Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes, France.
BMC Public Health. 2024 Sep 13;24(1):2500. doi: 10.1186/s12889-024-20055-1.
Visceral leishmaniasis (VL) is among the world's most serious public health threats, causing immense human suffering and death. In Ethiopia, little is known about the barriers and facilitators of visceral leishmaniasis case management. This study aimed to explore such barriers and facilitators in the Amhara Regional State, Northwest Ethiopia.
An exploratory qualitative study was conducted on 16 purposively selected patients and key informants from May 8 to June 2, 2023. The study participants were recruited using the maximum variation technique. The interviews were audio recorded, transcribed verbatim, and translated into English. Thematic analysis was employed using Atlas.ti 9 software with a blended approach of both deductive and inductive coding.
The study identified a variety of issues that hinder the success of visceral leishmaniasis case management. Treatment centers face frequent interruptions of medicinal supplies, a lack of funding, and a lack of trained healthcare providers. A lack of support from health authorities, including weak supervision and feedback systems, is also a source of concern. Most patients receive treatments after significant delays, which is primarily due to low awareness, poor surveillance, and misdiagnosis by healthcare workers. The case management is further constrained by malnutrition, VL-HIV co-infection, and other comorbidities. Despite these issues, we found that effective collaboration between hospital units and VL treatment centers, acceptance by hospitals, and the caring attitude of healthcare workers play a positive role in facilitating the program's effectiveness.
Despite the existence of certain efforts that facilitate the program's effectiveness, VL remains largely neglected, with little government attention or intervention. Such inattention is the root cause of most of the issues. Despite limited resources, most issues could be resolved with cost-effective strategies if health authorities at all levels have the will and commitment to do so.
内脏利什曼病（VL）是世界上最严重的公共卫生威胁之一，给人类带来了巨大的痛苦和死亡。在埃塞俄比亚，人们对内脏利什曼病病例管理的障碍和促进因素知之甚少。本研究旨在探索埃塞俄比亚阿姆哈拉地区的此类障碍和促进因素。
2023 年 5 月 8 日至 6 月 2 日，我们对 16 名来自埃塞俄比亚阿姆哈拉地区的有目的选择的患者和关键信息提供者进行了探索性定性研究。使用最大变异技术招募研究参与者。访谈进行了录音，逐字记录，并翻译成英文。使用 Atlas.ti 9 软件采用演绎和归纳编码的混合方法进行主题分析。
研究发现了许多阻碍内脏利什曼病病例管理成功的问题。治疗中心经常面临药品供应中断、缺乏资金和缺乏受过培训的医疗保健提供者的问题。卫生当局缺乏支持，包括监督和反馈系统薄弱，也是一个令人担忧的问题。大多数患者在接受治疗时已经出现了明显的延迟，这主要是由于意识水平低、监测不力和医疗工作者误诊所致。病例管理还受到营养不良、VL-HIV 合并感染和其他合并症的限制。尽管存在这些问题，但我们发现医院各单位与 VL 治疗中心之间的有效合作、医院的接受程度以及医疗保健工作者的关怀态度对促进该计划的有效性起到了积极的作用。
尽管存在一些促进计划有效性的努力，但 VL 仍然在很大程度上被忽视，政府很少关注或干预。这种关注不足是大多数问题的根源。尽管资源有限，但如果各级卫生当局有意愿和承诺，大多数问题都可以通过具有成本效益的策略来解决。
