IMPRESS – Improving access to integrated Morbidity management and disability PREvention Services through Stigma reduction for people with lower limb lymphoedema in Ethiopia: Feasibility and quasi-experimental study

"Background: NTDs resulting in lower limb lymphoedema are common in Ethiopia; podoconiosis accounts for about 64.8% (approx. 1.67 million cases), leprosy for 12.8%, and LF for 0.3% of the total country burden of lymphoedema. The NIHR-funded EnDPoINT programme is an implementation research programme that focuses on how best to integrate and scale up a holistic MMDP care package (including physical and psychosocial care) into government-run health services for patients with LF, leprosy and podoconiosis; however, the important element of stigma reduction to facilitate access to and create demand for MMDP services lies beyond the scope of EnDPoINT, leaving a gap in the programmatic activities. This provides a unique opportunity within which to focus on the specific question of how best to reduce stigma within an integrated MMDP programme. The proposed IMPRESS project will build on the EnDPoINT programme, thereby representing value for money. Methods: The first phase of the study involved a formative component to assess the capacity of the integrated morbidity management and disability prevention (MMDP) programme to incorporate a stigma reduction intervention for people with lower limb lymphoedema, and the barriers and facilitators to this. Following the formative work, in the second phase a stigma reduction intervention was developed and the impact of the intervention measured to see if it is effective in increasing demand and access to services within an integrated MMDP programme for people with lower limb lymphoedema. Results: There was capacity to include a stigma reduction intervention within an integrated MMDP program for people with lower limb lymphedema caused by LF, leprosy and podoconiosis in Ethiopia. Amongst patient cohort participants, trend towards reduced internalized stigma and experienced stigma (discrimination) over the 6-month follow-up period in both the intervention and control (slightly greater in control, but not significant). Internalized stigma was higher among respondents in the intervention site compared to the control site. Community survey didn’t find a significant difference in knowledge or attitudes between baseline and endline"