{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T14:38:03Z","timestamp":1774535883471,"version":"3.50.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0009332","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T00:00:00Z","timestamp":1619740800000}}],"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T00:00:00Z","timestamp":1618876800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["16\/136\/29"],"award-info":[{"award-number":["16\/136\/29"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Neglected Tropical Diseases (NTDs) are a group of several communicable and non-communicable diseases prevalent in tropical and subtropical areas. The co-endemicity of these diseases, the similarity of their clinical signs, and the need to maximize limited financial and human resources suggest the importance of adoptingan integratedapproach to their prevention and treatment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Aims<\/jats:title>\n<jats:p>This study describes the development of a comprehensive package of physical, mental health and psychosocial care for people with lower-limb lymphoedema caused bypodoconiosis, lymphatic filariasis (LF)or leprosy as part of the EnDPoINT program in Ethiopia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Method<\/jats:title>\n<jats:p>The care package was developed using a mixed-methods approach, consisting of a literature review, situational analysis, Theory of Change (ToC) workshops, qualitative research, and additional workshops to fine-tune the draft care package. The care package was developed between March 2018 and January 2020 in Addis Ababa and the implementation research site, Awi zone in the North-West of Ethiopia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>The holistic care package includes components implemented at three levels of the health care system:health organization, facility, and community. Sections of the care package are directed at strengthening capacity building, program management, community engagement, awareness-raising, stigma-reduction, morbidity management, disability prevention, follow-up visits, referral linkage, community-based rehabilitation, and monitoring and evaluation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The study developed a holistic integrated care package for lower limb disorder and co-morbid mental health problems caused by podoconiosis, LF or leprosy. The approach has the potential to significantly reduce lower limb disorder-associated morbidity, disability, and psychosocial problems. It also standardizes a scalable approach appropriate for the Ethiopian setting and, most likely, other countries where these NTDs are present.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pntd.0009332","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T22:44:52Z","timestamp":1618958692000},"page":"e0009332","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Development of an integrated, holistic care package for people with lymphoedema for use at the level of the Primary Health Care Unit in Ethiopia"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3734-2584","authenticated-orcid":true,"given":"Abraham","family":"Tesfaye","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0366-1093","authenticated-orcid":true,"given":"Maya","family":"Semrau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1066-6231","authenticated-orcid":true,"given":"Oumer","family":"Ali","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2395-1194","authenticated-orcid":true,"given":"Mersha","family":"Kinfe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mossie","family":"Tamiru","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2219-0952","authenticated-orcid":true,"given":"Abebaw","family":"Fekadu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2796-7468","authenticated-orcid":true,"given":"Gail","family":"Davey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,4,20]]},"reference":[{"issue":"5","key":"pntd.0009332.ref001","doi-asserted-by":"crossref","first-page":"e424","DOI":"10.1371\/journal.pntd.0000424","article-title":"Community-based control of a neglected tropical disease: the mossy foot treatment and prevention association","volume":"3","author":"G Davey","year":"2009","journal-title":"PLoS neglected tropical diseases"},{"key":"pntd.0009332.ref002","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1475-2883-6-2","article-title":"Morbidity management in the Global Programme to Eliminate Lymphatic Filariasis: a review of the scientific literature","volume":"6","author":"DG Addiss","year":"2007","journal-title":"Filaria journal"},{"issue":"3","key":"pntd.0009332.ref003","doi-asserted-by":"crossref","first-page":"e0213842","DOI":"10.1371\/journal.pone.0213842","article-title":"Evaluation of the cutaneous sensation of the face in patients with different clinical forms of leprosy","volume":"14","author":"MFd Oliveira","year":"2019","journal-title":"PLoS One"},{"issue":"12","key":"pntd.0009332.ref004","doi-asserted-by":"crossref","first-page":"2561","DOI":"10.1093\/cid\/ciz671","article-title":"The Health and Economic Burdens of Lymphatic Filariasis Prior to Mass Drug Administration Programs","volume":"70","author":"CG Mathew","year":"2020","journal-title":"Clinical infectious diseases: an official publication of the Infectious Diseases Society of America"},{"issue":"7","key":"pntd.0009332.ref005","doi-asserted-by":"crossref","first-page":"e795","DOI":"10.1016\/S2214-109X(18)30124-4","article-title":"Lymphoedema management to prevent acute dermatolymphangioadenitis in podoconiosis in northern Ethiopia (GoLBeT): a pragmatic randomised controlled trial","volume":"6","author":"H Negussie","year":"2018","journal-title":"The Lancet Global health"},{"key":"pntd.0009332.ref006","unstructured":"WHO. Leprosy key facts2019:[https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/leprosy pp.]."},{"issue":"Suppl 1","key":"pntd.0009332.ref007","first-page":"45","article-title":"The National Programme to Eliminate Lymphatic Filariasis from Ethiopia","volume":"55","author":"B Mengistu","year":"2017","journal-title":"Ethiopian medical journal"},{"issue":"7","key":"pntd.0009332.ref008","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003946","article-title":"Mapping and Modelling the Geographical Distribution and Environmental Limits of Podoconiosis in Ethiopia","volume":"9","author":"K Deribe","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pntd.0009332.ref009","doi-asserted-by":"crossref","first-page":"148","DOI":"10.4269\/ajtmh.14-0446","article-title":"Epidemiology and individual, household and geographical risk factors of podoconiosis in Ethiopia: results from the first nationwide mapping","volume":"92","author":"K Deribe","year":"2015","journal-title":"Am J Trop Med Hyg"},{"key":"pntd.0009332.ref010","article-title":"Depression and disability in people with podoconiosis: a comparative cross-sectional study in rural Northern Ethiopia","author":"J Bartlett","year":"2016","journal-title":"International Health"},{"issue":"4","key":"pntd.0009332.ref011","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1093\/trstmh\/traa003","article-title":"The health and economic burden of podoconiosis in Ethiopia","volume":"114","author":"K Deribe","year":"2020","journal-title":"Transactions of the Royal Society of Tropical Medicine and Hygiene"},{"issue":"10","key":"pntd.0009332.ref012","doi-asserted-by":"crossref","first-page":"712","DOI":"10.2471\/BLT.14.150276","article-title":"The feasibility of eliminating podoconiosis","volume":"93","author":"K Deribe","year":"2015","journal-title":"Bull World Health Organ"},{"key":"pntd.0009332.ref013","first-page":"1","article-title":"National Masterplan for Neglected Tropical Diseases (NTDs).","year":"2013","journal-title":"Ethioian Ministry of HealthAddis Ababa Ethiopia"},{"key":"pntd.0009332.ref014","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1186\/1756-3305-5-240","article-title":"The burden of neglected tropical diseases in Ethiopia, and opportunities for integrated control and elimination","volume":"5","author":"K Deribe","year":"2012","journal-title":"Parasites and Vectors"},{"key":"pntd.0009332.ref015","article-title":"Mental distress and podoconiosis in Northern Ethiopia: a comparative cross-sectional study","author":"E Mousley","year":"2014","journal-title":"International Health."},{"issue":"6","key":"pntd.0009332.ref016","doi-asserted-by":"crossref","first-page":"e0005567","DOI":"10.1371\/journal.pntd.0005567","article-title":"Prevalence of depression and associated clinical and socio-demographic factors in people living with lymphatic filariasis in Plateau State, Nigeria","volume":"11","author":"J Obindo","year":"2017","journal-title":"PLOS Neglected Tropical Diseases"},{"key":"pntd.0009332.ref017","doi-asserted-by":"crossref","first-page":"2581","DOI":"10.1001\/jama.291.21.2581","article-title":"Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys","volume":"291","author":"K Demyttenaere","year":"2004","journal-title":"JAMA"},{"issue":"10","key":"pntd.0009332.ref018","doi-asserted-by":"crossref","first-page":"e037675","DOI":"10.1136\/bmjopen-2020-037675","article-title":"EnDPoINT: protocol for an implementation research study to integrate a holistic package of physical health, mental health and psychosocial care for podoconiosis, lymphatic filariasis and leprosy into routine health services in Ethiopia","volume":"10","author":"M Semrau","year":"2020","journal-title":"BMJ Open"},{"key":"pntd.0009332.ref019","volume-title":"Population Projection of Ethiopia for All Regions. At Wereda Level from 2014\u20132017","author":"Ethiopian Central Statistic Authority","year":"2013"},{"key":"pntd.0009332.ref020","unstructured":"Ethiopian Ministry of Health. Lymphatic filariasis and podoconiosis morbidity management and disability prevention guideline. Addis Ababa, Ethiopia2016."},{"key":"pntd.0009332.ref021","unstructured":"Ethiopian national neglected tropical diseases master plan. Ministry of Health. Addis Ababa Ethiopia2016."},{"key":"pntd.0009332.ref022","unstructured":"Ethiopian Ministry of Health. The National Mental Health Strategy. Addis Ababa, Ethiopia2015."},{"key":"pntd.0009332.ref023","unstructured":"WHO. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings: mental health Gap Action Programme (mhGAP)\u2013version 2.0. Switherland2016."},{"key":"pntd.0009332.ref024","unstructured":"Ethiopian Ministry of Health. Ethiopia Health Sector Transformation Plan: 2015\u20132020. Addis Ababa, Ethiopia2015."},{"key":"pntd.0009332.ref025","unstructured":"Ethiopian Central Statistic Authority. The 2016 Ethiopia Demographic and Health Survey (2016 EDHS) Addis Ababa, Ethiopia2016."},{"key":"pntd.0009332.ref026","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1186\/1745-6215-15-267","article-title":"Theory of Change: a theory-driven approach to enhance the Medical Research Council\u2019s framework for complex interventions.","volume":"15","author":"M De Silva","year":"2014","journal-title":"Trials"},{"key":"pntd.0009332.ref027","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1186\/1745-6215-15-267","article-title":"Theory of Change: a theory-driven approach to enhance the Medical Research Council\u2019s framework for complex interventions","volume":"15","author":"MJ De Silva","year":"2014","journal-title":"Trials"},{"key":"pntd.0009332.ref028","unstructured":"WHO. WHO global strategy on people-centred and integrated health services2016."},{"key":"pntd.0009332.ref029","first-page":"113","article-title":"Primary Mental Health Care Services in Ethiopia: Experiences, Opportunities and Challenges from East African Country","volume":"1","author":"A G","year":"2016","journal-title":"J Neuropsychopharmacol Ment Health"},{"key":"pntd.0009332.ref030","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s13033-019-0272-0","article-title":"Health system constraints in integrating mental health services into primary healthcare in rural Uganda: perspectives of primary care providers","volume":"13","author":"EK Wakida","year":"2019","journal-title":"International journal of mental health systems"},{"key":"pntd.0009332.ref031","volume-title":"Integrating mental health into primary care: a global perspective","author":"WHO","year":"2008"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0009332","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T00:00:00Z","timestamp":1619740800000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0009332","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,30]],"date-time":"2021-04-30T17:53:25Z","timestamp":1619805205000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0009332"}},"subtitle":[],"editor":[{"given":"Richard Stewart","family":"Bradbury","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,4,20]]},"references-count":31,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,20]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0009332","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0009332","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,20]]}}}