02607nas a2200409   4500000000100000008004100001653001600042653002600058653001800084653002500102653003800127653001600165653000900181653001500190653001700205653001100222653003400233653004200267653001700309653001100326653001300337653001800350653002800368653000900396653001000405100001300415700001200428700001100440700001300451700001300464700001200477245011400489300001100603490000600614520156300620022001402183       2015                            d10aYoung Adult10aSocioeconomic Factors10aSocial stigma10aQualitative Research10aPatient Acceptance of Health Care10aMiddle Aged10aMale10aLymphedema10aLymphangitis10aHumans10aHealth Services Accessibility10aHealth Knowledge, Attitudes, Practice10aFocus Groups10aFemale10aEthiopia10aElephantiasis10aCross-Sectional Studies10aAged10aAdult1 aTsegay G1 aWubie M1 aDegu G1 aTamiru A1 aCooper M1 aDavey G00aBarriers to access and re-attendance for treatment of podoconiosis: a qualitative study in northern Ethiopia.  a285-920 v73 a<p><strong>BACKGROUND: </strong>Podoconiosis is a chronic non-infectious lymphoedema affecting individuals exposed to red clay soil in endemic areas. Evidence from International Orthodox Christian Charities (IOCC) treatment centers' registers suggests that a significant proportion of registered patients with podoconiosis fail to re-attend for treatment, putting them at risk of worsening disability associated with the lymphoedema and attacks of acute adenolymphangitis. The aim of this study was to explore barriers to access and re-attendance of patients with podoconiosis in northern Ethiopia.</p>

<p><strong>METHODS: </strong>A cross-sectional qualitative study was conducted at three IOCC treatment sites from February to April 2013. Twenty-eight patients and three project leaders took part in in-depth interviews. Three focus group discussions were undertaken with 22 patients, patient association leaders and project staff members.</p>

<p><strong>RESULTS: </strong>Barriers to access and to continued attendance at treatment centers were recognized by all participant groups. The following reasons were reported: lay beliefs about the disease's causation and presentation, occupational, geographic and financial barriers, stigma and conflicting expectations of treatment services.</p>

<p><strong>CONCLUSIONS: </strong>This study illustrates the multiple, step-wise barriers to accessing treatment faced by podoconiosis patients. These factors are dynamic, frequently interact and result from competing social and economic priorities.</p>
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