EnDPoINT: protocol for 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 health services in Ethiopia

Abstract

IntroductionNeglected tropical diseases (NTDs) causing lower limb lymphoedema such as podoconiosis, lymphatic filariasis (LF) and leprosy are common in Ethiopia. Routine health services for morbidity management and disability prevention (MMDP) of lymphoedema caused by these conditions are still lacking, even though it imposes a huge burden on affected individuals and their communities in terms of physical and mental health, and psychosocial and economic outcomes. This calls for an integrated, holistic approach to MMDP across these three diseases.Methods and analysisThe ‘Excellence in Disability Prevention Integrated across NTDs’ (EnDPoINT) implementation research study aims to assess the integration and scale-up of a holistic package of care—including physical health, mental health and psychosocial care—into routine health services for people with lymphoedema caused by podoconiosis, LF and leprosy in selected districts in Awi zone in the North–West of Ethiopia. The study is being carried out over three phases using a wide range of mixed methodologies. Phase 1 involves the development of a comprehensive holistic care package and strategies for its integration into the routine health services across the three diseases, and to examine the factors that influence integration and the roles of key health system actors. Phase 2 involves a pilot study conducted in one subdistrict in Awi zone, to establish the care package’s adoption, feasibility, acceptability, fidelity, potential effectiveness, its readiness for scale-up, costs of the interventions and the suitability of the training and training materials. Phase 3 involves scale-up of the care package in three whole districts, as well as its evaluation in regard to coverage, implementation, clinical (physical health, mental health and psychosocial) and economic outcomes.Ethics and disseminationEthics approval for the study has been obtained in the UK and Ethiopia. The results will be disseminated through publications in scientific journals, conference presentations, policy briefs and workshops.

Development of an integrated, holistic care package for people with lymphoedema for use at the level of the Primary Health Care Unit in Ethiopia

“…The packagewill helpstandardize care for patients with lower-limb lymphoedema and integrate this into government-run health services. The study was part of the ‘Excellence in Disability Prevention Integrated across NTDs’ (EnDPoINT) program[ 18 ].…”

Infrared Thermal Imaging as a Novel Non-Invasive Point-of-Care Tool to Assess Filarial Lymphoedema

“…This offers the potential to establish baseline measures for individuals, which can be used to monitor lymphoedema progression or the effects of interventions [32,33]. Such a portable and non-invasive tool is needed by health workers in LF-endemic regions [16,17], and may have use for filarial hydrocoele [46] or for other skin NTDs such as onchocerciasis, podoconiosis and leprosy, which could also help in differential diagnosis in co-endemic areas [8,32,[47][48][49]. The use of thermal imaging requires minimal training, and the results can be easily and immediately visualised and interpreted to guide ongoing lymphoedema detection and management at the point of care.…”

“…In order to achieve this, we need effective and inexpensive tools for researchers to provide the evidence for recommended practices. Such tools must also be accessible to health workers so they can monitor progress among existing cases, and detect new subclinical cases for preventive intervention [ 7 , 8 , 9 , 10 ].…”

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

“…The protocol for the EnDPoINT study is published elsewhere. 21 Briefly, this was an implementation research study that included three phases: phase 1 focused on the development of a comprehensive holistic care package for people with lower limb disorder caused by the three diseases and strategies for its integration into routine healthcare. In phase 2, a pilot study was conducted to assess the feasibility, acceptability, fidelity, potential effectiveness and costs of delivering the care package.…”