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Tigabu Daniel,1 Hunachew Beyene,2 Bereket A Tegene1 1Department of Surgery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia; 2Department of Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, EthiopiaCorrespondence: Tigabu Daniel, Email Danieltigabu96@gmail.comBackground: Podoconiosis and lymphatic filariasis are the most frequent causes of elephantiasis.Objective: The purpose of this study is to determine the etiology of Elephantiasis and associated factors in Hawella Tula, Sidama Region Ethiopia.Methods: From February to May 2024, a community-based cross-sectional survey was carried out to determine etiologies of elephantiasis in selected kebeles (the lowest administrative units) in Hawella Tula district, Sidama region, Ethiopia. Seven kebeles were included in the study because elephantiasis cases were quite high, according to woreda’s neglected tropical disease (NTD) information office report. Each respondent was interviewed and physically examined, a filariasis test strip (FTS) antibody test was performed for all elephantiasis cases diagnosed clinically, thick blood film was performed for only FTS-positive cases, and a soil study from selected kebeles (based on office’s report) was conducted to identify the irritant soil mineral responsible.Results: Among the 361 respondents, elephantiasis (Podoconiosis and lymphatic filariasis) accounted for 100 (27.7%). Podoconiosis accounted for 94 (94%) of the 100 elephantiasis cases, whereas lymphatic filariasis accounted for 6(6%). Forty percent of those affected were men, while 60% were women. Walking barefoot raised the chance of developing elephantiasis (AOR=40.088, 95% CI = 8.198, 146.484, P< 0.001). Spending the majority of time outdoor raised the risk of having elephantiasis (AOR=6.252, 95% CI= 3.507, 11.144, P< 0.001) and staying in the district (mentioned kebeles) for prolonged time increased the chance of having elephantiasis (AOR=2.753, 95% CI=1.545, 4.903, P=0.001). Podoconiosis cases observed in Tulla geter (25), Finchawa (25) and Harenfama (16) kebeles were directly related to the greatest proportion of silicon mineral concentration.Conclusion: Both Podoconiosis and lymphatic filariasis were observed as causes of elephantiasis in Hawella Tula district. Further study is recommended, and steps should be made to prevent and treat both causes of elephantiasis.Keywords: neglected tropical disease, Hawassa, Ethiopia, lymphatic filariasis in Hawella Tula