The health and economic burden of podoconiosis in East Africa: A systematic review and meta-analysis of health outcomes with narrative synthesis of economic evidence

Background: Podoconiosis is a neglected tropical disease (NTD) causing chronic lower limb lymphoedema through prolonged barefoot exposure to irritant volcanic soils. Despite affecting an estimated 4 million people globally, podoconiosis remains absent from the Global Burden of Disease study and severely under-researched relative to its impact. East Africa carries the greatest regional burden, yet no comprehensive synthesis of prevalence, disability-adjusted life years (DALYs), or economic burden data exists for the region. This systematic review and meta-analysis aimed to address this gap by synthesising available evidence on the prevalence and health and economic burden of podoconiosis across East Africa. Methods: We conducted a systematic search of PubMed/MEDLINE, EMBASE, SCOPUS, Web of Science, EconLit, WHO AFROLIB, and Google Scholar for studies published in English between 2011 and 2023. Studies reporting population-based podoconiosis prevalence, DALYs, or economic burden data from East African countries as defined by the UN M49 geoscheme were eligible for inclusion. Grey literature was also searched, including reports, ministry of health documents, and conference proceedings both in English and French, to capture evidence not indexed in academic databases. The search was updated in March 2026 to ensure the most current evidence was captured. Quality assessment was performed using the Newcastle-Ottawa Scale. Prevalence data were pooled using a random-effects model with the DerSimonian-Laird estimator and Freeman-Tukey double arcsine transformation. Subgroup analyses were conducted by country, sample size, and geographic scope. Results: Fourteen studies met the inclusion criteria, comprising 10 from Ethiopia, 2 from Kenya, and 1 each from Uganda and Rwanda, collectively examining 1,720,437 individuals. The overall pooled prevalence was 1.19 (95% CI: 1.14–1.25) on the transformed scale, with extreme heterogeneity (I² = 99.0%). The Ethiopia-specific pooled prevalence was 4.52% (95% CI: 3.92–5.16%), compared to 0.20% (95% CI: 0.10–0.33%) for the non-Ethiopian subgroup, a more than 20-fold difference. A consistent inverse relationship between sample size and observed prevalence was identified across all analyses, reflecting the systematic tendency of smaller studies to target confirmed endemic foci while larger surveys captured broader populations. Only one study Deribe et al. (2020), reported DALY and economic burden estimates, confined to Ethiopia, estimating 172,073 DALYs annually and a total economic burden of US$213.2 million per year. Conclusion: Podoconiosis imposes a substantial but profoundly under-quantified burden across East Africa, with disease intensity disproportionately concentrated in Ethiopian highland communities. The near-complete absence of DALY and economic burden data outside Ethiopia represents a critical evidence gap. Standardised nationally representative surveys, expansion of burden modelling beyond Ethiopia, and advocacy for inclusion of podoconiosis in the Global Burden of Disease study are urgently needed to support evidence-based policy and resource prioritisation across the region. This systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews with the registration number: CRD42023432640. Author summary: Podoconiosis is a preventable disease that causes severe and painful swelling of the lower legs, affecting millions of people living in poverty in tropical highland regions who walk barefoot on volcanic soils. Despite being recognised as a neglected tropical disease by the World Health Organization since 2011, podoconiosis remains largely invisible in global health accounting; it is not included in the Global Burden of Disease study, and receives minimal research funding. We conducted a systematic review and meta-analysis on prevalence of podoconiosis in East Africa and what it costs in terms of health and economic burden. We found 14 studies from four countries – Ethiopia, Kenya, Uganda and Rwanda – but the evidence was heavily concentrated in Ethiopia, which contributed 10 of the 14 studies. Podoconiosis was far more common in Ethiopian highland communities than elsewhere. We also found that only one study had attempted to quantify the disease’s broader health and economic burden and that study was limited to Ethiopia alone. This means that for millions of people living at risk of podoconiosis in Kenya, Uganda, Rwanda, and beyond, we simply do not know the full scale of what this disease costs in lost years of healthy life or in economic productivity. Our findings make a case that podoconiosis deserves more research attention, better funded surveillance systems, and a place in the global frameworks that determine how health resources are allocated.