Abstract:Background
Neglected Tropical Diseases (NTDs) are a group of several communicable and non-communicable diseases prevalent in tropical and subtropical areas. The co-endemicity of these diseases, the similarity of their clinical signs, and the need to maximize limited financial and human resources suggest the importance of adoptingan integratedapproach to their prevention and treatment.
Aims
This study describes the development of a comprehensive package of physical, mental health and psychosocial care for peo… Show more
“…Several lessons informally documented by IOCC were shared in Theory of Change workshops as part of the EnDPoINT project [ 23 ]. Based on expert suggestions in these workshops and a review of documented lessons, as part of the IMPRESS project, CC was thus added to the holistic care package of the EnDPoINT programme as one of the strategies to enhance health literacy about lower limb lymphoedema, to facilitate utilization of lymphoedema care and to reduce lymphoedema-related stigma [ 24 ].…”
Section: Methodsmentioning
confidence: 99%
“…In response, the EnDPoINT (Excellence in Disability Prevention Integrated across NTDs) project was set up with the aim of developing, standardizing, integrating and scaling-up MMDP care services for three highly stigmatizing NTD conditions found in Ethiopia, namely podoconiosis, LF and leprosy [ 23 ]. EnDPoINT is an implementation research programme focusing on how best to integrate and scale up a holistic MMDP care package (including physical health, mental health and psychosocial care) into government-run primary health care units.…”
Section: Introductionmentioning
confidence: 99%
“…It was implemented over three phases from 2018 to 2021: development of the care package in Phase 1; piloting of the care package in Phase 2; and scale up and integration of the care package into the primary health care system in Phase 3. Details about the EnDPoINT integrated holistic care package are available in previous reports [ 23 , 24 ]. In essence, this care package constituted capacity building, program management, health education, MMDP, and socio-economic rehabilitation.…”
Background
Lower limb lymphoedema (swelling of the lower leg) due to Neglected Tropical Diseases (NTDs) such as podoconiosis, lymphatic filariasis and leprosy is common in Ethiopia, imposing huge burdens on affected individuals and communities. Stigma significantly increases the disease burden and acts as a major barrier to accessing lymphoedema care services. A multi-component stigma reduction intervention was implemented in Northern Ethiopia. Community Conversation (CC) was one of the components implemented, and aimed to reduce stigma and enhance access to and uptake of integrated lymphoedema care services with the active engagement of community members.
Methods
A cross-sectional qualitative process evaluation was conducted to document lessons focusing on CC’s relevance, outcomes and implementation challenges. Data were collected from a total of 55 purposively selected participants (26 from the CC intervention site and 29 from the control site) through key informant interviews, in-depth individual interviews and focus group discussions.
Results
Community Conversations increased acceptability of health messages about lymphoedema and created peer learning opportunities for unaffected community members. Improvement in the awareness of CC participants about the causes, prevention and treatment of lymphoedema contributed significantly to the reduction of stigmatizing attitudes and discriminatory behaviors, thereby improving access to and utilization of lymphoedema care services provided through primary health care facilities. However, a range of challenges affecting implementation of CC and outcome quality were identified, including perceived complexity of the facilitation guide among facilitators, expectation of incentives among CC participants, inadequate implementation of facilitation principles and procedures, inadequacy of supportive supervision, and low engagement of untrained health workers in CC.
Conclusions
With these challenges addressed, the implementation of CC integrated with other lymphoedema care services shows potential to reduce stigma and promote access to lymphoedema care services.
“…Several lessons informally documented by IOCC were shared in Theory of Change workshops as part of the EnDPoINT project [ 23 ]. Based on expert suggestions in these workshops and a review of documented lessons, as part of the IMPRESS project, CC was thus added to the holistic care package of the EnDPoINT programme as one of the strategies to enhance health literacy about lower limb lymphoedema, to facilitate utilization of lymphoedema care and to reduce lymphoedema-related stigma [ 24 ].…”
Section: Methodsmentioning
confidence: 99%
“…In response, the EnDPoINT (Excellence in Disability Prevention Integrated across NTDs) project was set up with the aim of developing, standardizing, integrating and scaling-up MMDP care services for three highly stigmatizing NTD conditions found in Ethiopia, namely podoconiosis, LF and leprosy [ 23 ]. EnDPoINT is an implementation research programme focusing on how best to integrate and scale up a holistic MMDP care package (including physical health, mental health and psychosocial care) into government-run primary health care units.…”
Section: Introductionmentioning
confidence: 99%
“…It was implemented over three phases from 2018 to 2021: development of the care package in Phase 1; piloting of the care package in Phase 2; and scale up and integration of the care package into the primary health care system in Phase 3. Details about the EnDPoINT integrated holistic care package are available in previous reports [ 23 , 24 ]. In essence, this care package constituted capacity building, program management, health education, MMDP, and socio-economic rehabilitation.…”
Background
Lower limb lymphoedema (swelling of the lower leg) due to Neglected Tropical Diseases (NTDs) such as podoconiosis, lymphatic filariasis and leprosy is common in Ethiopia, imposing huge burdens on affected individuals and communities. Stigma significantly increases the disease burden and acts as a major barrier to accessing lymphoedema care services. A multi-component stigma reduction intervention was implemented in Northern Ethiopia. Community Conversation (CC) was one of the components implemented, and aimed to reduce stigma and enhance access to and uptake of integrated lymphoedema care services with the active engagement of community members.
Methods
A cross-sectional qualitative process evaluation was conducted to document lessons focusing on CC’s relevance, outcomes and implementation challenges. Data were collected from a total of 55 purposively selected participants (26 from the CC intervention site and 29 from the control site) through key informant interviews, in-depth individual interviews and focus group discussions.
Results
Community Conversations increased acceptability of health messages about lymphoedema and created peer learning opportunities for unaffected community members. Improvement in the awareness of CC participants about the causes, prevention and treatment of lymphoedema contributed significantly to the reduction of stigmatizing attitudes and discriminatory behaviors, thereby improving access to and utilization of lymphoedema care services provided through primary health care facilities. However, a range of challenges affecting implementation of CC and outcome quality were identified, including perceived complexity of the facilitation guide among facilitators, expectation of incentives among CC participants, inadequate implementation of facilitation principles and procedures, inadequacy of supportive supervision, and low engagement of untrained health workers in CC.
Conclusions
With these challenges addressed, the implementation of CC integrated with other lymphoedema care services shows potential to reduce stigma and promote access to lymphoedema care services.
Background
Neglected Tropical Diseases (NTDs) such as podoconiosis, lymphatic filariasis (LF) and leprosy mainly affect communities in low resource settings. These diseases are associated with physical disability due to lymphoedema as well as poor mental health and psychosocial outcomes. Integration of care across these NTDs at primary health care level, which includes mental health and psychosocial care alongside physical health care, is increasingly recommended.
Methods
A holistic integrated care package was developed and piloted as part of the EnDPoINT project in Gusha district, Awi zone, Ethiopia. The intervention was conducted at the health care organization, health facility and community levels. To assess the impact of the care package in terms of acceptability, scalability, sustainability and barriers to implementation, a qualitative study was conducted in January 2020. This included four focus group discussions (29 participants) and ten key informant interviews with decision makers, health professionals, patients, and community representatives.
Results
The integrated lymphoedema care package was found to be efficient compared to vertical programs in saving time and resources. It also resulted in improved awareness of the causes, treatment and prevention of lymphoedema, in marked improvements in the lymphoedema, and in reduced stigma and discrimination. The care package was found to be acceptable to patients, health professionals and decision makers. The barriers to integrated care were unrealistic patient expectations, inadequate dissemination across health workers, and poor transportation access. Health professionals, decision makers and patients believed the integrated lymphoedema care package to be scalable and sustainable.
Conclusion
The integrated holistic care package was found to be acceptable to patients, health professionals and decision makers. We recommend its scale-up to other endemic districts.
“…Barua et al (2021) the need to implement sustainable effective measures for the early diagnosis and treatment of leprosy to prevent disability, while raising awareness to ensure appropriate health-seeking behavior. Tesfaye et al (2021) The holistic care package includes components that are applied at three levels of health: care system: health organization, facility, and community. Part of the care package is directed at strengthening capacity building, program management, community involvement, awareness raising, stigma reduction, morbidity management, disability prevention, follow-up visits, referral relationships, community-based rehabilitation, and monitoring and evaluation.…”
Poor self-care in people with leprosy can cause progressive damage because leprosy attacks the peripheral nerves, skin, hands and feet and eyes, so patients need good self-care.It is necessary to increase the active role of sufferers to seek information about leprosy and to increase routine self-care habits to prevent disability. Aim of this study for reviewing the relevant literature available on the behavior of people with leprosy in preventing disability through patient self-care. Literature study in 2018-2022, data obtained from databases include Scopus, JSTOR, Science Direct with the keywords leprosy, self-care, disability, behavior, and prevention. This literature study found 28 articles that match the criteria inclusion and exclusion. From the review of the article it is known about behavior of people with leprosy in preventing disability through self care of patients. The results of the literature review show that there are five sub-findings, namely factors related to the incidence of leprosy, stigma about leprosy, incidence of disability, self-care practices of patients, and behavior of people with leprosy to prevent disability. Factors related to the incidence of leprosy are age, gender, social contact, care, personal hygiene, knowledge, education, occupation, income, and house density.
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