Gender-related factors affecting health seeking for neglected tropical diseases: findings from a qualitative study in Ethiopia

BackgroundDespite known gender-specific differences in terms of prevalence, transmission and exposure to neglected tropical diseases (NTDs), there is limited discussion of the influence of gender in NTD programmes and interventions. There is a paucity of research on how gender interacts with NTD service provision and uptake. This study, part of broader implementation research in Ethiopia, applied a gender lens to health seeking for five NTDs: lymphatic filariasis, podoconiosis, schistosomiasis, soil-transmitted helminth infection and trachoma.Methodology/principal findingsThe study was conducted in a district of the Southern Nations, Nationalities, and Peoples' Region of Ethiopia where the five NTDs are prevalent. A qualitative methodology was adopted to explore participants’ perspectives and experiences. Data generation methods included 20 interviews and four focus group discussions. Community members, volunteer Health Development Army leaders, Health Extension Workers and a range of health workers at the health post, health centre and hospital level (n = 59) were purposively sampled. Interviews and focus group discussions were audio recorded, transcribed verbatim into English then analysed through open coding, drawing on constant comparative methods.Gender related factors affected care seeking for NTDs and were described as reasons for not seeking care, delayed care seeking and treating NTDs with natural remedies. Women faced additional challenges in seeking health care due to gender inequalities and power dynamics in their domestic partnerships. Participants recommended raising community awareness about NTDs, however this remains problematic due to gender and social norms around appropriate discourse with members of the opposite gender.Conclusions/significanceThe findings from this study provide crucial insights into how gender interacts with accessing health services, at different levels of the health system. If we are committed to leaving no one behind and achieving universal health coverage, it is essential to address gender disparities to access and utilisation of interventions delivered by national NTD programmes.背景：尽管在被忽视的热带病（neglected tropical diseases, NTDs）的流行率、传播途径与暴露风险层面已明确存在性别差异，但目前针对性别在NTD防控项目及干预措施中的影响的探讨仍较为有限，且关于性别如何与NTD服务提供及服务利用产生交互作用的研究亦较为匮乏。本研究作为埃塞俄比亚一项更广泛实施研究的组成部分，将性别视角应用于五种NTD的就医行为研究，这五种NTD分别为淋巴丝虫病（lymphatic filariasis）、脚肿病（podoconiosis）、血吸虫病（schistosomiasis）、土源性蠕虫感染（soil-transmitted helminth infection）以及沙眼（trachoma）。 方法与主要结果：本研究在埃塞俄比亚南部各族、各民族与人民地区（Southern Nations, Nationalities, and Peoples' Region）的一个辖区内开展，该辖区内上述五种NTD均呈流行态势。本研究采用定性研究方法，以探究参与者的观点与经历。数据生成方式包括20次访谈与4次焦点小组讨论。采用目的抽样法纳入参与者，具体包括社区居民、志愿者健康发展军（Health Development Army）带头人、健康推广员（Health Extension Workers），以及卫生所、医疗中心与医院层级的各类医护人员，共计59名。对访谈与焦点小组讨论内容进行音频录制，随后逐字转录为英文文本，并通过开放编码法结合持续比较法开展分析。与性别相关的因素会对NTD的就医行为产生影响，参与者将其归纳为未就医、就医延迟以及采用自然疗法治疗NTD的各类原因。由于性别不平等及家庭伴侣间的权力动态关系，女性在寻求医疗护理时面临额外挑战。参与者建议提升社区对NTD的认知水平，但由于与异性进行合适对话的性别与社会规范限制，这一举措的落实仍存在困难。 结论与意义：本研究结果为理解性别如何在不同层级的卫生系统中影响卫生服务可及性提供了关键视角。若我们致力于践行“不让任何人掉队”的目标并达成全民健康覆盖，那么必须解决国家NTD项目所提供的干预措施在可及性与利用层面存在的性别差异问题。