Assessing the Capacity, Barriers, and Facilitators of the Health Care System to Handle Neglected Tropical Diseases in a Refugee Settlement in Uganda: A Mixed Methods Study
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Background
Neglected tropical diseases (NTDs) disproportionately affect over one billion people globally, particularly the poorest communities, with Uganda facing a significant burden where over 40 million people are at risk. Despite global efforts by the World Health Organization (WHO) to integrate NTD management into primary health care (PHC) systems, the capacity of health facilities in refugee settings to diagnose and manage these diseases remains largely unknown. This study aimed to assess the capacity of PHC facilities in Nakivale Refugee Settlement, Uganda, with a focus on health workers’ knowledge of NTDs (specifically, soil-transmitted helminths and schistosomiasis) and the perceived facilitators of and barriers to their diagnosis and management.
Methods
A mixed-methods cross-sectional study employing quantitative and qualitative methods was conducted. We administered a pre-tested questionnaire to health workers in Health Centre III (HCIII) and Health Centre IV (HCIV) facilities within the Nakivale Refugee Settlement. In-depth interviews were conducted with 22 health workers. A thematic analysis approach was employed to code and categorize the qualitative data systematically. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used, while qualitative themes were organized according to the research objectives, focusing on health workers’ knowledge of NTD symptoms and transmission, the availability of diagnostic tools and medications, and the systemic and community-level facilitators and barriers to effective NTD diagnosis and management.
Results
The study population comprised 150 health workers, predominantly females (60%) with a mean age of 31.5 years, who mostly held diplomas or certificates. Regarding capacity criteria, the findings were striking: 88% of health workers reported no previous training on NTDs, and 84% had not received supportive supervision for NTDs. The process of reporting was also challenging; while 39% found it easy, 38% found it difficult, and 71% reported that the NTD reporting form was difficult to fill out. In terms of knowledge, participants were more aware of the signs of urinary schistosomiasis, with 65% knowing about S. haematobium , compared to 58% for S. mansoni . The qualitative findings identified key barriers, including a lack of knowledge among health workers and communities, and the systemic under-prioritization of NTDs due to funding and a lack of supplies. Facilitators for improved management included health worker and community education programmes, integrated outreaches and Mass Drug Administration (MDA), and strengthening diagnostic capacity.
Conclusion
The findings reveal a critical gap in NTD-specific training and supportive supervision among health workers in the Nakivale refugee settlement. While basic knowledge of common NTD types, symptoms, and medications exists, the lack of formal training and the perceived complexity of reporting systems pose significant barriers to effective NTD management. Targeted interventions focusing on comprehensive training, structured supervision, and simplification of reporting mechanisms are crucial to enhancing the capacity of PHC facilities and facilitating the integration of NTD programs in refugee settings, thereby accelerating the realization of Sustainable Development Goal 3.
