{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T10:47:07Z","timestamp":1788173227556,"version":"build-2803163510"},"update-to":[{"DOI":"10.1371\/journal.pntd.0010132","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T00:00:00Z","timestamp":1643760000000}}],"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,21]],"date-time":"2022-01-21T00:00:00Z","timestamp":1642723200000},"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\"><jats:title>Background<\/jats:title><jats:p>Lower limb disorders including lymphoedema create a huge burden for affected persons in their physical and mental health, as well as socioeconomic and psychosocial consequences for them, their families and communities. As routine health services for the integrated management and prevention of lower limb disorders are still lacking, the \u2018Excellence in Disability Prevention Integrated across Neglected Tropical Diseases\u2019 (EnDPoINT) study was implemented to assess the development and delivery of an integrated package of holistic care\u2013including physical health, mental health and psychosocial care\u2013within routine health services for persons with lower limb disorders caused by podoconiosis, lymphatic filariasis and leprosy.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methodology\/Principal findings<\/jats:title><jats:p>This study was part of the first of three phases within EnDPoINT, involving the development of the integrated care package. Focus group discussions and key informant interviews were undertaken with 34 participants between January\u2013February 2019 in Awi zone, Ethiopia, in order to assess the draft care package\u2019s feasibility, acceptability and appropriateness.<\/jats:p><jats:p>Persons affected by lower limb disorders such as lymphoedema experience stigma, exclusion from families, communities and work as well as physical and financial hardship. Beliefs in disease causation inhibit affected persons from accessing care. Ignorance was a barrier for health care providers as well as affected persons. Training and education of affected persons, communities and caregivers is important in improving care access. It also requires time, space, materials and financial resources. Both top-down and grass roots input into service development are key, as well as collaboration across stakeholders including charities, community leaders and \u201cexpert patients\u201d.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Conclusions\/Significance<\/jats:title><jats:p>This study highlighted the need for the EnDPoINT integrated care package and provided suggestions for solutions according to its three aspects of integrated care (integration into routine care; integration of mental health and psychosocial care; and integration of care across the three diseases), thereby giving support for its feasibility, acceptability and appropriateness.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pntd.0010132","type":"journal-article","created":{"date-parts":[[2022,1,21]],"date-time":"2022-01-21T19:46:06Z","timestamp":1642794366000},"page":"e0010132","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Stakeholder perspectives on an integrated package of care for lower limb disorders caused by podoconiosis, lymphatic filariasis or leprosy: A qualitative study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0412-8426","authenticated-orcid":true,"given":"Bethany","family":"Davies","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mersha","family":"Kinfe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1066-6231","authenticated-orcid":true,"given":"Oumer","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asrat","family":"Mengiste","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraham","family":"Tesfaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mossie Tamiru","family":"Wondimeneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"Davey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0366-1093","authenticated-orcid":true,"given":"Maya","family":"Semrau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"EnDPoINT Research Team and Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,1,21]]},"reference":[{"issue":"3","key":"pntd.0010132.ref001","doi-asserted-by":"crossref","first-page":"e0006324","DOI":"10.1371\/journal.pntd.0006324","article-title":"Global epidemiology of podoconiosis: A systematic review","volume":"12","author":"K Deribe","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"issue":"12","key":"pntd.0010132.ref002","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/j.trstmh.2007.08.013","article-title":"Podoconiosis: non-infectious geochemical elephantiasis","volume":"101","author":"G Davey","year":"2007","journal-title":"Transactions of the Royal Society of Tropical Medicine and Hygiene"},{"key":"pntd.0010132.ref003","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1017\/UPO9781922064004.028","volume-title":"Mechanisms of Vascular Disease","author":"M. Waltham","year":"2011"},{"issue":"9","key":"pntd.0010132.ref004","doi-asserted-by":"crossref","first-page":"576","DOI":"10.12968\/bjon.2008.17.9.29243","article-title":"Classification, aetiology and nursing management of lymphoedema","volume":"17","author":"A Honnor","year":"2008","journal-title":"British journal of nursing"},{"key":"pntd.0010132.ref005","author":"World Health Organisation","year":"2021","journal-title":"Lymphatic filariasis. Epidemiology"},{"key":"pntd.0010132.ref006","article-title":"Second edition of National Neglected Tropical Diseases Master Plan","author":"Federal Democratic Republic of Ethiopia Ministry of Health","year":"2016","journal-title":"Ethiopia FMoH"},{"key":"pntd.0010132.ref007","volume-title":"Leprosy (Hansen\u2019s disease). Number of new leprosy cases: 2019","author":"Global Health Observatory","year":"2019"},{"key":"pntd.0010132.ref008","author":"The World Bank","year":"2019","journal-title":"Ethiopia: Rural population (% of total population). 2019 data"},{"issue":"7","key":"pntd.0010132.ref009","doi-asserted-by":"crossref","first-page":"e0003946","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."},{"key":"pntd.0010132.ref010","article-title":"Managing morbidity and preventing disability in the Global Programme to Eliminate Lymphatic Filariasis: WHO position statement","author":"World Health Organisation","journal-title":"2011 Contract No.: 51\u201352"},{"issue":"9709","key":"pntd.0010132.ref011","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/S0140-6736(09)61249-6","article-title":"Integration of control of neglected tropical diseases into health-care systems: challenges and opportunities","volume":"375","author":"JOP Gyapong","year":"2010","journal-title":"Lancet, The"},{"key":"pntd.0010132.ref012","volume-title":"Improving health system efficiency: Ethiopia: human resources for health reforms","author":"A Alebachew","year":"2015"},{"issue":"1","key":"pntd.0010132.ref013","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s12913-017-2031-8","article-title":"Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework","volume":"17","author":"M Sekhon","year":"2017","journal-title":"BMC Health Services Research"},{"issue":"7","key":"pntd.0010132.ref014","doi-asserted-by":"crossref","first-page":"e0003946","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"},{"key":"pntd.0010132.ref015","volume-title":"Summary and statistical report of the 2007 Population and Housing Census","author":"S Zekaria","year":"2008"},{"key":"pntd.0010132.ref016","first-page":"337","article-title":"Developing and evaluating complex interventions: the new Medical Research Council guidance","author":"P Craig","year":"2008","journal-title":"British Medical Journal"},{"issue":"1","key":"pntd.0010132.ref017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13012-017-0552-5","article-title":"Making sense of complexity in context and implementation: the Context and Implementation of Complex Interventions (CICI) framework","volume":"12","author":"LM Pfadenhauer","year":"2017","journal-title":"Implementation science"},{"issue":"1","key":"pntd.0010132.ref018","doi-asserted-by":"crossref","first-page":"1","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"},{"issue":"10","key":"pntd.0010132.ref019","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"},{"issue":"1","key":"pntd.0010132.ref020","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2193-1801-3-647","article-title":"Extent of podoconiosis-related stigma in Wolaita Zone, Southern Ethiopia: a cross-sectional study","volume":"3","author":"A Tora","year":"2014","journal-title":"Springerplus"},{"issue":"2","key":"pntd.0010132.ref021","doi-asserted-by":"crossref","DOI":"10.4081\/jphr.2016.689","article-title":"Dual perspectives on stigma: reports of experienced and enacted stigma by those affected and unaffected by podoconiosis","volume":"5","author":"D Ayode","year":"2016","journal-title":"Journal of public health research"},{"issue":"suppl_1","key":"pntd.0010132.ref022","doi-asserted-by":"crossref","first-page":"i53","DOI":"10.1093\/inthealth\/ihv071","article-title":"Social stigma towards neglected tropical diseases: a systematic review","volume":"8","author":"K Hofstraat","year":"2016","journal-title":"International health"},{"issue":"4","key":"pntd.0010132.ref023","doi-asserted-by":"crossref","first-page":"623","DOI":"10.4269\/ajtmh.2012.12-0204","article-title":"The association of beliefs about heredity with preventive and interpersonal behaviors in communities affected by podoconiosis in rural Ethiopia","volume":"87","author":"D Ayode","year":"2012","journal-title":"The American journal of tropical medicine and hygiene"},{"issue":"4","key":"pntd.0010132.ref024","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1093\/inthealth\/ihw016","article-title":"Interpretations of education about gene-environment influences on health in rural Ethiopia: the context of a neglected tropical disease","volume":"8","author":"A Tora","year":"2016","journal-title":"International health"},{"issue":"11","key":"pntd.0010132.ref025","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/j.pt.2016.08.005","article-title":"Opportunities for integrated control of neglected tropical diseases that affect the skin","volume":"32","author":"D Engelman","year":"2016","journal-title":"Trends in parasitology"},{"issue":"10","key":"pntd.0010132.ref026","doi-asserted-by":"crossref","first-page":"e0008740","DOI":"10.1371\/journal.pntd.0008740","article-title":"Podoconiosis in Rwanda: Knowledge, attitudes and practices among health professionals and environmental officers","volume":"14","author":"U Bayisenge","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"issue":"12","key":"pntd.0010132.ref027","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1093\/trstmh\/traa089","article-title":"\u2018Far from the views of decision-makers\u2019: podoconiosis instruction at medical schools across endemic countries in Africa","volume":"114","author":"K Fowler","year":"2020","journal-title":"Transactions of The Royal Society of Tropical Medicine and Hygiene"},{"issue":"1","key":"pntd.0010132.ref028","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.trstmh.2009.07.021","article-title":"Health professionals\u2019 attitudes and misconceptions regarding podoconiosis: potential impact on integration of care in southern Ethiopia","volume":"104","author":"B Yakob","year":"2010","journal-title":"Transactions of the Royal Society of Tropical Medicine and Hygiene"},{"issue":"3","key":"pntd.0010132.ref029","doi-asserted-by":"crossref","first-page":"101","DOI":"10.3390\/tropicalmed3030101","article-title":"The skin\u2014A common pathway for integrating diagnosis and management of NTDs","volume":"3","author":"DJ Chandler","year":"2018","journal-title":"Tropical medicine and infectious disease"},{"issue":"1","key":"pntd.0010132.ref030","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1186\/1471-2458-12-902","article-title":"Factors related to discontinued clinic attendance by patients with podoconiosis in southern Ethiopia: a qualitative study","volume":"12","author":"A Tora","year":"2012","journal-title":"BMC Public Health"},{"issue":"4","key":"pntd.0010132.ref031","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1093\/inthealth\/ihu085","article-title":"Barriers to access and re-attendance for treatment of podoconiosis: a qualitative study in northern Ethiopia","volume":"7","author":"G Tsegay","year":"2014","journal-title":"International Health"},{"issue":"3","key":"pntd.0010132.ref032","doi-asserted-by":"crossref","first-page":"e010354","DOI":"10.1136\/bmjopen-2015-010354","article-title":"\u2018Why should I worry, since I have healthy feet?\u2019A qualitative study exploring barriers to use of footwear among rural community members in northern Ethiopia","volume":"6","author":"A Kelemework","year":"2016","journal-title":"BMJ open"},{"issue":"4","key":"pntd.0010132.ref033","doi-asserted-by":"crossref","first-page":"e2199","DOI":"10.1371\/journal.pntd.0002199","article-title":"A qualitative study exploring barriers related to use of footwear in rural highland ethiopia: implications for neglected tropical disease control","volume":"7","author":"D Ayode","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"issue":"3","key":"pntd.0010132.ref034","article-title":"Podoconiosis control in rural Ethiopia: the roles of expert patients, appropriate treatment and community mobilization","volume":"10","author":"Y Molla","year":"2012","journal-title":"Commun Dermatol."},{"key":"pntd.0010132.ref035","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1183\/09031936.00027414","article-title":"The expert patient: towards a novel definition","volume":"44","author":"J-F Cordier","year":"2014","journal-title":"European Respiratory Journal"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0010132","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2022,2,2]],"date-time":"2022-02-02T00:00:00Z","timestamp":1643760000000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0010132","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T02:53:45Z","timestamp":1674528825000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0010132"}},"subtitle":[],"editor":[{"given":"Alison","family":"Krentel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,1,21]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0010132","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0010132","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,21]]}}}