (OR = 0.42; 95% CI: 0.26–0.70) (Figures 2–7). On the other hand, footwear use was not significantly associated with the occurrence of podoconiosis (OR: 0.63; 95% CI: 0.38–1.05), as seen in the forest plot of Figure 8. Estimates of I2 varied, including low heterogeneity: strongyloidiasis 0% (95% CI: 0–100%), Buruli ulcer 26% (95% CI: 0–100%); and moderate-to-high heterogeneity: tungiasis 63% (95% CI: 0–100%), leptospirosis 69% (95% CI: 33–100%), any STH infection 74% (95% CI: 51–100%), hookworm infection 74% (95% CI: 57–100%), and podoconiosis 96% (95% CI: 94–96%).


Association between footwear use and neglected tropical diseases: a systematic review and meta-analysis.

Tomczyk S, Deribe K, Brooker SJ, Clark H, Rafique K, Knopp S, Utzinger J, Davey G - PLoS Negl Trop Dis (2014)

Forest plot of studies showing the association between footwear use and podoconiosis.**Adjusted effect estimate: Molla et al. [38]. *Inverted Log [odds ratio] and standard error (SE) from effect estimate of barefoot exposure: Deribe et al. [81] and Molla et al. [38]. *Log [odds ratio] and SE calculated from raw data: Price et al. [82], Kloos et al. [35], and Yakob et al. [83].
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230915&req=5

pntd-0003285-g008: Forest plot of studies showing the association between footwear use and podoconiosis.**Adjusted effect estimate: Molla et al. [38]. *Inverted Log [odds ratio] and standard error (SE) from effect estimate of barefoot exposure: Deribe et al. [81] and Molla et al. [38]. *Log [odds ratio] and SE calculated from raw data: Price et al. [82], Kloos et al. [35], and Yakob et al. [83].
Mentions: As shown in Table 3, footwear use was mostly measured by self-report. The median proportion of footwear use was: Buruli ulcer (80% for both cases and those without infection), leptospirosis (cases: 40%; without infection: 50%), strongyloidiasis (cases: 25%; without infection: 40%), any STH infection (cases; 60%; without infection: 97%), hookworm infection (cases: 30%; without infection: 50%), podoconiosis (cases: 55%; without disease: 50%), and tungiasis (cases: 30%; without disease: 60%). Our meta-analyses showed that footwear use was significantly associated with a lower odds of Buruli ulcer (OR = 0.15; 95% CI: 0.08–0.29), CLM (OR = 0.24; 95% CI: 0.06–0.96), leptospirosis (OR = 0.59; 95% CI: 0.37–0.94), strongyloidiasis (OR = 0.56; 95% CI: 0.38–0.83), any STH infection (OR = 0.57; 95% CI: 0.39–0.84), hookworm infection (OR = 0.48; 95% CI: 0.37–0.61), and tungiasis (OR = 0.42; 95% CI: 0.26–0.70) (Figures 2–7). On the other hand, footwear use was not significantly associated with the occurrence of podoconiosis (OR: 0.63; 95% CI: 0.38–1.05), as seen in the forest plot of Figure 8. Estimates of I2 varied, including low heterogeneity: strongyloidiasis 0% (95% CI: 0–100%), Buruli ulcer 26% (95% CI: 0–100%); and moderate-to-high heterogeneity: tungiasis 63% (95% CI: 0–100%), leptospirosis 69% (95% CI: 33–100%), any STH infection 74% (95% CI: 51–100%), hookworm infection 74% (95% CI: 57–100%), and podoconiosis 96% (95% CI: 94–96%).

Bottom Line: No significant association between footwear use and podoconiosis (OR=0.63; 95% CI: 0.38-1.05) was found and no data were available for mycetoma, myiasis, and snakebite.Our results show that footwear use was associated with a lower odds of several different NTDs.Access to footwear should be prioritized alongside existing NTD interventions to ensure a lasting reduction of multiple NTDs and to accelerate their control and elimination.

View Article: PubMed Central - PubMed

Affiliation: Institute of Tropical Medicine, Antwerp, Belgium.

ABSTRACT

Background: The control of neglected tropical diseases (NTDs) has primarily focused on preventive chemotherapy and case management. Less attention has been placed on the role of ensuring access to adequate water, sanitation, and hygiene and personal preventive measures in reducing exposure to infection. Our aim was to assess whether footwear use was associated with a lower risk of selected NTDs.

Methodology: We conducted a systematic review and meta-analysis to assess the association between footwear use and infection or disease for those NTDs for which the route of transmission or occurrence may be through the feet. We included Buruli ulcer, cutaneous larva migrans (CLM), leptospirosis, mycetoma, myiasis, podoconiosis, snakebite, tungiasis, and soil-transmitted helminth (STH) infections, particularly hookworm infection and strongyloidiasis. We searched Medline, Embase, Cochrane, Web of Science, CINAHL Plus, and Popline databases, contacted experts, and hand-searched reference lists for eligible studies. The search was conducted in English without language, publication status, or date restrictions up to January 2014. Studies were eligible for inclusion if they reported a measure of the association between footwear use and the risk of each NTD. Publication bias was assessed using funnel plots. Descriptive study characteristics and methodological quality of the included studies were summarized. For each study outcome, both outcome and exposure data were abstracted and crude and adjusted effect estimates presented. Individual and summary odds ratio (OR) estimates and corresponding 95% confidence intervals (CIs) were calculated as a measure of intervention effect, using random effects meta-analyses.

Principal findings: Among the 427 studies screened, 53 met our inclusion criteria. Footwear use was significantly associated with a lower odds of infection of Buruli ulcer (OR=0.15; 95% CI: 0.08-0.29), CLM (OR=0.24; 95% CI: 0.06-0.96), tungiasis (OR=0.42; 95% CI: 0.26-0.70), hookworm infection (OR=0.48; 95% CI: 0.37-0.61), any STH infection (OR=0.57; 95% CI: 0.39-0.84), strongyloidiasis (OR=0.56; 95% CI: 0.38-0.83), and leptospirosis (OR=0.59; 95% CI: 0.37-0.94). No significant association between footwear use and podoconiosis (OR=0.63; 95% CI: 0.38-1.05) was found and no data were available for mycetoma, myiasis, and snakebite. The main limitations were evidence of heterogeneity and poor study quality inherent to the observational studies included.

Conclusions/significance: Our results show that footwear use was associated with a lower odds of several different NTDs. Access to footwear should be prioritized alongside existing NTD interventions to ensure a lasting reduction of multiple NTDs and to accelerate their control and elimination.

Protocol registration: PROSPERO International prospective register of systematic reviews CRD42012003338.

No MeSH data available.


Related in: MedlinePlus