03615nas a2200337   4500000000100000008004100001260004400042653000900086653001700095653003000112653001800142653001600160653002800176653001200204100001000216700001400226700001500240700002200255700001500277700001200292700001500304700001300319700001300332700001200345245022700357856008500584300000900669490000700678520257800685022001403263       2025                            d  bSpringer Science and Business Media LLC10aNTDs10aPodoconiosis10aLymphatic filariasis (LF)10aMental Health10aIntegration10aimplementation research10aLeprosy1 aAli O1 aMihretu A1 aHounsome N1 aAnagnostopoulou V1 aBremner SA1 aKinfe M1 aMengiste A1 aSemrau M1 aFekadu A1 aDavey G00aOutcomes and cost-effectiveness of an integrated holistic care package on persons affected by podoconiosis, lymphatic filariasis and leprosy and community members in north-western Ethiopia: an implementation research study  uhttps://bmcmedicine.biomedcentral.com/counter/pdf/10.1186/s12916-025-04108-9.pdf  a1-120 v233 a<p><strong>Background:&nbsp;</strong>Most studies on integration of neglected tropical disease programmes have focused on mass drug administration or environmental measures rather than Disease Management, Disability and Inclusion (DMDI). The study reported here explored integration of a DMDI care package across three disabling, stigmatising neglected tropical diseases (podoconiosis, lymphatic filariasis and leprosy), across physical and mental health, and into the state health system.</p>

<p><strong>Methods:</strong> We conducted this pre-post study, the third phase of an implementation research project, in two predominantly rural districts in north-west Ethiopia in 2021. We assessed physical and mental health outcomes on 192 afected persons and 817 community members at baseline and 6 months after initiation of the integrated care package, implemented by nurses and health ofcers. Key outcomes measured were disability (using WHODAS-2.0), depression (Patient Health Questionnaire-9), discrimination (Discrimination and Stigma Scale), internalised stigma (Internalized Stigma Related to Lymphoedema), quality of life (Dermatology Life Quality Index) and social support (Oslo-3 Social Support Scale). Mixed effects linear regression models were used to estimate change in outcomes between baseline and 6 months after initiation of the care package. We also evaluated implementation feasibility and conducted cost-effectiveness analysis.</p>

<p><strong>Results:</strong> Among 221 patients, improvements were observed in foot (−2.3 cm; 95% CI:−2.2,−1.8) and leg circumference (−1.8 cm;−2.0,−1.7) and acute attacks (6.2; 0.0, 6.6); these were statistically significant at the 5% level. Reductions were seen in disability scores (−6.5;−7.6,−5.5), depression (−5.3;−6.6,−4.6), discrimination (−3.3;−4.2,−2.3), internalised stigma (−3.7;−4.6,−2.8), quality of life (−4.0;−4.8,−3.2), and alcohol use (−1.6;−2.4,−0.8). No notable changes were found in the presence of wounds or moss, or perceived social support. Across 817 community&nbsp;members, there was strong evidence that knowledge improved, and stigmatising attitudes and social distance reduced. The intervention was cost-effective in reducing depression and disability and improving health-related quality of life and feasible to implement.</p>

<p><strong>Conclusion:</strong> The integrated intervention is feasible and cost-effective even in remote areas and appears ideal for scale-up to other endemic regions in Ethiopia and other countries.</p>
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