<p>The abstract covers an interesting topic, there is need for the author to further explain the unique lifestyle and practices that are assoviated with persons exhibiting the said determinants such barefoot, being female and being aged 40+. This will enhance the content of the abstract and making it a worthwhile discussion topic.</p><p>it would also be prudent to understand Machakel woreda in terms of geographical location,socioeconomic status and ways of life of the persons, i recommend that the author reviews again this content with an intention of describing what has been done before in areas affected by the disease and what remains the gap, and why this specific woreda provides a solution with the results that requires attention.</p>