Economic assessment of a community-based care package for people with lower limb disorder caused by lymphatic filariasis, podoconiosis and leprosy in Ethiopia

Abstract

We conducted an implementation research study to integrate a holistic package of physical health, mental health and psychosocial care for podoconiosis, lymphatic filariasis and leprosy into routine healthcare in Gusha cluster, Guagusa Shikudad district, northwest Ethiopia. The healthcare package included training patients in lower limb hygiene and skin care and provision of shoes, hygiene supplies and medication. The implementation activities included training events, workshops, awareness raising, self-help groups, supportive supervision, staff secondments and advisory board meetings. The cost of implementing the care package in Gusha cluster, with a population of 30 558 people, was 802 655 Ethiopian birr (ETB) (£48 159) and the cost of delivering care to 235 participants was 204 388 ETB (£12 263), or 870 ETB (£52) per person. There was a 35% decrease in the mean disability scores (measured using the World Health Organization Disability Assessment Schedule 2.0) and a 45% improvement in the dermatology-specific quality of life (measured using the Dermatology Life Quality Index) at the 3-month follow-up compared with baseline. There were reductions in the number of days with symptoms, days off usual activities/work and days with reduced activity due to illness, all of which were statistically significant. Our pilot suggests that integration of the care package into routine healthcare in Ethiopia may be effective in improving health-related quality of life and disability and reducing time out of economic activity due to illness.

Self-care programmes for people living with leprosy: a scoping review

“…We compared our yields with the study by Casado et al 21 Our search identified all 10 articles which were classified as self-care by Casado et al 21 Five of these articles met our inclusion criteria and they had all been included in our review. We identified an additional 10 articles not included in Casado et al 21 The 15 articles were conducted in the following eight countries-China, [24][25][26] Ethiopia, [27][28][29] Brazil, 30 Nepal, 31,32 Nigeria, 33,34 Indonesia, 35,36 India 37 and Mozambique. 38 All articles but one 26 were published between 2001 and 2021.…”

“…Reviewing the 15 articles, nine studies obtained quantitative data [24][25][26]28,29,[32][33][34]37 and the remaining six utilized exclusively qualitative designs. 27,30,35,36,38,39 Only one of the 9 studies that included quantitative data used a contemporaneous control group and this was not obtained by a process of randomization.…”

“…32 The other eight articles utilized cohort studies in which they followed the same group of participants over varying periods of time. [24][25][26]28,29,33,34,37 Additional details of the included studies are presented in Table 2.…”

“…Two interventions were developed by non-governmental organizations, 27,32 two by governmental bodies, 30,34 five of the interventions resulted from collaborations between non-governmental organizations and ministries of health 24,26,27,37,38 and the remaining five interventions were developed by research teams. [28][29][30][31]36 DE SC RI P TI ON OF SEL F-CA RE I NT E RVENTIONS All 14 interventions involved implementing self-care programs in communities or healthcare centers and training health care workers and people living with leprosy. Nine of the interventions included the formation of self-care groups in which people living with leprosy learned about wound care and management among other topics such as general hygiene.…”

“…The second study 29 focused on the family unit and included economic empowerment (via micro-finance loans). The final intervention by Hounsome et al 28 was integrated across lymphatic filariasis, podoconiosis and leprosy and was targeted at individuals. Additional details on all 14 included interventions are provided in Table 3.…”