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Paper Short Abstract:

Knowing the contextual aspects related to podoconiosis care is required for developing effective interventions. Our findings suggest more emphasis to be paid to sociocultural, economic, political, and geographic domains and how they interact and influence one another for further interventions.

Paper Abstract:

Background: Podoconiosis is a non-infectious tropical lymphoedema that leads to progressive swelling of a uni or bilateral limb. Knowing the contextual aspects related to podoconiosis care is required for developing effective interventions. We evaluated an existing health promotion intervention implemented by an NGO to understand the contextual aspects associated with the reduction of podoconiosis stigma in Musanze district, Rwanda.

Methods: We applied a mixed-methods sequential exploratory design to evaluate an existing health promotion intervention. Quantitative data included 377 household survey. Qualitative data included 6 KII, 36 In-depth interviews with patients and non-patients and four focus group discussions, document analysis of policies, master plans, reports as well as ethnography of implementing NGO.

Results: Our evaluation was based on six contextual domains: sociocultural, economic, political, legal, epidemiological and geographical. Key success within sociocultural included improved early diagnosis and increased awareness. Enacted stigma has decreased but felt stigma remained the same. Politico-legal domains have shown government programmes scale up, and effective teamwork but depended on external resources. Difficult hilly terrain and long distances to reach patients as geographical domain and denial of loans, discrimination of female patients in employment and service access as economic domain consequently lead to continued inability of patients and their siblings to afford buying shoes which prevent them from exposure to irritant volcanic shoes.

Conclusions: Our findings suggest more emphasis to be paid to sociocultural, economic, political, and geographic domains and how they interact and influence one another for further interventions.