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

Trop Med Int Health. 2008 Oct;13(10):1277-83. doi: 10.1111/j.1365-3156.2008.02133.x. Epub 2008 Aug 20.


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

Methods: 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.

Results: 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).

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

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aluminum Silicates
  • Clay
  • Elephantiasis / pathology*
  • Ethiopia
  • Female
  • Foot Diseases / pathology*
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • Reproducibility of Results
  • Risk Factors
  • Sensitivity and Specificity
  • Soil


  • Aluminum Silicates
  • Soil
  • Clay