Improving neglected tropical disease services and integration into primary healthcare in Southern Nations, Nationalities and People's Region, Ethiopia: Results from a mixed methods evaluation of feasibility, acceptability and cost effectiveness.

Background: Ethiopia is one of the countries with the highest burden of neglected tropical diseases (NTDs), with 16 of 20 recognised NTDs considered a public health problem, twelve of which have been identified as public health priorities by the Ethiopian Federal Ministry of Health. However, until recently NTDs have not received adequate attention at national and subnational levels in the country. This study assessed feasibility, acceptability, and cost-effectiveness of an NTD intervention when integrated into the primary health care system in Ethiopia.

Methods: This study was conducted in Damot Gale district, Wolaita Zone, Southern Ethiopia and used a mixed methods approach to evaluate an intervention integrating four common NTDs (trachoma, lymphatic filariasis, schistosomiasis and podoconiosis) into Ethiopia's primary healthcare system. The intervention consisted of adapted job aids, supportive supervision, and improved supplies of medical tools to improve diagnosis, management and reporting.

Results: The study found that the intervention was feasible and successful at improving the detection, management and reporting across the four common NTD's included and had a high level of acceptance from health workers. The intervention demonstrated cost-effectiveness.

Conclusion: The findings highlight the need for further investment and consideration of integrating and scaling up NTD interventions at the primary healthcare level in Ethiopia, demonstrating that providing a package of interventions to support integration can be a cost-effective method.