Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study

Abstract

BackgroundEthiopia bears a high burden of visceral leishmaniasis (VL). Early access to VL diagnosis and care improves clinical prognosis and reduces transmission from infected humans; however, significant obstacles exist. The approximate 250,000 seasonal mobile workers (MW) employed annually in northwestern Ethiopia may be particularly disadvantaged and at risk of VL acquisition and death. Our study aimed to assess barriers, and recommend interventions to increase access, to VL diagnosis and care among MWs.Methodology/Principal findingsIn 2017, 50 interviews and 11 focus group discussions were conducted with MWs, mobile residents, VL patients and caretakers, community leaders and healthcare workers in Kafta Humera District, Tigray. Participants reported high vulnerability to VL among MWs and residents engaged in transitory work. Multiple visits to health facilities were consistently needed to access VL diagnosis. Inadequate healthcare worker training, diagnostic test kit unavailability at the primary healthcare level, lack of VL awareness, insufficient finances for care-seeking and prioritization of income-generating activities were significant barriers to diagnosis and care. Social (decision-making and financial) support strongly and positively influenced care-seeking; workers unable to receive salary advances, compensation for partial work, or peer assistance for contract completion were particularly disadvantaged. Participants recommended the government/stakeholders intervene to ensure: MWs access to bed-nets, food, shelter, water, and healthcare at farms or sick leave; decentralization of diagnostic tests to primary healthcare facilities; surplus medications/staff during the peak season; improved referral/feedback/reporting/training within the health system; free comprehensive healthcare for all VL-related services; and community health education.Conclusions/SignificanceContrary to what health policy for VL dictates in this endemic setting, study participants reported very poor access to diagnosis and, consequently, significantly delayed access to treatment. Interventions tailored to the socio-economic and health needs of MWs (and other persons suffering from VL) are urgently needed to reduce health disparities and the VL burden.

Exploring global and country-level barriers to an effective supply of leishmaniasis medicines and diagnostics in eastern Africa: a qualitative study

“…All barriers related to the VL medicines supply chain inevitably affect VL diagnostics, mainly rK39 RDTs. Despite the suboptimal performance of RDT and worse for patients with VL/HIV,22 51–53 RDTs remain valuable for eastern Africa contexts, where delays in diagnosis remain an unaddressed needs 27 54. Unfortunately, in eastern Africa, not all brands of rK39 RDTs perform equally well and improved field-adjusted diagnostic tool is urgently needed 22 55…”

Protecting the neglected from disease: the role of gender, health equity and human rights in the fight against neglected tropical diseases

“…Discrimination also extends to access to diagnosis and treatment for certain marginalised groups. For example, Coulborn et al (2018) report that mobile workers in Ethiopia are more vulnerable than non-mobile workers because of insufficient familial support or as a result of transitory lifestyle or a lower socioeconomic class. The decision of mobile workers to seek care is typically associated with a loss of income and their illness is often not diagnosed or treated properly due to the visits with different healthcare providers (Coulborn et al 2018a).…”

“…® Access: Specific populations such as women, children, migrants, ethnic minorities, elderly, disabled, or mobile populations should benefit from greater attention as they encounter greater barrier to access NTD diagnosis and treatment (Coulborn et al 2018b). For example, permanent local clinics or mobile clinics should be established.…”

“…For example, permanent local clinics or mobile clinics should be established. Similarly, governments could encourage farm owners to offer fair contracts that allow for paid sick leave, salary advances (Coulborn et al 2018b). For example, local manufacturing of anti-venoms is desirable since their efficacy is greater when they derive from local snake species.…”

“…Where possible, the protocol to deliver NTD treatment should be simplified to ensure that drugs can reach the patient. This is particularly true for mobile workers (Coulborn et al, 2018) and populations in areas of conflicts (Beyrer et al, 2017). Similarly, in countries where NTDs are not endemic such as Europe, the access to drugs for NTDS should be simplified and immigrants systematically screened for such diseases (Cenderello et al 2016).…”