Rural youths' understanding of gene x environmental contributors to heritable health conditions: The case of podoconiosis in Ethiopia

Objectives: Assess the feasibility of engaging youth to disseminate accurate information about gene by environmental (GxE) influences on podoconiosis, a neglected tropical lymphedema endemic in southern Ethiopia. Methods: A cross sectional survey was conducted with 377 youth randomly selected from 2 districts of Southern Ethiopia. Measures included GxE knowledge (4 true/false statements), preventive action knowledge (endorse wearing shoes and foot hygiene), causal misconceptions (11 items related to contagion) and confidence to explain GxE (9 disagree/agree statements). Results: Over half (59%) accurately endorsed joint contributions of gene and environment to podoconiosis and preventive mechanisms (e.g., wearing protective shoes and keeping foot hygiene). Multivariable logistic regression showed that youth with accurate understanding about GxE contributors reported having: some education, friends or kin who were affected by the condition, and prior interactions with health extension workers. Surprisingly, higher accurate GxE knowledge was positively associated with endorsing contagion as a causal factor. Accuracy of GxE and preventive action knowledge were positively associated with youth’s confidence to explain podoconiosis-related information. Conclusions: Youth have the potential to be competent disseminators of GxE information about podoconiosis. Interventions to foster confidence among youth in social or kin relationships with affected individuals may be most promising. Efforts to challenge youth’s co-existing inaccurate beliefs about contagion could strengthen the link of GxE explanations to preventive actions. Author summary: This study considers the feasibility of engaging rural Ethiopian youth as lay health workers (LHWs) with the objective to improve community understanding of the joint influences of genetics and environment on health. Identifying LHWs to accurately convey contributors to the heritable but preventable neglected tropical disease of podoconiosis provides an optimal context to address this question. Misunderstanding that inherited susceptibility to podoconiosis makes the disease unavoidable has led to numerous negative social consequences (e.g., stigma) and poor uptake of protective footwear. We report data from a pilot study that included a cross-sectional survey of youth ages 15–24 in rural communities with endemic podoconiosis. Results provide preliminary support that a sizeable group of youth hold accurate knowledge about gene x environment influences and self-evaluate as being confident to explain these associations to others. Research to evaluate strategies to engage youth as LHWs and the impact of these approaches on communities’ understanding of the joint influences of genetics and environment in this context is needed. This manuscript fills an important gap in the literature about neglected tropical diseases, as it suggests opportunities to improve the prevention of podoconiosis and reduce misconceptions and stigma through engagement of LHWs in Ethiopia.