Developing an integrated community-based case detection and referral system for neglected tropical diseases affecting the skin: a pilot study in Kaduna and Ogun States, Nigeria

• To address current knowledge gaps regarding how best to detect and refer skin neglected tropical diseases (NTD) cases at community levels based on varying health worker capacities.

Many NTDs have significant skin manifestations, which can lead to chronic and lifelong disability, morbidity and stigma, with many affected people. Affected people often attend for treatment at health facilities in the latter stages of disease, once symptoms become severe. Early case detection of skin NTDs is therefore important to minimise the negative health impacts that delays in diagnosis can cause. The WHO Department for the Control of NTDs has proposed integrating programme implementation for more effective and efficient management.

In Nigeria, Buruli ulcer, leprosy, and clinical manifestations of lymphatic filariasis, specifically lymphedema and hydrocele, are four skin NTDs being prioritised for integrated (across disease and within the health system) case management.

It is anticipated that the findings from this study will support the Federal Ministry of Health (FMOH) in Nigeria to deliver their operational plan for the integrated case management of NTDs.

Kaduna and Ogun states were selected because they are both endemic for two or more of the NTDs affecting the skin and there is variation in partner support; Kaduna state has had partner support while Ogun has not.

Phase 1: Reflect

Existing mechanisms for case detection, referral and treatment of skin NTDs were explored through literature reviews and participatory meetings with affected people and frontline health workers in Ogun.

Phase 2: Plan

Findings from phase one informed participatory action planning meetings with community and health system stakeholders from Ogun and Kaduna to co-design an intervention for improving case detection, referral and treatment of skin NTDs.

Phase 3: Act

The implementation of the intervention over six months in two local government areas (LGAs) within each of the study states.

Phase 4: Observe

Evaluation of the intervention. Methods included analysis of routinely collected health systems information about the number of cases detected and the level of disability or morbidity at point of detection pre, mid-point and post-intervention. This also included semi-structured interviews, focus group discussions and review meetings.

• Summary of literature review: “Developing Integrated Management Strategies for Neglected Tropical Diseases that Affect the Skin”
• Case detection project summary
• Intervention manual for the integrated management of skin NTDs