Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis)
Identifieur interne : 006F97 ( Main/Curation ); précédent : 006F96; suivant : 006F98Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis)
Auteurs : Fasil Tekola [Royaume-Uni] ; Zewdu Ayele [Éthiopie] ; DEREJE HAILE MARIAM [Éthiopie] ; Claire Fuller [Royaume-Uni] ; Gail Davey [Éthiopie]Source :
- TM & IH. Tropical medicine & international health [ 1360-2276 ] ; 2008.
Descripteurs français
- KwdFr :
- MESH :
- anatomopathologie : Maladies du pied, Éléphantiasis.
- Pascal (Inist)
- Wicri :
- geographic : Éthiopie.
- topic : Classification.
English descriptors
- KwdEn :
- Adolescent, Adult, Aluminum Silicates, Classification, Elephantiasis, Elephantiasis (pathology), Ethiopia, Female, Foot Diseases (pathology), Humans, Lymphedema, Male, Middle Aged, Observer Variation, Podoconiosis, Reproducibility of Results, Risk Factors, Sensitivity and Specificity, Soil, Tropical medicine.
- MESH :
- chemical : Aluminum Silicates, Soil.
- geographic : Ethiopia.
- pathology : Elephantiasis, Foot Diseases.
- Adolescent, Adult, Female, Humans, Male, Middle Aged, Observer Variation, Reproducibility of Results, Risk Factors, Sensitivity and Specificity.
Abstract
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.
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i1="02"><s1>Department of Dermatovenereology, ALERT & Tikur Anbessa Hospitals</s1><s2>Addis Ababa</s2><s3>ETH</s3><sZ>2 aut.</sZ></inist:fA14><country>Éthiopie</country><wicri:noRegion>Addis Ababa</wicri:noRegion></affiliation></author><author><name sortKey="Dereje Haile Mariam" sort="Dereje Haile Mariam" uniqKey="Dereje Haile Mariam" last="Dereje Haile Mariam">DEREJE HAILE MARIAM</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Otona Hospital</s1><s2>Wolaita Sodo</s2><s3>ETH</s3><sZ>3 aut.</sZ></inist:fA14><country>Éthiopie</country><wicri:noRegion>Otona Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Fuller, Claire" sort="Fuller, Claire" uniqKey="Fuller C" first="Claire" last="Fuller">Claire Fuller</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>East Kent Hospitals NHS Trust</s1><s2>Canterbury</s2><s3>GBR</s3><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>East Kent Hospitals NHS Trust</wicri:noRegion></affiliation></author><author><name sortKey="Davey, Gail" sort="Davey, Gail" uniqKey="Davey G" first="Gail" last="Davey">Gail Davey</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>School of Public Health, Addis Ababa University</s1><s3>ETH</s3><sZ>5 aut.</sZ></inist:fA14><country>Éthiopie</country><wicri:noRegion>School of Public Health, Addis Ababa University</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">TM & IH. Tropical medicine & international health</title><title level="j" type="abbreviated">TM IH, Trop. med. int. health</title><idno type="ISSN">1360-2276</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">TM & IH. Tropical medicine & international health</title><title level="j" type="abbreviated">TM IH, Trop. med. int. health</title><idno type="ISSN">1360-2276</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aluminum Silicates</term><term>Classification</term><term>Elephantiasis</term><term>Elephantiasis (pathology)</term><term>Ethiopia</term><term>Female</term><term>Foot Diseases (pathology)</term><term>Humans</term><term>Lymphedema</term><term>Male</term><term>Middle Aged</term><term>Observer Variation</term><term>Podoconiosis</term><term>Reproducibility of Results</term><term>Risk Factors</term><term>Sensitivity and Specificity</term><term>Soil</term><term>Tropical medicine</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Biais de l'observateur</term><term>Facteurs de risque</term><term>Femelle</term><term>Humains</term><term>Maladies du pied (anatomopathologie)</term><term>Mâle</term><term>Reproductibilité des résultats</term><term>Sensibilité et spécificité</term><term>Silicates d'aluminium</term><term>Sol</term><term>Éléphantiasis (anatomopathologie)</term><term>Éthiopie</term></keywords><keywords scheme="MESH" type="chemical" xml:lang="en"><term>Aluminum Silicates</term><term>Soil</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Ethiopia</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Maladies du pied</term><term>Éléphantiasis</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Elephantiasis</term><term>Foot Diseases</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Observer Variation</term><term>Reproducibility of Results</term><term>Risk Factors</term><term>Sensitivity and Specificity</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Biais de l'observateur</term><term>Facteurs de risque</term><term>Femelle</term><term>Humains</term><term>Lymphoedème</term><term>Eléphantiasis</term><term>Classification</term><term>Mâle</term><term>Médecine tropicale</term><term>Podoconiose</term><term>Reproductibilité des résultats</term><term>Sensibilité et spécificité</term><term>Silicates d'aluminium</term><term>Sol</term><term>Éthiopie</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Éthiopie</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Classification</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><double idat="1360-2276:2008:Tekola F:development:and:testing"><INIST><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis)</title><author><name sortKey="Tekola, Fasil" sort="Tekola, Fasil" uniqKey="Tekola F" first="Fasil" last="Tekola">Fasil Tekola</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Brighton and Sussex Medical School</s1><s2>Brighton</s2><s3>GBR</s3><sZ>1 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Brighton and Sussex Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Ayele, Zewdu" sort="Ayele, Zewdu" uniqKey="Ayele Z" first="Zewdu" last="Ayele">Zewdu Ayele</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Dermatovenereology, ALERT & Tikur Anbessa Hospitals</s1><s2>Addis Ababa</s2><s3>ETH</s3><sZ>2 aut.</sZ></inist:fA14><country>Éthiopie</country><wicri:noRegion>Addis Ababa</wicri:noRegion></affiliation></author><author><name sortKey="Dereje Haile Mariam" sort="Dereje Haile Mariam" uniqKey="Dereje Haile Mariam" last="Dereje Haile Mariam">DEREJE HAILE MARIAM</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Otona Hospital</s1><s2>Wolaita Sodo</s2><s3>ETH</s3><sZ>3 aut.</sZ></inist:fA14><country>Éthiopie</country><wicri:noRegion>Otona Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Fuller, Claire" sort="Fuller, Claire" uniqKey="Fuller C" first="Claire" last="Fuller">Claire Fuller</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>East Kent Hospitals NHS Trust</s1><s2>Canterbury</s2><s3>GBR</s3><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>East Kent Hospitals NHS Trust</wicri:noRegion></affiliation></author><author><name sortKey="Davey, Gail" sort="Davey, Gail" uniqKey="Davey G" first="Gail" last="Davey">Gail Davey</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>School of Public Health, Addis Ababa University</s1><s3>ETH</s3><sZ>5 aut.</sZ></inist:fA14><country>Éthiopie</country><wicri:noRegion>School of Public Health, Addis Ababa University</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">08-0481263</idno><date when="2008">2008</date><idno type="stanalyst">PASCAL 08-0481263 INIST</idno><idno type="RBID">Pascal:08-0481263</idno><idno type="wicri:Area/PascalFrancis/Corpus">000369</idno><idno type="wicri:Area/PascalFrancis/Curation">000591</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000400</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000400</idno><idno type="wicri:doubleKey">1360-2276:2008:Tekola F:development:and:testing</idno><idno type="wicri:Area/Main/Merge">007116</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis)</title><author><name sortKey="Tekola, Fasil" sort="Tekola, Fasil" uniqKey="Tekola F" first="Fasil" last="Tekola">Fasil Tekola</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Brighton and Sussex Medical School</s1><s2>Brighton</s2><s3>GBR</s3><sZ>1 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Brighton and Sussex Medical School</wicri:noRegion></affiliation></author><author><name sortKey="Ayele, Zewdu" sort="Ayele, Zewdu" uniqKey="Ayele Z" first="Zewdu" last="Ayele">Zewdu Ayele</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Dermatovenereology, ALERT & Tikur Anbessa Hospitals</s1><s2>Addis Ababa</s2><s3>ETH</s3><sZ>2 aut.</sZ></inist:fA14><country>Éthiopie</country><wicri:noRegion>Addis Ababa</wicri:noRegion></affiliation></author><author><name sortKey="Dereje Haile Mariam" sort="Dereje Haile Mariam" uniqKey="Dereje Haile Mariam" last="Dereje Haile Mariam">DEREJE HAILE MARIAM</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Otona Hospital</s1><s2>Wolaita Sodo</s2><s3>ETH</s3><sZ>3 aut.</sZ></inist:fA14><country>Éthiopie</country><wicri:noRegion>Otona Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Fuller, Claire" sort="Fuller, Claire" uniqKey="Fuller C" first="Claire" last="Fuller">Claire Fuller</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>East Kent Hospitals NHS Trust</s1><s2>Canterbury</s2><s3>GBR</s3><sZ>4 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>East Kent Hospitals NHS Trust</wicri:noRegion></affiliation></author><author><name sortKey="Davey, Gail" sort="Davey, Gail" uniqKey="Davey G" first="Gail" last="Davey">Gail Davey</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>School of Public Health, Addis Ababa University</s1><s3>ETH</s3><sZ>5 aut.</sZ></inist:fA14><country>Éthiopie</country><wicri:noRegion>School of Public Health, Addis Ababa University</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">TM & IH. Tropical medicine & international health</title><title level="j" type="abbreviated">TM IH, Trop. med. int. health</title><idno type="ISSN">1360-2276</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">TM & IH. Tropical medicine & international health</title><title level="j" type="abbreviated">TM IH, Trop. med. int. health</title><idno type="ISSN">1360-2276</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Classification</term><term>Elephantiasis</term><term>Lymphedema</term><term>Podoconiosis</term><term>Tropical medicine</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Lymphoedème</term><term>Eléphantiasis</term><term>Classification</term><term>Médecine tropicale</term><term>Podoconiose</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Classification</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI></INIST><PMC><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis)</title><author><name sortKey="Tekola, Fasil" sort="Tekola, Fasil" uniqKey="Tekola F" first="Fasil" last="Tekola">Fasil Tekola</name></author><author><name sortKey="Ayele, Zewdu" sort="Ayele, Zewdu" uniqKey="Ayele Z" first="Zewdu" last="Ayele">Zewdu Ayele</name></author><author><name sortKey="Hailemariam, Dereje" sort="Hailemariam, Dereje" uniqKey="Hailemariam D" first="Dereje" last="Hailemariam">Dereje Hailemariam</name></author><author><name sortKey="Fuller, Claire" sort="Fuller, Claire" uniqKey="Fuller C" first="Claire" last="Fuller">Claire Fuller</name></author><author><name sortKey="Davey, Gail" sort="Davey, Gail" uniqKey="Davey G" first="Gail" last="Davey">Gail Davey</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">18721188</idno><idno type="pmc">2992944</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992944</idno><idno type="RBID">PMC:2992944</idno><idno type="doi">10.1111/j.1365-3156.2008.02133.x</idno><date when="2008">2008</date><idno type="wicri:Area/Pmc/Corpus">003A47</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003A47</idno><idno type="wicri:Area/Pmc/Curation">003A46</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">003A46</idno><idno type="wicri:Area/Pmc/Checkpoint">003996</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">003996</idno><idno type="wicri:source">PubMed</idno><idno type="wicri:Area/PubMed/Corpus">003163</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">003163</idno><idno type="wicri:Area/PubMed/Curation">003163</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Curation">003163</idno><idno type="wicri:Area/PubMed/Checkpoint">003163</idno><idno type="wicri:explorRef" wicri:stream="Checkpoint" wicri:step="PubMed">003163</idno><idno type="wicri:Area/Ncbi/Merge">002E98</idno><idno type="wicri:Area/Ncbi/Curation">002E98</idno><idno type="wicri:Area/Ncbi/Checkpoint">002E98</idno><idno type="wicri:doubleKey">1360-2276:2008:Tekola F:development:and:testing</idno><idno type="wicri:Area/Main/Merge">006C63</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Development and testing of a de novo clinical staging system for podoconiosis (endemic non-filarial elephantiasis)</title><author><name sortKey="Tekola, Fasil" sort="Tekola, Fasil" uniqKey="Tekola F" first="Fasil" last="Tekola">Fasil Tekola</name></author><author><name sortKey="Ayele, Zewdu" sort="Ayele, Zewdu" uniqKey="Ayele Z" first="Zewdu" last="Ayele">Zewdu Ayele</name></author><author><name sortKey="Hailemariam, Dereje" sort="Hailemariam, Dereje" uniqKey="Hailemariam D" first="Dereje" last="Hailemariam">Dereje Hailemariam</name></author><author><name sortKey="Fuller, Claire" sort="Fuller, Claire" uniqKey="Fuller C" first="Claire" last="Fuller">Claire Fuller</name></author><author><name sortKey="Davey, Gail" sort="Davey, Gail" uniqKey="Davey G" first="Gail" last="Davey">Gail Davey</name></author></analytic><series><title level="j">Tropical medicine & international health : TM & IH</title><idno type="ISSN">1360-2276</idno><idno type="eISSN">1365-3156</idno><imprint><date when="2008">2008</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aluminum Silicates</term><term>Elephantiasis (pathology)</term><term>Ethiopia</term><term>Female</term><term>Foot Diseases (pathology)</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Observer Variation</term><term>Reproducibility of Results</term><term>Risk Factors</term><term>Sensitivity and Specificity</term><term>Soil</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Biais de l'observateur</term><term>Facteurs de risque</term><term>Femelle</term><term>Humains</term><term>Maladies du pied (anatomopathologie)</term><term>Mâle</term><term>Reproductibilité des résultats</term><term>Sensibilité et spécificité</term><term>Silicates d'aluminium</term><term>Sol</term><term>Éléphantiasis (anatomopathologie)</term><term>Éthiopie</term></keywords><keywords scheme="MESH" type="chemical" xml:lang="en"><term>Aluminum Silicates</term><term>Soil</term></keywords><keywords scheme="MESH" type="geographic" xml:lang="en"><term>Ethiopia</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Maladies du pied</term><term>Éléphantiasis</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Elephantiasis</term><term>Foot Diseases</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Observer Variation</term><term>Reproducibility of Results</term><term>Risk Factors</term><term>Sensitivity and Specificity</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Biais de l'observateur</term><term>Facteurs de risque</term><term>Femelle</term><term>Humains</term><term>Mâle</term><term>Reproductibilité des résultats</term><term>Sensibilité et spécificité</term><term>Silicates d'aluminium</term><term>Sol</term><term>Éthiopie</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Éthiopie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Summary</title><sec id="S1"><title>Background</title><p id="P3">Podoconiosis (endemic non-filarial elephantiasis) is a geochemical disease in individuals exposed to red-clay soil. Despite the prevalence and public health importance of podoconiosis, there is as yet no accepted clinical staging system.</p></sec><sec id="S2"><title>Objective</title><p id="P4">We aimed to develop and test a robust clinical staging system for podoconiosis.</p></sec><sec id="S3"><title>Methods</title><p id="P5">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 finally arrived at has five stages according to proximal spread of disease and presence of dermal nodules, ridges and bands. We measured the one-week repeatability and the inter-observer agreement of the final staging system.</p></sec><sec id="S4"><title>Results</title><p id="P6">We have developed a five-stage system that is readily understood by community workers with little health training. Kappa for one-week repeatability was 0.88 (95% CI 0.80 to 0.96), Kappa for agreement between health professionals was 0.71 (95% CI 0.60 to 0.82), while that between health professionals and community podoconiosis agents without formal health training averaged 0.64 (95% CI 0.52 to 0.78).</p></sec><sec id="S5"><title>Conclusions</title><p id="P7">A simple staging system with good inter-observer agreement and repeatability has been developed to assist in the management and further study of podoconiosis.</p></sec></div></front></TEI></PMC></double></record>Pour manipuler ce document sous Unix (Dilib)
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