Background There is a dearth of experience in and evidence for cost-effective integrated communitybased management of skin neglected tropical diseases (NTDs). The objective of this study was to assess the knowledge, attitude and care-seeking practices including self-care with a view to introducing appropriate community-based interventions for skin NTDs in an endemic setting in Southern Nigeria. Methods/Principal findings This exploratory study adopted a mixed-methods design consisting of cross-sectional surveys of community members and health workers using interviewer-administered questionnaires; and focus group discussions (FGDs) with community members, health care workers and patients with NTDs in Anambra State, Nigeria. The survey was completed by 353 community members (61.8% female) and 15 health care workers (100.0% female). A total of 52 individuals participated in six FGDs. Of the community members, 236 (66.9%) had heard or seen a case of leprosy; 324 (91.8%) and 131 (37.5%) had heard or seen a case of Buruli ulcer and lymphatic filariasis, respectively. Again, 213 (60.3%) of the respondents reported that the diseases were caused by witchcraft or curse. As regards prevention, 241 (68.3%) suggested avoiding handshake with affected persons. Up to 223 (63.2%) of respondents strongly agreed to the seriousness of skin NTDs in their community. Meanwhile, 272 (77.1%) of the respondents believed that the transmission of these skin NTDs can be prevented. Furthermore, 324 (91.7%) desired active community engagement for control of skin NTDs. Regarding community care seeking practices, 197 (55.8%) would first visit the health centre/hospital, followed by 91 (25.8%) traditional healer/herbalist and 35 (9.9%) pharmacy/ patent medicine vendor if they develop a skin NTD. Overall, 332 (94.1%) of respondents expressed interest in being taught self-care practices for skin NTDs. Out of 15 healthcare workers, 13 (86.7%) were able to correctly diagnose two of these skin NTDs and 10 (66.7%) would encourage patients to practice self-care. Prominent themes in the FGDs were belief PLOS NEGLECTED TROPICAL DISEASES

Sustained capacity building for health professionals on better monitoring and management of leprosy and its complications is strongly recommended in Nigeria.

Introduction: Diabetes mellitus (DM) and tuberculosis (TB) are of great public health importance globally, especially in Sub-Saharan Africa. Tuberculosis is the third cause of death among subjects with non-communicable diseases. DM increases risk of progressing from latent to active tuberculosis. The study aimed to ascertain yield of TB cases and the number needed to screen (NNS) among DM patients. Material and methods: A cross-sectional study was conducted at 10 health facilities with high DM patient load and readily accessible DOTS center in 6 states of southern region of Nigeria over a period of 6 months under routine programme conditions. All patients who gave consent were included in the study. Yield and NNS were calculated using an appropriate formula. Results: 3 457 patients were screened with a mean age (SD) of 59.9 (12.9) years. The majority were male, 2 277 (65.9%). Overall prevalence of TB was 0.8% (800 per 100 000). Sixteen (0.5%) were known TB cases (old cases). There were 221 presumptive cases (6.4%) out of which 184 (83.3%) were sent for Xpert MTB/Rif assay. Eleven (0.3%) new cases of TB were detected, giving additional yield of 40.7% and the number needed to screen (NNS) of 315. All the 11 patients were placed on anti-TB treatment. Conclusions: The prevalence of TB among DM patients was higher than in the general population. The yield was also good and comparable to other findings. This underscores the need for institute active screening for TB among DM patients. Further studies are recommended to identify associated factors to guide policy makers in planning and development of TB-DM integrated services.

Background Lymphatic filariasis (LF), Buruli ulcer (BU) and leprosy are neglected tropical diseases (NTDs) of the skin co-endemic in some communities in Nigeria. Not enough is known about the effectiveness of integrated morbidity management and disability prevention in people with these conditions. An integrated self-care intervention was carried out for people with these skin NTDs in two endemic communities of Anambra state, Nigeria. The objective of the study was to assess the effectiveness of self-care practices on costs of care, disability status and health-related quality of life. Methods This study utilised a quasi-experimental pre-test/post-test design to assess the effectiveness of the self-care interventions for people affected by NTDs to care for these impairments at home. Data were collected using questionnaires administered at the beginning and at the end of the intervention on monthly cost of morbidity care, and on participants’ disability status and their quality of life (QoL). Focus group discussions (FGDs) were held with both the participants and healthcare workers at follow-up. Results Forty-eight participants were recruited. Thirty participants (62.5%) continued the self-care interventions until the end of the project. Of those, 25 (83%) demonstrated improvement from their baseline impairment status. The mean household costs of morbidity care per participant decreased by 66% after the intervention, falling from US$157.50 at baseline to US$53.24 after 6 months of self-care (p = 0.004). The mean disability score at baseline was 22.3; this decreased to 12.5 after 6 months of self-care (p < 0.001). Among the 30 participants who continued the interventions until the end of the project, 26 (86.7%) had severe disability score (i.e. a score of 10–46) at baseline, and the number with severe disability fell to 18 (60%) of the 30 after the intervention. The mean QoL score increased from 45.7 at baseline to 57.5 at the end of the intervention (p = 0.004). Conclusions The 6-month self-care intervention for participants affected by BU, leprosy, or LF led to lower costs of care (including out-of-pocket costs and lost earnings due to morbidity), improved QoL scores, and reduced disability status. Trial registration ISRCTN Registry: ISRCTN20317241; 27/08/2021, Retrospectively registered.

Background Little is known about the challenges and barriers to tuberculosis (TB) service delivery in hard-to-reach riverine populations in Nigeria. The missing TB cases in such key populations need to be found if the End TB targets are to be met. This study explored perceptions and attitudes related to TB, as well as the level of diagnostic and treatment delays in communities of the riverine Niger Delta.Methods This was an exploratory mixed-methods study carried out in two states (Bayelsa and Delta) situated in the Niger Delta region in Nigeria. It consisted of quantitative surveys of community members and TB patients, FGDs with community members and KIIs with health care workers.Results The questionnaire survey was completed by 597 community members (51.6% female) and 51 TB patients (56.9% female); 73 community members and 15 HCWs participated in FGDs and interviews respectively. Community members’ mean [SD] knowledge and attitude scores were 6.1/10 [2.2] and 4.8/12 [1.9] respectively. Older age (>40y) (p=0.04) and regular income (p<0.001) were independent predictors of TB knowledge. Good TB knowledge (aOR 2.5; 95% C.I. 1.5 – 4.4) and formal education (aOR 5.8; 95% C.I. 1.3 – 25.6) were associated with positive TB attitudes. Patients’ TB knowledge was similar at 6.8/8 [1.5]. Most (98.8%) respondents took >1 hour to access the nearest diagnostic centre. Mean patient-related and health system-related diagnostic delays were 16.3 and 3.7 weeks respectively. Mean treatment delay was found to be 0.5 weeks. Patient-related, financial, cultural and structural barriers were found to delay TB diagnosis and treatment in this environment. Belief in faith healing and herbal remedies, transport barriers, and negative HCW attitudes were prominent themes in FGDs. Problems transporting sputum samples and tracing mobile communities were primary HCW complaints.Conclusions A number of barriers affect TB service delivery in hard-to-reach riverine communities in Nigeria. Our study suggests that an appropriately designed community intervention can improve TB service delivery in these communities. The main focus will be to address information asymmetry between service providers and the community, empower affected communities to find cases, engage informal providers such as patent medicine vendors, and strengthen the health system.