03410nas a2200385   4500000000100000008004100001260001600042653001000058653001300068653002000081653003900101653002000140653001800160653001400178653003000192100001900222700001500241700001200256700001300268700001100281700001300292700001300305700001100318700001300329700001400342700001300356700001100369700001100380245017100391856015300562300000900715490000800724520227800732022001403010       2024                            d  bElsevier BV10aGhana10aEthiopia10aeconomic burden10aNeglected tropical diseases (NTDs)10aHousehold costs10aOut-of-pocket10aInsurance10aFinancial risk protection1 aHailemichael Y1 aNovignon J1 aOwusu L1 aOkyere D1 aMtuy T1 aAlemu AY1 aOcloo EK1 aKoka E1 aPalmer J1 aWalker SL1 aGadisa E1 aKaba M1 aPitt C00aThe role of economic factors in shaping and constituting the household burden of neglected tropical diseases of the skin: Qualitative findings from Ghana and Ethiopia  uhttps://www.sciencedirect.com/science/article/pii/S0277953624005471/pdfft?md5=b14ae816ef9c6cf055292bfbe8798fa0&pid=1-s2.0-S0277953624005471-main.pdf  a1-110 v3563 a<p>Tracers of health system equity, neglected tropical diseases (NTDs) disproportionately affect marginalized populations. NTDs that manifest on the skin – “skin NTDs” – are associated with scarring, disfigurement, physical disability, social exclusion, psychological distress, and economic hardship. To support development and evaluation of appropriate intervention strategies, we aimed to improve understanding of the role of economic factors in shaping and constituting the burden that skin NTDs place on households. We collected data in 2021 in two predominantly rural districts: Atwima Mponua in Ghana (where Buruli ulcer, yaws, and leprosy are endemic) and Kalu in Ethiopia (where cutaneous leishmaniasis and leprosy are endemic). We conducted interviews (n = 50) and focus group discussions (n = 14) that explored economic themes with affected individuals, caregivers, and community members and analysed the data thematically using a pre-defined framework. We found remarkable commonalities across countries and diseases. We developed a conceptual framework which illustrates skin NTDs’ negative economic impact, including financial costs of care-seeking and reductions in work and schooling; categorises coping strategies by their degree of risk-pooling; and clarifies the mechanisms through which skin NTDs disproportionately affect the poorest. Despite health insurance schemes in both countries, wide-ranging, often harmful coping strategies were reported. Traditional healers were often described as more accessible, affordable and offering more flexible payment terms than formal health services, except for Ethiopia’s wellestablished leprosy programme. Our findings are important in informing strategies to mitigate the skin NTD burden and identifying key drivers of household costs to measure in future evaluations. To reduce skin NTDs’ impact on households’ physical, mental, and economic wellbeing, intervention strategies should address economic constraints to prompt and effective care-seeking. While financial support and incentives for referrals and promotion of insurance enrolment may mitigate some constraints, structural interventions that decentralise care may offer more equitable and sustainable access to skin NTD care.</p>
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