Understanding experiences of neglected tropical diseases of the skin: a mixed-methods study to inform intervention development in Ethiopia
Background The 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...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-02-01
|
| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/10/2/e016650.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1823865078156361728 |
|---|---|
| author | Michael Marks David Mabey Ruth Canter Elizabeth Allen Charles Opondo Jennifer Palmer Iris Mosweu Jacob Novignon Sinéad Langan Maria Zuurmond Catherine Pitt Stephen L Walker Dorothy Yeboah-Manu Tara Mtuy Rachel L Pullan Richard Phillips Daniel Okyere Anthony Ablordey Samantha Owen Portia Boakye Okyere Kidist Bobosha Katherine Halliday Steve Walker Galana Mamo Ayana Rachel Pullan Mirgissa Kaba Tara B Mtuy Yaw Amoako Adwoa Asante-Poku Abigail Agbanyo Eric Koka Joseph Timothy Yohannes Hailemichael Abebaw Yeshambel Alemu Teklu Cherkose Getachew Kebebew Fikregabrail Aberra Kassa Tedros Nigusse Kibur Engedawork Zenebu Begna Abay Waday Saba Lambert Katherine Elizabeth Halliday Endalamaw Gadisa Vanessa Yardley Collins Ahorlu Anita Achiaa Gyekye Emmanuel Afreh Esther Amon Abraham Kwabena Anang Ruth Dede Tuwor Giulia D’Odorico Kibur Engidawork Mehari Getaneh Bernadette Morkporkpor Emmanuel Narh Dorcas Opai-Tetteh Yohannes Michael Amel Mohammed Fewzia Shikur Mohammed Shimelis Doni Nigusse Maja Niksic Edmond Okloo Michael Oppong Lucy Owusu Ishaque Siam Ingrid Sobel Feleke Tilahum Joseph Tuffour Abay Woday Abebaw Yeshambel Adelaide Forkuo- Boadu Derrick Kontoh Jojo Cobbinah |
| author_facet | Michael Marks David Mabey Ruth Canter Elizabeth Allen Charles Opondo Jennifer Palmer Iris Mosweu Jacob Novignon Sinéad Langan Maria Zuurmond Catherine Pitt Stephen L Walker Dorothy Yeboah-Manu Tara Mtuy Rachel L Pullan Richard Phillips Daniel Okyere Anthony Ablordey Samantha Owen Portia Boakye Okyere Kidist Bobosha Katherine Halliday Steve Walker Galana Mamo Ayana Rachel Pullan Mirgissa Kaba Tara B Mtuy Yaw Amoako Adwoa Asante-Poku Abigail Agbanyo Eric Koka Joseph Timothy Yohannes Hailemichael Abebaw Yeshambel Alemu Teklu Cherkose Getachew Kebebew Fikregabrail Aberra Kassa Tedros Nigusse Kibur Engedawork Zenebu Begna Abay Waday Saba Lambert Katherine Elizabeth Halliday Endalamaw Gadisa Vanessa Yardley Collins Ahorlu Anita Achiaa Gyekye Emmanuel Afreh Esther Amon Abraham Kwabena Anang Ruth Dede Tuwor Giulia D’Odorico Kibur Engidawork Mehari Getaneh Bernadette Morkporkpor Emmanuel Narh Dorcas Opai-Tetteh Yohannes Michael Amel Mohammed Fewzia Shikur Mohammed Shimelis Doni Nigusse Maja Niksic Edmond Okloo Michael Oppong Lucy Owusu Ishaque Siam Ingrid Sobel Feleke Tilahum Joseph Tuffour Abay Woday Abebaw Yeshambel Adelaide Forkuo- Boadu Derrick Kontoh Jojo Cobbinah |
| collection | DOAJ |
| description | Background The 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.Methods Between 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.Results Availability 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.Conclusion Our 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. |
| format | Article |
| id | doaj-art-59c54b79dc3743a89505a33da4f6cc36 |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-59c54b79dc3743a89505a33da4f6cc362025-02-08T12:00:12ZengBMJ Publishing GroupBMJ Global Health2059-79082025-02-0110210.1136/bmjgh-2024-016650Understanding experiences of neglected tropical diseases of the skin: a mixed-methods study to inform intervention development in Ethiopia 0Michael Marks1David MabeyRuth CanterElizabeth AllenCharles Opondo2Jennifer Palmer3Iris MosweuJacob NovignonSinéad LanganMaria Zuurmond4Catherine Pitt5Stephen L Walker6Dorothy Yeboah-ManuTara MtuyRachel L Pullan7Richard PhillipsDaniel OkyereAnthony AblordeySamantha OwenPortia Boakye OkyereKidist BoboshaKatherine HallidaySteve WalkerGalana Mamo Ayana8Rachel PullanMirgissa Kaba9Tara B Mtuy10Yaw AmoakoAdwoa Asante-PokuAbigail AgbanyoEric KokaJoseph TimothyYohannes Hailemichael11Abebaw Yeshambel Alemu12Teklu Cherkose13Getachew Kebebew14Fikregabrail Aberra Kassa15Tedros Nigusse16Kibur Engedawork17Zenebu Begna18Abay Waday19Saba Lambert20Katherine Elizabeth Halliday21Endalamaw Gadisa22Vanessa YardleyCollins AhorluAnita Achiaa GyekyeEmmanuel AfrehEsther AmonAbraham Kwabena AnangRuth Dede TuworGiulia D’OdoricoKibur EngidaworkMehari GetanehBernadette MorkporkporEmmanuel NarhDorcas Opai-TettehYohannes MichaelAmel MohammedFewzia Shikur MohammedShimelis Doni NigusseMaja NiksicEdmond OklooMichael OppongLucy OwusuIshaque SiamIngrid SobelFeleke TilahumJoseph TuffourAbay WodayAbebaw YeshambelAdelaide Forkuo- BoaduDerrick KontohJojo CobbinahKenya National Bureau of Statistics, Nairobi, Nairobi, KenyaDepartment of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK4 Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UKDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UKDepartment of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UKDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UKDepartment of Clinical Research, London School of Hygiene & Tropical Medicine, London, UKDepartment of Disease Control, London School of Hygiene & Tropical Medicine, London, UKArmauer Hansen Research Institute, Addis Ababa, EthiopiaSchool of Public Health, Addis Ababa University, Addis Ababa, EthiopiaDepartment of Clinical Research, London School of Hygiene & Tropical Medicine, London, UKArmauer Hansen Research Institute, Addis Ababa, EthiopiaArmauer Hansen Research Institute, Addis Ababa, EthiopiaArmauer Hansen Research Institute, Addis Ababa, EthiopiaDepartment of Sociology, Debre Markos University, Debre Markos, Amhara, EthiopiaArmauer Hansen Research Institute, Addis Ababa, EthiopiaArmauer Hansen Research Institute, Addis Ababa, EthiopiaDepartment of Sociology, Addis Ababa University, Addis Ababa, EthiopiaDepartment of Public Health, Ambo University, Ambo, EthiopiaSchool of Population Health, Curtin University, Perth, Western Australia, AustraliaArmauer Hansen Research Institute, Addis Ababa, EthiopiaDepartment of Disease Control, London School of Hygiene & Tropical Medicine, London, UKArmauer Hansen Research Institute, Addis Ababa, EthiopiaBackground The 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.Methods Between 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.Results Availability 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.Conclusion Our 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.https://gh.bmj.com/content/10/2/e016650.full |
| spellingShingle | Michael Marks David Mabey Ruth Canter Elizabeth Allen Charles Opondo Jennifer Palmer Iris Mosweu Jacob Novignon Sinéad Langan Maria Zuurmond Catherine Pitt Stephen L Walker Dorothy Yeboah-Manu Tara Mtuy Rachel L Pullan Richard Phillips Daniel Okyere Anthony Ablordey Samantha Owen Portia Boakye Okyere Kidist Bobosha Katherine Halliday Steve Walker Galana Mamo Ayana Rachel Pullan Mirgissa Kaba Tara B Mtuy Yaw Amoako Adwoa Asante-Poku Abigail Agbanyo Eric Koka Joseph Timothy Yohannes Hailemichael Abebaw Yeshambel Alemu Teklu Cherkose Getachew Kebebew Fikregabrail Aberra Kassa Tedros Nigusse Kibur Engedawork Zenebu Begna Abay Waday Saba Lambert Katherine Elizabeth Halliday Endalamaw Gadisa Vanessa Yardley Collins Ahorlu Anita Achiaa Gyekye Emmanuel Afreh Esther Amon Abraham Kwabena Anang Ruth Dede Tuwor Giulia D’Odorico Kibur Engidawork Mehari Getaneh Bernadette Morkporkpor Emmanuel Narh Dorcas Opai-Tetteh Yohannes Michael Amel Mohammed Fewzia Shikur Mohammed Shimelis Doni Nigusse Maja Niksic Edmond Okloo Michael Oppong Lucy Owusu Ishaque Siam Ingrid Sobel Feleke Tilahum Joseph Tuffour Abay Woday Abebaw Yeshambel Adelaide Forkuo- Boadu Derrick Kontoh Jojo Cobbinah Understanding experiences of neglected tropical diseases of the skin: a mixed-methods study to inform intervention development in Ethiopia BMJ Global Health |
| title | Understanding experiences of neglected tropical diseases of the skin: a mixed-methods study to inform intervention development in Ethiopia |
| title_full | Understanding experiences of neglected tropical diseases of the skin: a mixed-methods study to inform intervention development in Ethiopia |
| title_fullStr | Understanding experiences of neglected tropical diseases of the skin: a mixed-methods study to inform intervention development in Ethiopia |
| title_full_unstemmed | Understanding experiences of neglected tropical diseases of the skin: a mixed-methods study to inform intervention development in Ethiopia |
| title_short | Understanding experiences of neglected tropical diseases of the skin: a mixed-methods study to inform intervention development in Ethiopia |
| title_sort | understanding experiences of neglected tropical diseases of the skin a mixed methods study to inform intervention development in ethiopia |
| url | https://gh.bmj.com/content/10/2/e016650.full |
| work_keys_str_mv | AT understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT michaelmarks understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT davidmabey understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT ruthcanter understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT elizabethallen understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT charlesopondo understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT jenniferpalmer understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT irismosweu understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT jacobnovignon understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT sineadlangan understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT mariazuurmond understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT catherinepitt understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT stephenlwalker understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT dorothyyeboahmanu understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT taramtuy understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT rachellpullan understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT richardphillips understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT danielokyere understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT anthonyablordey understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT samanthaowen understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT portiaboakyeokyere understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT kidistbobosha understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT katherinehalliday understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT stevewalker understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT galanamamoayana understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT rachelpullan understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT mirgissakaba understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT tarabmtuy understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT yawamoako understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT adwoaasantepoku understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT abigailagbanyo understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT erickoka understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT josephtimothy understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT yohanneshailemichael understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT abebawyeshambelalemu understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT teklucherkose understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT getachewkebebew understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT fikregabrailaberrakassa understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT tedrosnigusse understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT kiburengedawork understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT zenebubegna understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT abaywaday understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT sabalambert understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT katherineelizabethhalliday understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT endalamawgadisa understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT vanessayardley understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT collinsahorlu understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT anitaachiaagyekye understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT emmanuelafreh understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT estheramon understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT abrahamkwabenaanang understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT ruthdedetuwor understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT giuliadodorico understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT kiburengidawork understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT meharigetaneh understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT bernadettemorkporkpor understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT emmanuelnarh understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT dorcasopaitetteh understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT yohannesmichael understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT amelmohammed understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT fewziashikurmohammed understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT shimelisdoninigusse understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT majaniksic understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT edmondokloo understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT michaeloppong understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT lucyowusu understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT ishaquesiam understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT ingridsobel understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT feleketilahum understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT josephtuffour understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT abaywoday understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT abebawyeshambel understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT adelaideforkuoboadu understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT derrickkontoh understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia AT jojocobbinah understandingexperiencesofneglectedtropicaldiseasesoftheskinamixedmethodsstudytoinforminterventiondevelopmentinethiopia |