03341nas a2200457   4500000000100000008004100001260001200042100001300054700001200067700001200079700001300091700001200104700001100116700001500127700001800142700001100160700001200171700001400183700001300197700001400210700001300224700001500237700001400252700001400266700001200280700001500292700001300307700001300320700001300333700001500346700001800361700001100379700001300390700002000403245017900423856010900602300000900711490000600720520214300726022001402869       2024                            d  c01/20241 aOkyere D1 aOcloo E1 aOwusu L1 aAmoako Y1 aTuwor R1 aKoka E1 aNovignon J1 aAsante-Poku A1 aSiam I1 aAfreh E1 aAgbanyo A1 aAkuffo R1 aGyabaah S1 aOppong M1 aHalliday K1 aSimpson H1 aTimothy J1 aMarks M1 aZuurmond M1 aWalker S1 aPullan R1 aAhorlu C1 aPhillips R1 aYeboah-Manu D1 aPitt C1 aPalmer J1 acollaboration S00aImproving experiences of neglected tropical diseases of the skin: Mixed methods formative research for development of a complex intervention in Atwima Mponua District, Ghana.  uhttps://journals.plos.org/globalpublichealth/article/file?id=10.1371/journal.pgph.0002833&type=printable  a1-210 v43 a<p>Integrated approaches to managing co-endemic neglected tropical diseases (NTDs) of the skin within primary healthcare services are complex and require tailoring to local contexts. We describe formative research in Atwima Mponua District in Ghana's Ashanti Region designed to inform the development of a sustainable intervention to improve access to skin NTD care. We employed a convergent, parallel, mixed-methods design, collecting data from February 2021 to February 2022. We quantitatively assessed service readiness using a standardised checklist and reviewed outpatient department registers and condition-specific case records in all government health facilities in the district. Alongside a review of policy documents, we conducted 49 interviews and 7 focus group discussions with purposively selected affected persons, caregivers, community members, health workers, and policy-makers to understand skin NTD care-seeking practices and the policy landscape. Outside the district hospital, skin NTD reporting rates in the surveyed facilities were low; supply chains for skin NTD diagnostics, consumables, and medicines had gaps; and health worker knowledge of skin NTDs was limited. Affected people described fragmented care, provided mostly by hospitals (often outside the district) or traditional healers, resulting in challenges obtaining timely diagnosis and treatment and high care-seeking costs. Affected people experienced stigma, although the extent to which stigma influenced care-seeking behaviour was unclear. National actors were more optimistic than district-level actors about local resource availability for skin NTD care and were sceptical of including traditional healers in interventions. Our findings indicate that improvement of the care cascade for affected individuals to reduce the clinical, economic, and psychosocial impact of skin NTDs is likely to require a complementary set of interventions. These findings have informed the design of a strategy to support high-quality, integrated, decentralised care for skin NTDs in Atwima Mponua, which will be assessed through a multidisciplinary evaluation.</p>
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