Development of an integrated and decentralised skin health strategy to improve experiences of skin neglected tropical diseases and other skin conditions in Atwima Mponua District, Ghana

Richard Odame Phillips; Lucy Owusu; Eric Koka; Edmond Kwaku Ocloo; Hope Simpson; Abigail Agbanyo; Daniel Okyere; Ruth Dede Tuwor; Adelaide Fokuoh-Boadu; Richard Adjei Akuffo; Jacob Novignon; Michael Ntiamoah Oppong; Iris Mosweu; Adwoa Asante-Poku; Jojo Cobbinah; Tara B Mtuy; Jennifer Palmer; Collins Ahorlu; Yaw Ampem Amoako; Stephen L Walker; Dorothy Yeboah-Manu; Michael Marks; Catherine Pitt; Rachel Pullan; SHARP collaboration

doi:10.1371/journal.pgph.0002809

Development of an integrated and decentralised skin health strategy to improve experiences of skin neglected tropical diseases and other skin conditions in Atwima Mponua District, Ghana

PLOS Glob Public Health. 2024 Jan 19;4(1):e0002809. doi: 10.1371/journal.pgph.0002809. eCollection 2024.

Authors

Richard Odame Phillips^{1

2}, Lucy Owusu¹, Eric Koka³, Edmond Kwaku Ocloo^{3

4}, Hope Simpson⁵, Abigail Agbanyo¹, Daniel Okyere⁴, Ruth Dede Tuwor¹, Adelaide Fokuoh-Boadu¹, Richard Adjei Akuffo⁴, Jacob Novignon^{1

6}, Michael Ntiamoah Oppong¹, Iris Mosweu⁷, Adwoa Asante-Poku⁴, Jojo Cobbinah⁸, Tara B Mtuy⁹, Jennifer Palmer⁹, Collins Ahorlu⁴, Yaw Ampem Amoako^{1

2}, Stephen L Walker⁹, Dorothy Yeboah-Manu⁴, Michael Marks^{5

9

10}, Catherine Pitt⁵, Rachel Pullan⁵; SHARP collaboration

Affiliations

¹ Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
² School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
³ Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana.
⁴ Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
⁵ Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
⁶ Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
⁷ Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
⁸ Atwima Mponua District Health Directorate, Nhinahin, Ghana.
⁹ Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom.
¹⁰ Division of Infection and Immunity, University College London, London, United Kingdom.

Abstract

Integrated strategies are recommended to tackle neglected tropical diseases of the skin (skin NTDs), which pose a substantial health and economic burden in many countries, including Ghana. We describe the development of an integrated and decentralised skin health strategy designed to improve experiences of skin NTDs in Atwima Mponua district in Ashanti Region. A multidisciplinary research team led an iterative process to develop an overall strategy and specific interventions, based on a theory of change informed by formative research conducted in Atwima Mponua district. The process involved preparatory work, four co-development workshops (August 2021 to November 2022), collaborative working groups to operationalise intervention components, and obtaining ethical approval. Stakeholders including affected individuals, caregivers, other community members and actors from different levels of the health system participated in co-development activities. We consulted these stakeholders at each stage of the research process, including discussion of study findings, development of our theory of change, identifying implementable solutions to identified challenges, and protocol development. Participants determined that the intervention should broadly address wounds and other skin conditions, rather than only skin NTDs, and should avoid reliance on non-governmental organisations and research teams to ensure sustainable implementation by district health teams and transferability elsewhere. The overall strategy was designed to focus on a decentralised model of care for skin conditions, while including other interventions to support a self-care delivery pathway, community engagement, and referral. Our theory of change describes the pathways through which these interventions are expected to achieve the strategy's aim, the assumptions, and problems addressed. This complex intervention strategy has been designed to respond to the local context, while maximising transferability to ensure wider relevance. Implementation is expected to begin in 2023.

Copyright: © 2024 Phillips et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

The Skin Health Africa Research Programme (SHARP) is a collaboration between the London School of Hygiene and Tropical Medicine in the UK, the Noguchi Memorial Institute for Medical Research and the Kumasi Centre for Collaborative Research into Tropical Medicine of Kwame Nkrumah University of Science and Technology in Ghana, and the Armauer Hansen Research Institute and Addis Ababa University in Ethiopia. This project is funded by the National Institute for Health and Care Research (NIHR) under its Research and Innovation for Global Health Transformation (RIGHT) Programme [Grant Reference Number NIHR200125] awarded to ROP, SLW, DYM, MM, CP and RP. The views expressed are those of the author(s) and not necessarily those of the NIHR. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.