abstract: 'Background

  Ethiopia bears a high burden of visceral leishmaniasis (VL). Early

  access to VL diagnosis and care improves clinical prognosis and reduces

  transmission from infected humans; however, significant obstacles exist.

  The approximate 250,000 seasonal mobile workers (MW) employed annually

  in northwestern Ethiopia may be particularly disadvantaged and at risk

  of VL acquisition and death. Our study aimed to assess barriers, and

  recommend interventions to increase access, to VL diagnosis and care

  among MWs.

  Methodology/Principal findings

  In 2017, 50 interviews and 11 focus group discussions were conducted

  with MWs, mobile residents, VL patients and caretakers, community

  leaders and healthcare workers in Kafta Humera District, Tigray.

  Participants reported high vulnerability to VL among MWs and residents

  engaged in transitory work. Multiple visits to health facilities were

  consistently needed to access VL diagnosis. Inadequate healthcare worker

  training, diagnostic test kit unavailability at the primary healthcare

  level, lack of VL awareness, insufficient finances for care-seeking and

  prioritization of income-generating activities were significant barriers

  to diagnosis and care. Social (decision-making and financial) support

  strongly and positively influenced care-seeking; workers unable to

  receive salary advances, compensation for partial work, or peer

  assistance for contract completion were particularly disadvantaged.

  Participants recommended the government/stakeholders intervene to

  ensure: MWs access to bed-nets, food, shelter, water, and healthcare at

  farms or sick leave; decentralization of diagnostic tests to primary

  healthcare facilities; surplus medications/staff during the peak season;

  improved referral/feedback/reporting/training within the health system;

  free comprehensive healthcare for all VL-related services; and community

  health education.

  Conclusions/Significance

  Contrary to what health policy for VL dictates in this endemic setting,

  study participants reported very poor access to diagnosis and,

  consequently, significantly delayed access to treatment. Interventions

  tailored to the socio-economic and health needs of MWs (and other

  persons suffering from VL) are urgently needed to reduce health

  disparities and the VL burden.'
affiliation: 'Coulborn, RM (Corresponding Author), Epictr, Paris, France.

  Coulborn, Rebecca Marie; Schneider, Martin; Gerstl, Sibylle; Porten, Klaudia, Epictr,
  Paris, France.

  Gebrehiwot, Tesfay Gebregzabher, Mekelle Univ, Sch Publ Hlth, Mekelle, Ethiopia.

  Adera, Cherinet; Herrero, Merce; den Boer, Margriet, KalaCORE, London, England.

  Herrero, Merce, WHO, Geneva, Switzerland.

  den Boer, Margriet, Med Sans Frontieres, London, England.

  Ritmeijer, Koert, Med Sans Frontieres, Amsterdam, Netherlands.

  Alvar, Jorge, Drugs Neglected Dis Initiat, Geneva, Switzerland.

  Hassen, Abrahim, Tigray Reg Hlth Bur, Dept Hlth Promot \& Dis Prevent, Tigray, Ethiopia.'
article-number: e0006778
author: Coulborn, Rebecca Marie and Gebrehiwot, Tesfay Gebregzabher and Schneider,
  Martin and Gerstl, Sibylle and Adera, Cherinet and Herrero, Merce and Porten, Klaudia
  and den Boer, Margriet and Ritmeijer, Koert and Alvar, Jorge and Hassen, Abrahim
  and Mulugeta, Afework
author-email: rebecca.coulborn@epicentre.msf.org
author_list:
- family: Coulborn
  given: Rebecca Marie
- family: Gebrehiwot
  given: Tesfay Gebregzabher
- family: Schneider
  given: Martin
- family: Gerstl
  given: Sibylle
- family: Adera
  given: Cherinet
- family: Herrero
  given: Merce
- family: Porten
  given: Klaudia
- family: den Boer
  given: Margriet
- family: Ritmeijer
  given: Koert
- family: Alvar
  given: Jorge
- family: Hassen
  given: Abrahim
- family: Mulugeta
  given: Afework
da: '2023-09-28'
doi: 10.1371/journal.pntd.0006778
files: []
issn: 1935-2735
journal: PLOS NEGLECTED TROPICAL DISEASES
keywords-plus: 'KALA-AZAR; HIV-INFECTION; RISK; PREVALENCE; OUTBREAK; DISEASES; AFRICA;

  HUMERA; IMPACT; KENYA'
language: English
month: NOV
number: '11'
number-of-cited-references: '40'
orcid-numbers: Mulugeta, Afework/0000-0003-0707-4363
papis_id: 253970d9d1da4638fe1da1597ef5c644
ref: Coulborn2018barriersaccess
times-cited: '8'
title: 'Barriers to access to visceral leishmaniasis diagnosis and care among seasonal
  mobile workers in Western Tigray, Northern Ethiopia: A qualitative study'
type: Article
unique-id: WOS:000452162500005
usage-count-last-180-days: '1'
usage-count-since-2013: '11'
volume: '12'
web-of-science-categories: Infectious Diseases; Parasitology; Tropical Medicine
year: '2018'