Facilitators and Barriers of Healthcare Seeking Behavior for Cutaneous Leishmaniasis and Leprosy in Kallu District of South Wollo, Amhara Region, Ethiopia
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Date
2023-11
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Addis Ababa University
Abstract
Background: Leprosy and cutaneous leishmaniasis (CL) are preventable and treatable neglected
tropical diseases (NTDs) that disproportionately affect impoverished populations in Ethiopia.
Despite the availability of treatments, delays in healthcare seeking remain a challenge, hindering
timely diagnosis and treatment and contributing to the persistence of these NTDs. Understanding
the facilitators and barriers to healthcare-seeking behaviour is crucial for designing effective
interventions to improve disease management and control.
Objective: This study aims to assess the facilitators and barriers to healthcare seeking behavior for
cutaneous leishmaniasis and leprosy among community members in Kallu district, South Wollo,
Amhara region, Ethiopia.
Method: This study employed an exploratory mixed-methods design. A quantitative study
involving 602 participants was conducted using structured interviewer-administered questionnaires
among community members, who were selected using multicluster sampling. Additionally, a
qualitative study was carried out with 17 participants, including leprosy patients, cutaneous
leishmaniasis patients, and key informant health professionals, who were recruited via criterion-
purposive sampling. The quantitative data was collected electronically and analyzed using SPSS
version 26 statistical software. Descriptive statistics, including frequencies, mean, and standard
deviation, were employed to summarize the quantitative data. For the qualitative data, thematic
analysis was conducted using MAXQDA 2022
Results The study found that about543 (90%) and518 (86%) of participants had heard or seen
leprosy and cutaneous leishmaniasis (CL), respectively. In the past six months, 33 (6%) and45
(8.5%) of households experienced leprosy and CL, respectively. Eventhough they diagnosed late
afer disabilities occurs, among those who experienced leprosy, 31(94%) sought treatment from
health facilities, compared to only 6(13%) of those who experienced CL. The qualitative analysis
explored several facilitators, such as the perceived severity of leprosy and CL, the societal emphasis
on skin aesthetics, as well as family and social support, Additionally, access to free drug and
services, community education initiatives, and a pathway through health extension workers (HEW)
were identified as facilitators, Conversely, barriers to healthcare seeking in the community included
limited knowledge, financial constraints, reliance on traditional treatments, geographical and
logistical challenges, drug shortages, and prolonged waiting times.
Conclusion: To minimize delays in healthcare seeking for leprosy and cutaneous leishmaniasis, it is
crucial to tackle the barriers identified at the individual, community, and health facility levels in this
study. These barriers include lack of awareness, financial constraints, and unavailability of drugs
and services. Moreover, it is essential to leverage the facilitators of healthcare seeking, such as
community education iniiattives, free drug and service and social and family support.
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Keywords
Facilitators, barrier, healthcare seeking, cutaneous leishmaniasis, leprosy, Kallu district.