title: Barriers to access and re-attendance for treatment of podoconiosis: a qualitative study in northern Ethiopia.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia girmshe@gmail.com.
authors.forename: Girmay
authors.initials: G
authors.lastname: Tsegay
authors.affiliation: College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
authors.forename: Moges
authors.initials: M
authors.lastname: Wubie
authors.affiliation: College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
authors.forename: Genet
authors.initials: G
authors.lastname: Degu
authors.affiliation: International Orthodox Christian Charities, Debre Markos, Ethiopia.
authors.forename: Abreham
authors.initials: A
authors.lastname: Tamiru
authors.affiliation: Brighton and Sussex Medical School, Brighton, UK.
authors.forename: Max
authors.initials: M
authors.lastname: Cooper
authors.affiliation: Brighton and Sussex Medical School, Brighton, UK.
authors.forename: Gail
authors.initials: G
authors.lastname: Davey
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004604:Elephantiasis / Q000473:pathology / Q000628:therapy*; D005002:Ethiopia; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008205:Lymphangitis / Q000209:etiology / Q000517:prevention & control; D008209:Lymphedema / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D057545:Social Stigma; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Continuity of care; East and West Gojam Zone; Ethiopia; Podoconiosis