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Learning lessons from implementation of health interventions to reduce podoconiosis-related stigma in Musanze district, Rwanda
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DOI：10.1186/s12939-026-02972-2.png)
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Abstract
En 中文
Podoconiosis is a neglected tropical disease (NTD) marked by lymphedema. It develops when a person with genetic susceptibility is repeatedly exposed to environmental risk factors, particularly long-term barefoot contact with irritant red clay soils. Effective interventions rely on understanding the critical milestones an intervention undergoes which are usually underestimated. We focused on a health promotion intervention used to improve on podoconiosis awareness to mitigate podoconiosis-related stigma implemented by Heart and Sole for Africa, a local non-governmental organization. Using Context and Implementation of Complex Intervention (CICI) framework, we evaluated the implementation process and the effectiveness of an existing health promotion intervention in regard reducing podoconiosis-related stigma in Musanze district, Rwanda. This was an exploratory mixed methods study conducted between October 2022 and March 2023 to assess implementation domains comprised of theory, agents, process, strategies and outcomes. Qualitative data was obtained through document analysis, field observations, 36 in-depth interviews (24 with people affected with podoconiosis and 12 community members), six key informant interviews and four focus group discussions. In addition, we administered a survey to 336 community members and 48 people affected with podoconiosis. Data were inductively analysed and mapped onto the five-implementation domains in which the health promotion intervention was put into practice and their implications for reducing stigma. The health promotion intervention was found to be efficient as it prioritized patient needs, increased podoconiosis awareness using effective supportive family members/peer to peer/implementing partners. HASA provided free medical care and supplies and trained community member and patients. Consequently, they increased patient knowledge about podoconiosis (n = 34/37; 91.8%), improved adherence, foot hygiene, and self-confidence, and ensured employment resumption. HASA won a national trust to scale up podoconiosis services to another eleven endemic districts using acquired national grants. Barriers in implementation of podonociosis services included bureaucracies, unrealistic patient and staff expectations and dependency on donor/grant funding. Missed opportunities are the use of community health workers and patient peers in podoconiosis care and in the Fit feet Fit campaign, the integration of podoconiosis care into routine care and the training in nursing and medical schools. Our implementation findings were used as a source of advocacy for HASA to scale up podoconiosis care to another eleven endemic districts in Rwanda. We also anticipate that the identified implementation steps and domains will be useful in guiding new interventions elsewhere where podoconiosis is highly prevalent. Thus, we advocate for continuous partnerships across different stakeholders which will sustain program activities at different points of interventions.
Keywords:
Health promotion
Stigma
Podoconiosis
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