Knowledge, attitudes and practices of health professionals towards people living with lymphoedema caused by lymphatic filariasis, podoconiosis and leprosy in northern Ethiopia

Abstract

Background Podoconiosis, lymphatic filariasis and leprosy are highly stigmatised neglected tropical diseases that cause lymphoedema. Their enormous impacts on health-related quality of life, mental health and economic productivity can be significantly reduced by morbidity management and disability prevention (MMDP) services, but to deliver such services requires appropriate training of healthcare professionals. The aim of this study was to assess the knowledge, attitudes and practices (KAP) of rural Ethiopian healthcare professionals towards people with lymphoedema as a way to assess training needs. Methods This study used questionnaires to quantitatively assess KAP towards people with lymphoedema among rural healthcare professionals in northwest Ethiopia before and 12 months after a short training intervention. Results Questionnaires were administered to 14 health professionals at baseline and 21 at follow-up. At baseline, 71% (10/14) were found to hold at least one stigmatising attitude towards lymphoedema patients, compared with 66% (14/21) at follow-up. Large gaps in knowledge were noted, with many unable to identify ways of treating/preventing the diseases. Conclusions This study showed high proportions of healthcare workers holding stigmatising views and lacking essential knowledge about lymphoedema. To maximise the impact of MMDP interventions, further research is urgently needed to understand how to address these issues.

A qualitative process evaluation of a community conversation intervention to reduce stigma related to lower limb lymphoedema in Northern Ethiopia

“…In conclusion, even though there was a range of observed challenges, the CC intervention was found to play an important role in promoting access to integrated holistic lymphoedema care services through addressing misconceptions and reducing stigma. Apart from serving as inputs for further improving the quality of the CC implementation process, the lessons documented through this qualitative process evaluation could help researchers, development partners and policy makers to optimize the benefits of integrating CC into the primary health care system as a feasible health communication strategy in the context of stigmatizing disease conditions like lymphoedema [5,14,25,26].…”

“…In essence, this care package constituted capacity building, program management, health education, MMDP, and socio-economic rehabilitation. The piloting and scale-up of the EnDPoINT programme was conducted in selected districts of Awi zone in the North West of Ethiopia [24][25][26][27][28]. During Phase 3 of EnDPoINT, a more detailed investigation into stigma reduction was enabled through the embedded IMPRESS ('Improving access to integrated Morbidity management and disability Prevention Services through Stigma reduction for people with lower limb lymphoedema in Ethiopia') project.…”

Self-Care Practice and Its Associated Factors Among Podoconiosis Patients in East Gojjam Zone, North West Ethiopia

“…The majority of podoconiosis patients have reduced productivity due to loss of working days, are socially isolated, and are stigmatized by the communities as well as by health care professionals. 12 , 16 , 21 , 30 This is due to gender inequalities of the inferiority beliefs and attitudes of females. However, women podoconiosis cases were stigmatized, not allowed to participate in social activities as a result of fear of discrimination, hopelessness in the restoring after treatment, wrong beliefs resulting from the punishment of wrong behaviors, limited time to care for themselves, and stayed overloaded (wife, mothers, and employee) at home to care of their families.…”

“…32 Across Ethiopia, the knowledge, attitude, and practice level for podoconiosis causes, prevention measures, and treatment misconceptions need attention. 15 , 16 , 33 , 34 …”

“…15 Around 11 million Ethiopians (18% of the population) are at risk of exposure to irritant soil. 13 The total number of podoconiosis cases is highest in Ethiopia, as an estimated 1.5 million people are affected with a national average prevalence of 4% 1,[14][15][16][17][18][19] with geographical variations of 6.3% in Dano district, 14 3.3% in East and West Gojjam Zone, 20 6.2% in Gamo Zone, 17 and 4.3% in Waghemra Zone. 21 The pathogenesis is not well known, soil mineral particles penetrate the skin, which is characterized by low hydration of the stratum corneum, and these particles are taken up by macrophages in the dermis, causing chronic inflammation process of lymphatic systems, this will lead to progressive lymphedema.…”