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

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 cross-sectional study to evaluate depression and quality of life among patients with lymphoedema due to podoconiosis, lymphatic filariasis and leprosy

Background Podoconiosis, lymphatic filariasis (LF) and leprosy are neglected tropical diseases (NTDs) that cause lymphoedema. When left untreated, they lead to substantial disability. This study determined the quality of life (QOL) and depression associated with lymphoedema in patients with podoconiosis, LF and leprosy. The study was conducted in northwestern Ethiopia. Methods This baseline cross-sectional study, nested within an interventional, non-comparative, longitudinal study, included patients with lymphoedema. Depression and QOL were assessed using versions of the 9-item Patient Health Questionnaire and Dermatologic Life Quality Index (DLQI), respectively, that had been translated into Amharic and validated. Factors associated with depression and QOL were assessed using multivariate linear regression analysis. Results Of the 251 patients with lymphoedema included in the study, 119 (47.4%) had moderate to severe depression and overall QOL was poor (mean±standard deviation [SD] DLQI score: 11.4±4.2). Disability was significantly associated with depression (β=0.26 [95% confidence interval {CI} 0.19 to 0.33]). Currently receiving treatment (β=−3.05 [95% CI −5.25 to −0.85), disability (β=−0.08 [95% CI −0.15 to −0.01]) and social support (moderate support: β=−2.27 [95% CI −3.66 to −0.89] and strong support: β=−2.87 [95% CI −5.35 to −0.38]) were significantly associated with better QOL. Conclusion High levels of depression and low QOL were found among patients with lymphoedema due the three NTDs in Ethiopia

Stakeholder perspectives on an integrated package of care for lower limb disorders caused by podoconiosis, lymphatic filariasis or leprosy: a qualitative study

Background Lower limb disorders including lymphoedema create a huge burden for affected persons in their physical and mental health, as well as socioeconomic and psychosocial consequences for them, their families and communities. As routine health services for the integrated management and prevention of lower limb disorders are still lacking, the ‘Excellence in Disability Prevention Integrated across Neglected Tropical Diseases’ (EnDPoINT) study was implemented to assess the development and delivery of an integrated package of holistic care–including physical health, mental health and psychosocial care–within routine health services for persons with lower limb disorders caused by podoconiosis, lymphatic filariasis and leprosy. Methodology/Principal findings This study was part of the first of three phases within EnDPoINT, involving the development of the integrated care package. Focus group discussions and key informant interviews were undertaken with 34 participants between January–February 2019 in Awi zone, Ethiopia, in order to assess the draft care package’s feasibility, acceptability and appropriateness. Persons affected by lower limb disorders such as lymphoedema experience stigma, exclusion from families, communities and work as well as physical and financial hardship. Beliefs in disease causation inhibit affected persons from accessing care. Ignorance was a barrier for health care providers as well as affected persons. Training and education of affected persons, communities and caregivers is important in improving care access. It also requires time, space, materials and financial resources. Both top-down and grass roots input into service development are key, as well as collaboration across stakeholders including charities, community leaders and “expert patients”. Conclusions/Significance This study highlighted the need for the EnDPoINT integrated care package and provided suggestions for solutions according to its three aspects of integrated care (integration into routine care; integration of mental health and psychosocial care; and integration of care across the three diseases), thereby giving support for its feasibility, acceptability and appropriatenes

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

Introduction Neglected 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 analysis The ‘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 dissemination Ethics 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. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made

Improving human rights through constitutionalism and socio-economic reforms in Ethiopia

A Paper Presented at on Commissioning the past by the Truth and Reconciliation Commission, The University of Witwaterstrand, Johannesburg South Africa, History Workshop, 1999In this paper we will examine the atrocities committed by the Derg, the attempts made by EPRDF to bring to justice those government officials who were responsible for human rights violations, and the legislative reforms which have led to era of Constitutionalism

Prevalence of Intestinal Parasites and Gastrointestinal Carriage of Pathogenic Gram Negative Enteric Bacteria among Apparently Healthy Food Handlers of Public Hospitals, Addis Ababa, Ethiopia

Background. Foodborne diseases are major public health problems in developing countries like Ethiopia. Food handlers with poor personal hygiene working in hospitals could be infected with different intestinal parasites and pathogenic enteric bacteria. Therefore, they could pose a potential risk of foodborne infection to patients and the community. Methods. An institutional based cross-sectional study conducted from March to June 2017. Besides, sociodemographic data were collected using a structured questionnaire, freshly passed stool specimens for direct wet mount smear examination, and formalin ether concentration techniques performed for the detection of parasites. For bacterial identification culture, biochemical tests and antimicrobial sensitivity (Kirby-Baure disk diffusion method) have been performed. Finally, validated data were analyzed using statistical package for social science version 20 (SPSS). Results. From 368 food handlers who participated in the study, 81% were females. 119 (32.34%) were positive for at least one intestinal parasite. The most prevalent parasite was Entamoeba histolytica/dispar 48 (13%), followed by Giardia lamblia 36 (9.78%), Taenia Species 21 (5.7%), Ascaris lumbricoide 8 (2.2%), Trichuris trichiura 5 (1.4%), and Hook worm 1 (0.3%). Regarding the prevalence of enteric bacteria 17(4.6%), food handlers were positive for Salmonella 14 (3.8%) and Shigella flexneri 3 (0.8%). No E. coli O157 : H7 was isolated. All 100% (n = 14) Salmonella isolates were resistant to ampicillin (10 µg) and erythromycin (15 µg). Similarly, 100% (n = 3) of Shigella flexneri isolates were resistant to ampicillin (10 µg) and tetracycline (30 µg). 14.3% (n = 2) Salmonella and 66.7% (n = 2) Shigella flexneri isolates were MDR. Conclusion. The study showed significant carriage of pathogenic microorganisms among food handlers. Therefore, hospital administrators and other stake holders should put measures in place to break chain of transmission routes from silent carrier to other peoples particularly patients at hospital and the community at large.</jats:p

Prevalence of Intestinal Parasites and Gastrointestinal Carriage of Pathogenic Gram Negative Enteric Bacteria among Apparently Healthy Food Handlers of Public Hospitals, Addis Ababa, Ethiopia

Background. Foodborne diseases are major public health problems in developing countries like Ethiopia. Food handlers with poor personal hygiene working in hospitals could be infected with different intestinal parasites and pathogenic enteric bacteria. Therefore, they could pose a potential risk of foodborne infection to patients and the community. Methods. An institutional based cross-sectional study conducted from March to June 2017. Besides, sociodemographic data were collected using a structured questionnaire, freshly passed stool specimens for direct wet mount smear examination, and formalin ether concentration techniques performed for the detection of parasites. For bacterial identification culture, biochemical tests and antimicrobial sensitivity (Kirby-Baure disk diffusion method) have been performed. Finally, validated data were analyzed using statistical package for social science version 20 (SPSS). Results. From 368 food handlers who participated in the study, 81% were females. 119 (32.34%) were positive for at least one intestinal parasite. The most prevalent parasite was Entamoeba histolytica/dispar 48 (13%), followed by Giardia lamblia 36 (9.78%), Taenia Species 21 (5.7%), Ascaris lumbricoide 8 (2.2%), Trichuris trichiura 5 (1.4%), and Hook worm 1 (0.3%). Regarding the prevalence of enteric bacteria 17(4.6%), food handlers were positive for Salmonella 14 (3.8%) and Shigella flexneri 3 (0.8%). No E. coli O157 : H7 was isolated. All 100% (n = 14) Salmonella isolates were resistant to ampicillin (10 µg) and erythromycin (15 µg). Similarly, 100% (n = 3) of Shigella flexneri isolates were resistant to ampicillin (10 µg) and tetracycline (30 µg). 14.3% (n = 2) Salmonella and 66.7% (n = 2) Shigella flexneri isolates were MDR. Conclusion. The study showed significant carriage of pathogenic microorganisms among food handlers. Therefore, hospital administrators and other stake holders should put measures in place to break chain of transmission routes from silent carrier to other peoples particularly patients at hospital and the community at large

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

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 people with lower-limb lymphoedema caused bypodoconiosis, lymphatic filariasis (LF)or leprosy as part of the EnDPoINT program in Ethiopia. Method The care package was developed using a mixed-methods approach, consisting of a literature review, situational analysis, Theory of Change (ToC) workshops, qualitative research, and additional workshops to fine-tune the draft care package. The care package was developed between March 2018 and January 2020 in Addis Ababa and the implementation research site, Awi zone in the North-West of Ethiopia. Results The holistic care package includes components implemented at three levels of the health care system:health organization, facility, and community. Sections of the care package are directed at strengthening capacity building, program management, community engagement, awareness-raising, stigma-reduction, morbidity management, disability prevention, follow-up visits, referral linkage, community-based rehabilitation, and monitoring and evaluation. Conclusions The study developed a holistic integrated care package for lower limb disorder and co-morbid mental health problems caused by podoconiosis, LF or leprosy. The approach has the potential to significantly reduce lower limb disorder-associated morbidity, disability, and psychosocial problems. It also standardizes a scalable approach appropriate for the Ethiopian setting and, most likely, other countries where these NTDs are present