Evidence map›Paper›PMID 39914875›Full record

ArticleBMJ global health2025

Understanding experiences of neglected tropical diseases of the skin: a mixed-methods study to inform intervention development in Ethiopia.

Mirgissa Kaba, Yohannes Hailemichael, Abebaw Yeshambel Alemu, Teklu Cherkose, Getachew Kebebew, Fikregabrail Aberra Kassa, Galana Mamo Ayana, Tedros Nigusse, Kibur Engedawork, Zenebu Begna and 12 more

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Article in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors.

Mirgissa KabaSchool of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
Yohannes HailemichaelArmauer Hansen Research Institute, Addis Ababa, Ethiopia.
Abebaw Yeshambel AlemuArmauer Hansen Research Institute, Addis Ababa, Ethiopia.
Teklu CherkoseArmauer Hansen Research Institute, Addis Ababa, Ethiopia.
Getachew KebebewDepartment of Sociology, Debre Markos University, Debre Markos, Amhara, Ethiopia.
Fikregabrail Aberra KassaArmauer Hansen Research Institute, Addis Ababa, Ethiopia.
Galana Mamo AyanaArmauer Hansen Research Institute, Addis Ababa, Ethiopia.
Tedros NigusseArmauer Hansen Research Institute, Addis Ababa, Ethiopia.
Kibur EngedaworkDepartment of Sociology, Addis Ababa University, Addis Ababa, Ethiopia.
Zenebu BegnaDepartment of Public Health, Ambo University, Ambo, Ethiopia.
Abay WadaySchool of Population Health, Curtin University, Perth, Western Australia, Australia.
Tara B MtuyDepartment of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.ORCID http://orcid.org/0000-0003-3436-0162
Saba LambertArmauer Hansen Research Institute, Addis Ababa, Ethiopia.
Katherine Elizabeth HallidayDepartment of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.ORCID http://orcid.org/0000-0001-5307-2823
Maria ZuurmondDepartment of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Rachel L PullanDepartment of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.
Stephen L WalkerDepartment of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
Catherine PittDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.ORCID http://orcid.org/0000-0003-4967-8966
Endalamaw GadisaArmauer Hansen Research Institute, Addis Ababa, Ethiopia.
Michael MarksDepartment of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
Jennifer PalmerDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK jennifer.palmer@lshtm.ac.uk.ORCID http://orcid.org/0000-0001-7777-722X
SHARP Collaboration

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe WHO and Ethiopia's Ministry of Health have developed strategies to expand and integrate services for co-endemic neglected tropical diseases (NTDs) which manifest in the skin. To inform these strategies, we aimed to understand the social, economic and health system context of skin NTD care in Kalu woreda, Amhara region, Ethiopia, where cutaneous leishmaniasis (CL) and leprosy are endemic.

methodsBetween October 2020 and May 2022, we surveyed and reviewed records of 41 primary healthcare facilities and explored common disease experiences in focus group discussions (n=40) and interviews with people affected by leprosy (n=37) and CL (n=33), health workers (n=23), kebele authorities and opinion leaders (n=33) and traditional healers (n=7). Opportunities for integrated skin NTD service provision were explored through policy document review, interviews with health officials (n=25), and stakeholder meetings.

resultsAvailability of diagnostic supplies and health worker competence to provide skin care was very limited across primary healthcare facilities, particularly for CL. People with leprosy commonly sought care from healthcare facilities, while people with CL administered self-care or sought help from traditional healers. Travel and costs of care at specialised facilities outside the district inhibited timely care-seeking for both diseases. Transmission discourses shaped different understandings of who was affected by leprosy and CL and expectations of behaviour during and after treatment. Many policy actors felt that existing supply chain interventions, decentralised treatment approaches and community engagement initiatives for leprosy could also benefit CL, but others also warned against increasing care-seeking unless CL treatment could be provided on a scale commensurate with the large burden they perceived.

conclusionOur findings demonstrate significant gaps in the provision of care for skin NTDs within primary healthcare, very different health-seeking patterns for leprosy and CL, and a need to develop new models of care, especially for CL.

Indexed as

Leishmaniasis, CutaneousLeprosyNeglected DiseasesAdultEthiopiaFemaleFocus GroupsHumansMaleMiddle AgedPrimary Health CareCutaneous leishmaniasisHealth economicsHealth services researchLeprosyQualitative study

Identifiers

PMID39914875
PMCPMC11800212

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.