2023-09-28 14:46:10 +00:00
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abstract: 'Background
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Ethiopia bears a high burden of visceral leishmaniasis (VL). Early
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access to VL diagnosis and care improves clinical prognosis and reduces
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transmission from infected humans; however, significant obstacles exist.
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The approximate 250,000 seasonal mobile workers (MW) employed annually
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in northwestern Ethiopia may be particularly disadvantaged and at risk
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of VL acquisition and death. Our study aimed to assess barriers, and
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recommend interventions to increase access, to VL diagnosis and care
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among MWs.
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Methodology/Principal findings
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In 2017, 50 interviews and 11 focus group discussions were conducted
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with MWs, mobile residents, VL patients and caretakers, community
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leaders and healthcare workers in Kafta Humera District, Tigray.
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Participants reported high vulnerability to VL among MWs and residents
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engaged in transitory work. Multiple visits to health facilities were
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consistently needed to access VL diagnosis. Inadequate healthcare worker
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training, diagnostic test kit unavailability at the primary healthcare
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level, lack of VL awareness, insufficient finances for care-seeking and
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prioritization of income-generating activities were significant barriers
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to diagnosis and care. Social (decision-making and financial) support
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strongly and positively influenced care-seeking; workers unable to
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receive salary advances, compensation for partial work, or peer
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assistance for contract completion were particularly disadvantaged.
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Participants recommended the government/stakeholders intervene to
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ensure: MWs access to bed-nets, food, shelter, water, and healthcare at
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farms or sick leave; decentralization of diagnostic tests to primary
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healthcare facilities; surplus medications/staff during the peak season;
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improved referral/feedback/reporting/training within the health system;
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free comprehensive healthcare for all VL-related services; and community
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health education.
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Conclusions/Significance
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Contrary to what health policy for VL dictates in this endemic setting,
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study participants reported very poor access to diagnosis and,
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consequently, significantly delayed access to treatment. Interventions
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tailored to the socio-economic and health needs of MWs (and other
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persons suffering from VL) are urgently needed to reduce health
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disparities and the VL burden.'
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affiliation: 'Coulborn, RM (Corresponding Author), Epictr, Paris, France.
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Coulborn, Rebecca Marie; Schneider, Martin; Gerstl, Sibylle; Porten, Klaudia, Epictr,
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Paris, France.
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Gebrehiwot, Tesfay Gebregzabher, Mekelle Univ, Sch Publ Hlth, Mekelle, Ethiopia.
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Adera, Cherinet; Herrero, Merce; den Boer, Margriet, KalaCORE, London, England.
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Herrero, Merce, WHO, Geneva, Switzerland.
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den Boer, Margriet, Med Sans Frontieres, London, England.
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Ritmeijer, Koert, Med Sans Frontieres, Amsterdam, Netherlands.
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Alvar, Jorge, Drugs Neglected Dis Initiat, Geneva, Switzerland.
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Hassen, Abrahim, Tigray Reg Hlth Bur, Dept Hlth Promot \& Dis Prevent, Tigray, Ethiopia.'
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article-number: e0006778
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author: Coulborn, Rebecca Marie and Gebrehiwot, Tesfay Gebregzabher and Schneider,
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Martin and Gerstl, Sibylle and Adera, Cherinet and Herrero, Merce and Porten, Klaudia
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and den Boer, Margriet and Ritmeijer, Koert and Alvar, Jorge and Hassen, Abrahim
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and Mulugeta, Afework
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author-email: rebecca.coulborn@epicentre.msf.org
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author_list:
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- family: Coulborn
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given: Rebecca Marie
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- family: Gebrehiwot
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given: Tesfay Gebregzabher
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- family: Schneider
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given: Martin
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- family: Gerstl
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given: Sibylle
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- family: Adera
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given: Cherinet
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- family: Herrero
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given: Merce
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- family: Porten
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given: Klaudia
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- family: den Boer
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given: Margriet
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- family: Ritmeijer
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given: Koert
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- family: Alvar
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given: Jorge
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- family: Hassen
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given: Abrahim
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- family: Mulugeta
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given: Afework
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da: '2023-09-28'
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doi: 10.1371/journal.pntd.0006778
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files: []
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issn: 1935-2735
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journal: PLOS NEGLECTED TROPICAL DISEASES
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keywords-plus: 'KALA-AZAR; HIV-INFECTION; RISK; PREVALENCE; OUTBREAK; DISEASES; AFRICA;
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HUMERA; IMPACT; KENYA'
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language: English
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month: NOV
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number: '11'
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number-of-cited-references: '40'
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orcid-numbers: Mulugeta, Afework/0000-0003-0707-4363
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papis_id: 253970d9d1da4638fe1da1597ef5c644
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ref: Coulborn2018barriersaccess
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times-cited: '8'
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title: 'Barriers to access to visceral leishmaniasis diagnosis and care among seasonal
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mobile workers in Western Tigray, Northern Ethiopia: A qualitative study'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000452162500005
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usage-count-last-180-days: '1'
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usage-count-since-2013: '11'
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volume: '12'
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web-of-science-categories: Infectious Diseases; Parasitology; Tropical Medicine
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year: '2018'
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