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Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study

BACKGROUND: Ethiopia bears a high burden of visceral leishmaniasis (VL). Early access to VL diagnosis and care improves clinical prognosis and reduces transmission from infected humans; however, significant obstacles exist. The approximate 250,000 seasonal mobile workers (MW) employed annually in no...

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Autores principales: Coulborn, Rebecca Marie, Gebrehiwot, Tesfay Gebregzabher, Schneider, Martin, Gerstl, Sibylle, Adera, Cherinet, Herrero, Mercè, Porten, Klaudia, den Boer, Margriet, Ritmeijer, Koert, Alvar, Jorge, Hassen, Abrahim, Mulugeta, Afework
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224040/
https://www.ncbi.nlm.nih.gov/pubmed/30408042
http://dx.doi.org/10.1371/journal.pntd.0006778
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author Coulborn, Rebecca Marie
Gebrehiwot, Tesfay Gebregzabher
Schneider, Martin
Gerstl, Sibylle
Adera, Cherinet
Herrero, Mercè
Porten, Klaudia
den Boer, Margriet
Ritmeijer, Koert
Alvar, Jorge
Hassen, Abrahim
Mulugeta, Afework
author_facet Coulborn, Rebecca Marie
Gebrehiwot, Tesfay Gebregzabher
Schneider, Martin
Gerstl, Sibylle
Adera, Cherinet
Herrero, Mercè
Porten, Klaudia
den Boer, Margriet
Ritmeijer, Koert
Alvar, Jorge
Hassen, Abrahim
Mulugeta, Afework
author_sort Coulborn, Rebecca Marie
collection PubMed
description BACKGROUND: Ethiopia bears a high burden of visceral leishmaniasis (VL). Early access to VL diagnosis and care improves clinical prognosis and reduces transmission from infected humans; however, significant obstacles exist. The approximate 250,000 seasonal mobile workers (MW) employed annually in northwestern Ethiopia may be particularly disadvantaged and at risk of VL acquisition and death. Our study aimed to assess barriers, and recommend interventions to increase access, to VL diagnosis and care among MWs. METHODOLOGY/PRINCIPAL FINDINGS: In 2017, 50 interviews and 11 focus group discussions were conducted with MWs, mobile residents, VL patients and caretakers, community leaders and healthcare workers in Kafta Humera District, Tigray. Participants reported high vulnerability to VL among MWs and residents engaged in transitory work. Multiple visits to health facilities were consistently needed to access VL diagnosis. Inadequate healthcare worker training, diagnostic test kit unavailability at the primary healthcare level, lack of VL awareness, insufficient finances for care-seeking and prioritization of income-generating activities were significant barriers to diagnosis and care. Social (decision-making and financial) support strongly and positively influenced care-seeking; workers unable to receive salary advances, compensation for partial work, or peer assistance for contract completion were particularly disadvantaged. Participants recommended the government/stakeholders intervene to ensure: MWs access to bed-nets, food, shelter, water, and healthcare at farms or sick leave; decentralization of diagnostic tests to primary healthcare facilities; surplus medications/staff during the peak season; improved referral/feedback/reporting/training within the health system; free comprehensive healthcare for all VL-related services; and community health education. CONCLUSIONS/SIGNIFICANCE: Contrary to what health policy for VL dictates in this endemic setting, study participants reported very poor access to diagnosis and, consequently, significantly delayed access to treatment. Interventions tailored to the socio-economic and health needs of MWs (and other persons suffering from VL) are urgently needed to reduce health disparities and the VL burden.
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spelling pubmed-62240402018-11-19 Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study Coulborn, Rebecca Marie Gebrehiwot, Tesfay Gebregzabher Schneider, Martin Gerstl, Sibylle Adera, Cherinet Herrero, Mercè Porten, Klaudia den Boer, Margriet Ritmeijer, Koert Alvar, Jorge Hassen, Abrahim Mulugeta, Afework PLoS Negl Trop Dis Research Article BACKGROUND: Ethiopia bears a high burden of visceral leishmaniasis (VL). Early access to VL diagnosis and care improves clinical prognosis and reduces transmission from infected humans; however, significant obstacles exist. The approximate 250,000 seasonal mobile workers (MW) employed annually in northwestern Ethiopia may be particularly disadvantaged and at risk of VL acquisition and death. Our study aimed to assess barriers, and recommend interventions to increase access, to VL diagnosis and care among MWs. METHODOLOGY/PRINCIPAL FINDINGS: In 2017, 50 interviews and 11 focus group discussions were conducted with MWs, mobile residents, VL patients and caretakers, community leaders and healthcare workers in Kafta Humera District, Tigray. Participants reported high vulnerability to VL among MWs and residents engaged in transitory work. Multiple visits to health facilities were consistently needed to access VL diagnosis. Inadequate healthcare worker training, diagnostic test kit unavailability at the primary healthcare level, lack of VL awareness, insufficient finances for care-seeking and prioritization of income-generating activities were significant barriers to diagnosis and care. Social (decision-making and financial) support strongly and positively influenced care-seeking; workers unable to receive salary advances, compensation for partial work, or peer assistance for contract completion were particularly disadvantaged. Participants recommended the government/stakeholders intervene to ensure: MWs access to bed-nets, food, shelter, water, and healthcare at farms or sick leave; decentralization of diagnostic tests to primary healthcare facilities; surplus medications/staff during the peak season; improved referral/feedback/reporting/training within the health system; free comprehensive healthcare for all VL-related services; and community health education. CONCLUSIONS/SIGNIFICANCE: Contrary to what health policy for VL dictates in this endemic setting, study participants reported very poor access to diagnosis and, consequently, significantly delayed access to treatment. Interventions tailored to the socio-economic and health needs of MWs (and other persons suffering from VL) are urgently needed to reduce health disparities and the VL burden. Public Library of Science 2018-11-08 /pmc/articles/PMC6224040/ /pubmed/30408042 http://dx.doi.org/10.1371/journal.pntd.0006778 Text en © 2018 Coulborn et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Coulborn, Rebecca Marie
Gebrehiwot, Tesfay Gebregzabher
Schneider, Martin
Gerstl, Sibylle
Adera, Cherinet
Herrero, Mercè
Porten, Klaudia
den Boer, Margriet
Ritmeijer, Koert
Alvar, Jorge
Hassen, Abrahim
Mulugeta, Afework
Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study
title Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study
title_full Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study
title_fullStr Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study
title_full_unstemmed Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study
title_short Barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in Western Tigray, Northern Ethiopia: A qualitative study
title_sort barriers to access to visceral leishmaniasis diagnosis and care among seasonal mobile workers in western tigray, northern ethiopia: a qualitative study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6224040/
https://www.ncbi.nlm.nih.gov/pubmed/30408042
http://dx.doi.org/10.1371/journal.pntd.0006778
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