title: Reasons for loss to follow-up of patients with podoconiosis in the Amhara Region, northern Ethiopia.
abstract: BACKGROUND
  Podoconiosis is a non-infectious form of tropical lymphoedema characterised by swelling of the feet and lower legs. Treatment is simple and effective yet evidence indicates that a proportion of patients become lost to follow-up.
  
  
  METHODS
  This study was a quantitative questionnaire-based study which aimed to identify the most common reasons for loss to follow-up of patients. A total of 191 participants registered with the International Orthodox Christian Charities (IOCC) who had become lost to follow-up were included in a cross-sectional survey based in the Amhara Region, northern Ethiopia.
  
  
  RESULTS
  The most common reason was distance, stated by 26.7% (51/191). This was significantly associated with living further from the treatment site (p=0.02). Having had podoconiosis for longer was protective against this (p=0.03). For each additional hour of travel time a patient lived from the treatment centre, the odds of them reporting 'distance' as the main reason for becoming lost to follow-up increased by 1.61 (95% CI: 1.25-2.08).
  
  
  CONCLUSIONS
  The consequences of podoconiosis are exacerbated by walking long distances, but in most areas, this is currently required of patients in order to receive treatment. We recommend expansion of services to widen treatment availability, since provision of transport to and from treatment centres is unlikely to be feasible.
authors.affiliation: Brighton and Sussex Medical School, Falmer, East Sussex, BN1 9PX, UK a.campion1@uni.bsms.ac.uk.
authors.forename: Alice
authors.initials: A
authors.lastname: Campion
authors.affiliation: International Orthodox Christian Charities, Debre Markos, Ethiopia.
authors.forename: Abreham
authors.initials: A
authors.lastname: Tamiru
authors.affiliation: Debre Markos University, Debre Markos, Ethiopia.
authors.forename: Girmay
authors.initials: G
authors.lastname: Tsegay
authors.affiliation: Brighton and Sussex Medical School, Falmer, East Sussex, BN1 9PX, UK.
authors.forename: Gail
authors.initials: G
authors.lastname: Davey
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004604:Elephantiasis / Q000628:therapy*; D005002:Ethiopia; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000523:psychology*; D013997:Time Factors; D014195:Travel
keywords: Clinic attendance; Elephantiasis; Ethiopia; Neglected tropical disease; Podoconiosis; Treatment adherence