Socio-economic burden, Stigma, and Risk factors of Podoconiosis in Mattu woreda, South west Ethiopia: a community-based mixed-methods study

<title>Abstract</title> <p>Podoconiosis is a neglected tropical disease causing non-filarial lower-limb elephantiasis, primarily triggered by long-term barefoot exposure to volcanic red-clay soil. In Southwest Ethiopia, including Mattu Woreda, high rainfall, topography, and agricultural practices intensify community vulnerability. This study aimed to assess podoconiosis prevalence, socio-economic risk factors, disease-associated economic losses, and stigma dimensions in Mattu Woreda and Town, Ilu Aba Bor Zone. A community-based mixed-methods cross-sectional study was conducted in November 2025 among 363 households selected via multi-stage random sampling. Clinical lower-limb screenings and structured questionnaires assessed disease status, household wealth, water access, and footwear practices. Qualitative Focus Group Discussions and Key Informant Interviews explored social stigma and health-seeking barriers. Logistic regression models identified independent predictors (p &lt; 0.05). Low wealth status (AOR = 2.09, 95% CI: 1.38–5.34), lack of formal education (AOR = 2.23, 95% CI: 1.18–3.82), walking over 30 minutes to a water source (AOR = 2.06, 95% CI: 1.78–7.35), and irregular/barefoot footwear habits (AOR = 3.15, 95% CI: 1.45–6.85) were significant independent risk factors. Patients suffered an average annual productivity loss of 45% (160–180 workdays) due to disability and acute adenolymphangitis (ALA), incurring individual income losses between $63.00 and $136.90 USD annually. Furthermore, 20% to 30% of household income was spent on treatment and hygiene supplies. Only 26.8% of respondents correctly understood disease etiology, while 41.8% believed it was contagious, driving severe marital disruption (&gt; 80%), institutional exclusion, and forced urban displacement. Podoconiosis poses a catastrophic health, economic, and social burden in Mattu Woreda, operating within a severe poverty-disease trap. Addressing this burden requires expanding rural WASH infrastructure within 30 minutes of communities, integrating morbidity management kits at health posts, conducting public anti-stigma campaigns, and providing subsidized protective footwear alongside micro-finance support for affected families.</p>