A mixed methods evaluation of an integrated training package for skin neglected tropical diseases in Kaduna and Ogun, Nigeria

Abstract

Background The overall burden of neglected tropical diseases (NTDs) affecting the skin is undetermined. Skin conditions are among the top 10 causes of disability worldwide. Affected persons seek treatment at advanced stages of the disease, resulting in morbidity and disability. We developed and evaluated an integrated training intervention for early case detection, referral and management of skin NTDs in two states in Nigeria. Methods This was a mixed-methods study using participatory approaches to develop specific skin algorithms and training packages for community and primary level health workers. This supported the identification, referral and clinical diagnosis of suspected cases. We used Kirkpatrick's model to evaluate the training package. Results Participants’ knowledge improved after the 2-months intervention. Across both states, knowledge retention appeared more robust for cadres at all levels: state, local government area and primary healthcare. All (100%) participants mentioned that the training assisted them in detecting, referring and managing skin NTDs. Training was understood by participants and training materials were easy to understand. Materials were also effective in educating community members about the symptoms of NTDs and supported referral to facilities for appropriate management. Conclusions Community implementers can be trained and supervised to detect people affected by skin NTDs and support appropriate management within the existing patient care pathway.

Improving experiences of neglected tropical diseases of the skin: Mixed methods formative research for development of a complex intervention in Atwima Mponua District, Ghana

“…For example, our finding that people with skin NTDs faced out-of-pocket payments at health facilities, even though Ghana’s NHIS notionally covers treatment of skin diseases (including skin NTDs), reflects systemic problems with the NHIS; only half of Ghana’s population is enrolled in the NHIS, and even for those with a valid subscription, delayed claim payments, frequent facility stock-outs, and unapproved charges result in out-of-pocket expenditure [ 33 ]. Our findings on illness representations and stigma echo other studies from Ghana, which found yaws to be associated with dirty water and witchcraft [ 11 ] and BU to be associated with working, bathing, swimming in or drinking unclean water [ 12 , 34 – 37 ]; insect bites [ 12 , 34 , 38 ]; “weak blood” in children [ 12 ]; and witchcraft [ 11 , 12 , 17 , 18 , 21 , 25 , 32 ]. A minority of people, including health workers, consistently perceive BU as contagious [ 11 , 12 , 17 , 18 , 21 , 25 , 32 ] and BU-affected individuals commonly experience stigma [ 38 , 39 ].…”

“…Our findings on illness representations and stigma echo other studies from Ghana, which found yaws to be associated with dirty water and witchcraft [ 11 ] and BU to be associated with working, bathing, swimming in or drinking unclean water [ 12 , 34 – 37 ]; insect bites [ 12 , 34 , 38 ]; “weak blood” in children [ 12 ]; and witchcraft [ 11 , 12 , 17 , 18 , 21 , 25 , 32 ]. A minority of people, including health workers, consistently perceive BU as contagious [ 11 , 12 , 17 , 18 , 21 , 25 , 32 ] and BU-affected individuals commonly experience stigma [ 38 , 39 ]. A recent study we conducted with children and adolescents with yaws and BU in Atwima Mponua and a neighbouring district found that school staff contributed to stigmatising practices affecting children with yaws and BU, mainly because of an overinterpreted fear of contagion, and suggested the need for school-based infection control interventions that are sensitive to social context [ 40 ].…”

Development of an integrated and decentralised skin health strategy to improve experiences of skin neglected tropical diseases and other skin conditions in Atwima Mponua District, Ghana

“…School children in the district with skin NTDs also face substantial social exclusion by peers and staff. While studies have demonstrated that case-finding activities can be integrated across skin NTDs [13][14][15], there is little evidence on how best to integrate health system responses more broadly to build sustainable holistic models of skin care [16,17].…”