Barriers to cutaneous leishmaniasis care faced by indigenous communities of rural areas in Colombia: a qualitative study

Abstract

Background Neglected tropical diseases (NTDs) such as cutaneous leishmaniasis (CL) are often associated with rural territories and vulnerable communities with limited access to health care services. The objective of this study is to identify the potential determinants of CL care management in the indigenous communities in the rural area of the municipality of Pueblo Rico, through a people-centered approach. Methods To achieve this goal, qualitative ethnographic methods were used, and a coding framework was developed using procedures in accordance with grounded theory. Results Three dimensions that affect access to health care for CL in this population were identified: (1) contextual barriers related to geographic, economic and socio-cultural aspects; (2) health service barriers, with factors related to administration, insufficient health infrastructure and coverage, and (3) CL treatment, which covers perceptions of the treatment and issues related to the implementation of national CL treatment guidelines. This study identified barriers resulting from structural problems at the national level. Moreover, some requirements of the national guidelines for CL management in Colombia impose barriers to diagnosis and treatment. We furthermore identified cultural barriers that influence the perceptions and behavior of the community and health workers. Conclusions While the determinants to CL management are multidimensional, the most important barrier is the inaccessibility to CL treatment to the most vulnerable populations and its inadequacy for the socio-territorial setting, as it is not designed around the people, their needs and their context.

Knowledge, attitude, and practice of the rural community about cutaneous leishmaniasis in Wolaita zone, southern Ethiopia

“…Rural communities bear the highest disease burden [18][19][20]. The lack of health facilities and inaccessibility of appropriate treatments worsen the situation [21]. Due to a lack of awareness, there are also misconceptions about CL among remote communities [22].…”

Involving patients in drug development for Neglected Tropical Diseases (NTDs): A qualitative study exploring and incorporating preferences of patients with cutaneous leishmaniasis into Target Product Profile development

“…They compounded with perceived and encountered barriers ( S2 File ), reflecting the often-complex life realities of patients. This was most pronounced in the interviews with patients living in very remote areas, migrant agricultural workers and those working with illicit crops, which is aligned with experiences in rural areas of Colombia [ 43 ] and Latin America [ 44 ]. NTDs are diseases of poverty [ 45 ].…”

Cutaneous leishmaniasis treatment and therapeutic outcomes in special populations: A collaborative retrospective study

“…Losses to follow-up may affect our measures of treatment effectiveness, which might have been under-estimated because cured patients possibly return with less frequency for follow-up to health services, as most of them live in remote rural areas and returning to the clinic is costly and time-consuming. Other factors unrelated to treatment outcome, such as migration of seasonal coffee workers [ 47 ], may also contribute to losses to follow-up. Therefore, improving patient retention is key to ensure accurate measures of treatment effectiveness in the region.…”