Our researchers

Dr Kebede Deribe, Intermediate Fellowship

Global Atlas of Podoconiosis
Funded by the Wellcome Trust

I have received a Wellcome Trust Training Fellowship in Public Health and Tropical Medicine and an Intermediate Fellowship in Public Health and Tropical Medicine. My research investigates the spatial aspect of podoconiosis in order to provide an improved evidence-base for the control of podoconiosis at a local and global scale.

Having previously drawn up a map of podoconiosis in Ethiopia, my primary focus is to now advance the mapping and spatial investigation of podoconiosis globally.
I would like to respond to these critical questions:

• What is the global distribution of podoconiosis?
• Are there universal environmental and demographic drivers of podoconiosis that delineate its geographical distribution at a global scale?
• What is the global burden of disease attributed to podoconiosis in disability adjusted life years (DALYs)?
• How much will it cost globally to control or eliminate podoconiosis?

To map the historical distribution of podoconiosis in Ethiopia we collected data from 659 districts, 1,315 communities and 129,959 individuals. Using this data, I was able to identify individual and environmental drivers of the disease, determined the environmental limits and estimated population at risk across Ethiopia. Based on this work, I have also set up endemicity classifications and targets for podoconiosis elimination. All these findings have informed the national podoconiosis control programme and have been included in long-term national plans.

I now hope to develop a Global Atlas of Podoconiosis and provide global estimates of the disease burden associated with podoconiosis, as well as quantitative targets for global control. Podoconiosis is a highly neglected disease, of which there is low awareness among communities and local health workers. Most of the endemic countries are low income countries and mapping the distribution, estimating the global burden and the costs of control will help countries to target the disease in their national plans. The outputs of this work will also be used as an advocacy tool to develop an evidence-based global strategy and case for investment by organisations such as WHO.

Dr Jennifer LeBlond

Mineral trigger/macrophage responses to soil 
Funded by the Wellcome Trust

My role, as a geologist within a team of predominantly medical doctors and epidemiologists, is to investigate the geochemistry of the soils in podoconiosis-endemic areas. Over the past few years, I have collected and analysed hundreds of samples of soils and rock from Ethiopia and Cameroon, using a comprehensive protocol of analysis to identify specific components that could trigger inflammatory changes within the lymphatic system.

Our research has been fundamentally innovative as our team has worked collaboratively, bringing together a variety of disciplines such as public health, epidemiology, earth sciences, social sciences etc., to investigate podoconiosis. Novel protocols have been used to identify and quantify the components in soil samples involved in disease onset and progression and I have used in vitro analysis methods to assess how 'toxic' the soil samples could potentially be in the human body.

Finally, in order to do evaluate all the data within the study and draw conclusions regarding the link between the characteristics of the soil and podoconiosis, we have designed and employed spatial analysis techniques, which have not been previously used.  

Although preliminary, our research indicates that fine clay minerals could potentially play an important role in disease initiation, and we have already challenged the few pre-existing hypotheses regarding the causes of podoconiosis. In addition, we have developed a range of protocols, which combine methodologies from different disciplines, that can be used not only in helping investigate podoconiosis but also other studies where there may be a component within the environment that is linked to poor health outcomes

Members of our team work collectively to investigate both the disease-causing agents and effects of podoconiosis, and we are united in two principle aims: to be able to effectively and efficiently treat patients with the podoconiosis, and eventually eliminate the disease altogether.

Henok Negussie, PhD Student, Ethiopia

Trial of Lymphoedema Management 
Funded by Medical Research Council, Dept for International Development, Wellcome Trust

In 2013, I was appointed as Trial Coordinator on the Gojjam Lymphoedema Best Practice Trial (GoLBet), a project funded by the Wellcome Trust. This highly pragmatic randomised controlled trial (pRCT) aimed to evaluate the effectiveness of simple foot care and hygiene management on acute dermatolymphangioadenitis (ADLA) in podoconiosis lymphoedema. My subsequent PhD application to the Chancellor’s International Scholarship scheme at the University of Sussex was successful and I joined the Wellcome Trust Brighton and Sussex Centre for Global Health Research to study acute adenolymphangitis (ADL) and its management.

ADL is a distressing complication of lymphoedema. Recurrent attacks lead to a more chronic pathology, damaging peripheral lymphatic vessels (fibrosis) and facilitating a progression to elephantiasis. Treatment modalities in podoconiosis are not well defined and thus, my research aims to develop and validate a standard case definition of ADLA, estimating the incidence, duration and social impact of ADLA and measuring the impact of a simple foot care and hygiene management system.

Discussion with health professionals working in different regions of Ethiopia have revealed that foot care and hygiene management procedures vary. A disease recognition and morbidity management tool for patients and health workers is highly likely to inform Ethiopia’s plan to control Neglected Tropical Diseases and, as Dr Kebede Deribe has mapped podoconiosis to an additional 300 woredas (districts) in Ethiopia, the evidence will limit the economic investment needed for Ethiopia to eliminate podoconiosis on a national scale.

In addition, knowledge and experience gained from the conduct of this rare, pragmatic trial will provide me with a unique position to be a trialist in Ethiopia contributing to continued global health research.

Tewodros Tariku, PhD Student, Ethiopia

Replication of Genetic Susceptibility Genes in Ethiopia and Cameroon 
Funded by Medical Research Council

After completing my Masters at Addis Ababa University (AAU) in Microbiology, focusing on immunology of tuberculosis, I joined the Armauer Hansen Research Institute (AHRI), Ethiopia, as a research assistant. I learned that the AHRI was collaborating with the Brighton and Sussex Medical School in podoconiosis genomics research and decided to pursue my doctoral studies in bioinformatics. After expressing my interest to Professor Melanie Newport, I began my PhD studies, based at AHRI and the Institute of Biotechnology at AAU. The podoconiosis project enables me to work on an important but neglected disease (affecting millions in Ethiopia), while developing skills in advanced genomic analysis.

I am working to learn why some individuals develop podoconiosis and others do not, despite their long-term exposure to the irritant soil particles. We have collected DNA samples from patients and healthy controls from three ethnic groups in Ethiopia and conducted a genome-wide association (GWA) study to discover genetic variants that confer susceptibility to the disease.

Preliminary findings from our study corroborate previous reports, which found association between podoconiosis and variants in the HLA type II region of chromosome 6 – a region known for controlling antigen presentation and initiation of the immune response. Validating the findings will create new avenues in podoconiosis research and facilitate our effort to better characterise the pathogenesis of the disease.

Once the involvement of HLA-II in podoconiosis pathogenesis is shown, we hope to conduct functional studies to understand the biological relevance of the associated variants. Doing so will facilitate the search for better treatment and prevention modalities.

Dr Mei L Trueba

Tackling podoconiosis in Central America 
Funded by University of Sussex IRPNF

I am a qualified nurse and socio-cultural anthropologist with a PhD in Development Studies from the Institute of Development Studies (University of Sussex). I joined the Wellcome Trust Centre for Global Health Research in December 2014, taking leadership of the Centre’s MSc in Global Health in August 2015.

My research is predominantly concerned with the politics of health and disease. Since 2008, my main areas of research have been international development, labour relations and medical anthropology, in particular, occupational health and safety in low-and middle-income countries.

Funded by the IRPNF and developed in collaboration with the Universidad del Valle de Guatemala, Pan American Health Organisation and Footwork, the ‘Tackling podoconiosis in Guatemala’ project seeks to understand the extent to which podoconiosis is a neglected public health issue in Guatemala, raise awareness at a local, national and international level, and work towards building a sustainable local infrastructures for elimination.

Abebayehu Tora

PhD Student, Ethiopia
Funded by NIH and BSMSCGHR

The Research Development Fund supports my research 'Exploring health beliefs of young rural children at high risk for podoconiosis in Wolaita Zone, Southern Ethiopia: a qualitative study'. The project aims to describe children's knowledge and understanding of podoconiosis, perceptions of risk, and self-efficacy and expectations of engaging in podoconiosis preventive behaviours. Exploration of these health beliefs among school age children should inform the development of behavioural change programs against podoconiosis in poor rural settings. The study identified various forms of misconceptions, inaccurate risk perceptions, and low confidence among children to engage in podoconiosis preventive behaviors. These findings have highlighted priority areas for further research. In line with this, I have planned to scale up the outcomes of this study in broader intervention research, including diverse cultural and socioeconomic settings where podoconiosis is highly endemic. This will not only broaden our knowledge of how to promote health behavior among children at high risk of podoconiosis and other NTDs, it may also suggest possible strategies that can optimise disease preventive behaviors in poor rural settings.