Preventing recurring painful attacks

Why this intervention

Fewer attacks, more days without acute pain

Podoconiosis is a non-infectious form of leg swelling linked to prolonged barefoot exposure to irritant soil. WHO describes painful acute attacks that can leave people bedbound for 3–5 days. [P3]

The GoLBeT randomized trial enrolled 696 adults in northern Ethiopia. A supported self-care package reduced the attack rate from 23.9 to 19.4 per person-year, a difference of 4.5 attacks. The reported 95% confidence interval for that reduction was 3.8–5.1. [P1]

The package combined hygiene, skin care, exercise, elevation, footwear and bandaging where appropriate, supported by monthly community meetings. The comparator received no added package during the first year. [P1] This is a care program, not the effect of buying shoes alone.

Participants recorded attacks in validated diaries and knew their treatment assignment. Effects varied by setting and sex. [P1] The trial supports fewer attacks in a similar population; it does not directly measure USU or guarantee the same reduction in a new program.

What the estimate includes

This is gross acute benefit. It does not subtract the burden of daily self-care or all treatment harms. It also gives no extra credit for shortening attacks that still occur.

Explore the estimate

What could a foot-care budget help prevent?

These scenarios change several inputs together. The trial’s statistical confidence interval does not cover uncertainty in delivery costs, intensity, duration or transfer to a future program.

Evidence and judgment

What supports the inputs?

Cost: the main information gap

The companion economic study reported 2,419 Ethiopian birr per participant, including 529 for supplies and 1,890 for delivery and training. Its converted figure, I$314, uses 2016 purchasing-power-parity international dollars. Research and delivery expenses could not be fully separated. [P2]

I$314 is not US$314. We retain those historical figures as context and do not convert them using today’s exchange rate. They show why a supplies-only price would miss much of the program.

Our $200 allowance is an illustrative WSI planning choice, not a price derived from that study. We intend it to cover a year of supplies, staff support, training, transport and administration. The $100 and $300 alternatives test how much this unknown matters; none is a verified current quote. Patient time and household costs are outside this provider-budget calculation.

With all other central choices fixed, a $100 yearly cost would give 10.3 USU per $100, while $300 would give 3.4. A current, itemized provider budget is the most useful next refinement.

Effect: retain half of the trial reduction

We apply 50% of the observed 4.5-attack annual reduction, or 2.25 fewer attacks per additional participant-year. This is a judgment about a future program’s population, implementation and access to comparable care. It is not a measured probability of success or a proven conservative bound.

The trial estimate already reflects adherence within its study population. We do not multiply by another success or adherence rate. The calculation assumes the supported care is additional to what would otherwise happen.

Duration: one simple three-day attack

WHO’s description of 3–5 bedbound days gives context for choosing a three-day course. [P3] It does not establish the arithmetic mean of suffering days in the trial or in future care. This duration is a modeling choice. Doubling it would double the USU result, with other inputs fixed.

Intensity: an unvalidated average

We use 3 on the WSI 0–10 intensity scale, averaged across the whole attack, including sleep and milder periods. Severe peaks need not last all day. The alternatives are 2 and 4. Neither the trial nor the WHO description calibrates these values against kidney-stone pain; they are explicit WSI judgments.

Harms: left unestimated

The trial reported no serious intervention-related adverse events, while noting that minor events could have been missed. [P1] We do not infer that treatment is burden-free. Daily self-care, treatment discomfort and adverse effects would need their own estimates before calling this net benefit.

Follow the calculation

From supported care to avoided attacks

1. Estimate additional full-year care

   Use the $200 planning assumption per participant for one year.

   $100 ÷ $200 = 0.5 full-year participant equivalents

2. Count attacks prevented in that year

   Apply half of the trial’s annual attack-rate reduction.

   0.5 × 4.5 attacks × 50% = 1.125 attacks prevented

3. Assign the same suffering profile to each avoided attack

   Use three days at an average intensity of 3. Only acute attack days are counted, not every day of the year.

   1.125 × 3 days × 24 hours × 3 ÷ 47.25
   = 5.14 USU of acute suffering averted

Calculations retain full precision before rounding. One USU is the stipulated six-hour kidney-stone pain reference of 47.25 intensity-hours, using linear weighting (p = 1). It supplies a shared scale, not empirical validation of these assumptions. Read about the reference

Current work · reviewed 18 October 2026

A current field of work, with funding details still to establish

Footwork International brings partners together to prevent and treat podoconiosis and has published a 2026–2031 strategy. Its website provides a donation route. [P4]

We have not verified a remaining funding gap, a current full-year delivery cost or the share of new donations that would fund this particular care package. The model therefore describes conditional program spending. It does not estimate the effect of giving $100 to Footwork or another organization.

Explore Footwork’s work →

A donation-linked estimate would need a delivery budget and evidence that additional funding expands care. No organization has endorsed this USU model.

Inspect and improve

Sources and reproducible inputs

1. Negussie et al. (2018): GoLBeT randomized trialPrimary attack-rate effect, Table 2; trial design and limitations. DOI: 10.1016/S2214-109X(18)30124-4.
2. Hounsome et al. (2019): GoLBeT economic evaluationCosting methods, Table 1 and intervention-cost results. Historical ETB and 2016 PPP international dollars, not current US dollars.
3. WHO (2023): Podoconiosis fact sheetCondition, painful acute attacks and care context. Does not supply a USU intensity.
4. Footwork International: current work and 2026–2031 strategyReviewed 18 October 2026. Active public initiative and donation route; no verified current delivery price or remaining funding gap.

The package includes inputs, a scenario CSV and a dependency-free Python calculation. Unestimated outcomes use null, not zero. Model v0.1 · 18 October 2026.

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