Semahegn et al. Systematic Reviews (2023) 12:140 Systematic Reviews https://doi.org/10.1186/s13643-023-02302-5 RESEARCH Open Access Burden of neglected tropical diseases and access to medicine and diagnostics in Ethiopia: a scoping review Agumasie Semahegn1,2,3* , Tsegahun Manyazewal1, Eyerusalem Getachew1, Bethelhem Fekadu1, Esubalew Assefa1,4,5, Munir Kassa6, Gail Davey7,8, Michael Hopkins9, Mesele Araya10,11, Tassew Woldehanna10, Charlotte Hanlon1,12,13 and Abebaw Fekadu1,7,13 Abstract Background More than 1.7 billion people are affected by neglected tropical diseases (NTDs) worldwide. Forty percent of the NTD-affected people live in Africa with the poorest, most vulnerable, and hard to reach geographi- cal areas. The NTDs cause significant social and economic burden and deepen marginalization and stigmatization. The World Health Organization’s current roadmap for NTD aims to prevent, control, eliminate, or eradicate 20 tropi- cal diseases. Ethiopia experiences a high burden of these diseases, but current access to diagnostics, medicine, and/ or care has been little explored to inform the country’s NTD strategic plan. The overall purpose of the scoping review was to map and characterize the burden of NTDs and challenges in access to diagnostics, medicine, and/or care in Ethiopia. Methods A systematic search of evidence was conducted in PubMed, Cochrane Library, and Google Scholar from January 2000 until May 2022, without restrictions of language or study design. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review was followed for screening of studies. Key findings were extracted and narrated qualitatively. Results The search resulted in 4532 articles, of which 105 met the inclusion criteria and were included in the scoping review under three themes: burden of NTDs, access to diagnostics, medicine and/or care, and key barriers. Although gains have been made in the prevention and control of NTDs in Ethiopia, the burden remains high, and progress in access to diagnostics, medicine/drugs, and/or care is very slow. Poverty, poor quality of life, and underfunding of NTD programs decelerate the process of NTD elimination program in the country. Conclusions The scoping review identified a considerable number of studies on the burden of NTDs in Ethio- pia and strategies for diagnosis, treatment, and/or care; however, there is a paucity of evidence on the suitability and potential benefits of novel diagnostic technologies and medicines in the country. A regular review and analy- sis of such country-level evidence is important to inform the country NTDs roadmap and local implementation strategies. Keywords Neglected tropical diseases, Diagnosis, Treatment, Medicine, Scoping review, Ethiopia *Correspondence: Agumasie Semahegn agumas04@gmail.com Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat ivecom mons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons.o rg/p ubli cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Semahegn et al. Systematic Reviews (2023) 12:140 Page 2 of 13 Background Scoping review question(s) Neglected tropical diseases (NTDs) are a group of more than twenty preventable and treatable infec- ▪ What is the scope and volume of literature on NTDs tious diseases in the tropics [1], which affect around in Ethiopia? 1.7 billion people in 149 countries worldwide [2–4]. ▪ What is the burden of NTDs in Ethiopia? Of these, 40% live in Africa with the poorest and most ▪ What are the available NTD diagnostics, medicines, vulnerable people living in hard to reach geographical and/or care for in Ethiopa? areas [3]. NTDs cause significant social and economic ▪ What are the challenges to NTD diagnostics, medi- burden and deepen marginalization and stigmatiza- cine, and/or care in Ethiopia? tion [5]. NTDs are also associated with huge costs and losses to productivity [6]. The World Health Organiza- tion’s (WHO) new roadmap for NTDs (2021–2030) is Methods looking ahead to prevent, control, eliminate, or eradi- The methodology of this scoping review was developed cate 20 tropical diseases [7]. The roadmap is aimed based on the recommendation of Preferred Reporting at reducing morbidities and mortalities from vector- Items for Systematic Review and Meta-Analyses Extension borne diseases and achieving integrated coverage of for Scoping Reviews (PRISMA-ScR) statement [15, 16], preventive chemotherapy for NTDs [2, 7]. Ending the and items in the PRISMA-ScR checklist are completed [16] epidemics of infectious diseases including NTDs is one (Additional file 1). The type of NTDs to be considered in of the United Nations (UN) Sustainable Development this scoping review was informed by the revised national Goals (SDG:3) under target 3.3 [8]. In response to this, NTDs master plans of Ethiopia [5, 10]. the WHO urged countries to develop national road- maps on NTDs by 2020 to sustain enhanced and equi- Search and identification of studies table access to high-quality healthcare coverage against Studies were searched from major electronic data- NTDs by 2030. More than 74 countries [2], including bases that include both published and unpublished Ethiopia [5, 9, 10], are ready to implement national (gray literature) and available from January 2000 to NTDs roadmap, stimulating increased demand for May 2022. The year 2000 was selected to capture com- program implementation and donated medicines cru- prehensive evidence since the inception of the Millen- cial to reach the roadmap’s targets. nium Development Goals (MDGs) [17, 18]. Systematic Almost all regions of Ethiopia have been affected by search was carried out to retrieve studies indexed in at least three NTDs. The burden is higher in the central, PubMed, Cochrane Library, and direct search from western, and northwestern parts of the country [11], and Google Scholar (Additional file  2). Medical Subject more than 75 million people were at risk of infection by Headings (MeSHs) were used to search studies from at least one NTD in Ethiopia [12]. Over a third of those the databases that were designed considering the par- in need (27 million) had not received treatment in 2016 ticipants, concepts, and contexts (PCC) of the research [3]. In response to this, increasing attention has been questions. Terms included NTDs prioritized in Ethio- given to NTDs over the last couple of decades in Ethio- pia (onchocerciasis, trachoma, lymphatic filariasis, pia [2, 5, 12]. The ambitious goals of ending NTDs have podoconiosis, soil transmitted helminthiasis, schisto- to be matched by strategies tailored to local settings, somiasis, leishmaniasis, scabies, and dracunculiasis/ evidence-based decision-making, and sufficient access to guinea-worm), poverty-related disease, key challenges, therapeutics [13]. Likewise, there is an urgent need for barriers, associated factors, determinants, constraints, effective and efficient data monitoring and national sur- prevention and control, and Ethiopia (Table 1). Gener- veillance systems to enable early detection and mitiga- ally, MeSH terms were combined according to the data- tion of the spread of NTDs [7, 14]. bases interface compatibility and recommendation. All Quality evidence is required to inform NTD policy- the searches were imported into EndNote citation man- making and implementation Ethiopia. However, there ager, and duplicates were removed. is a paucity of synthesized evidence relating to disease burden, challenges around access to diagnostics, drugs/ Eligibility criteria therapeutics, and/or care to inform NTD policymaking Existing evidence was included into the scoping review and program implementation in Ethiopia. The main aim using the following eligibility criteria: of this scoping review was to map the available research undertaken on the burden of NTDs and implementation ▪ Studies focused on prioritized NTD in Ethiopia key challenges on access to diagnostic and treatment ser- according to the WHO definition. vices in Ethiopia. S emahegn et al. Systematic Reviews (2023) 12:140 Page 3 of 13 Table 1 Search terms using participant, concept, and context (PCC) framework Participants Studies conducted among adults, women, children, women-child pairs, and NTDs patients/victims Concept Burden/prevalence of NTDs (onchocerciasis, trachoma, dracunculiasis/guinea-worm, lymphatic filariasis, soil-transmitted helminthiasis, schistosomiasis, leishmaniasis, podoconiosis, and scabies) Diagnostics used to investigate onchocerciasis, trachoma, dracunculiasis/guinea-worm, lymphatic filariasis, soil-transmitted helminthiasis, schistosomiasis, leishmaniasis, podoconiosis, and scabies Access to treatment or care: onchocerciasis, trachoma, dracunculiasis/guinea-worm, lymphatic filariasis, soil-transmitted helminthiasis, schistosomiasis, leishmaniosis and podoconiosis, scabies Challenges, policy documents, NTDs roadmap Context Studies conducted in Ethiopia Studies published from January 2000 to May 2022 ▪ Any type of study — observational, interventional, template was designed in Microsoft Word to record key evaluation study designs, and reviews findings of included studies (Additional file 3). The main ▪ Both facility- and community-based studies con- characteristics of individual studies such as author, pub- ducted in Ethiopia lication year, study area (specific geographic, administra- ▪ Both published and unpublished (gray literature) tion site and regional state, national), aim of the study, studies design, sampling method, and type of NTDs considered ▪ Year of publication: January 2000 to May 2022 in the study, burden of NTDs, diagnostic method used, medicine (drug/therapeutics) used and/or care, and other key findings were recorded in the data abstraction tem- Selection process plate. The content of the studies was grouped into three Studies selection was carried out in a stepwise process. thematic areas: burden of NTDs (theme 1), studies on Initially, screening of studies was performed based on diagnostic (theme 2), and access to medicine (drug/thera- their title and abstract by two authors (A. S. and E. G.). peutic) services (theme 3). Studies with title and abstract that clearly stated one or more of the prioritized NTDs in Ethiopia, associated fac- Results tors, access to diagnostics, medicine, and/or care were Description of characteristics of studies considered for further evaluation. Second, the same two A total of 4532 articles related to NTDs in Ethiopia were authors (A. S. and E. G.) performed full-text assessment retrieved. Of these, 1518 duplicates were removed. Next, of included studies. The full-text assessment involved documents were screened by title, abstract, and full text evaluation of the study design, sample size, participants to decide their eligibility for the scoping review. Finally, recruitment, data analysis, presentation of key findings, 105 articles were included into the scoping review. Details conclusions, and recommendations. Third, any uncer- of the screening and selection process are depicted using tainty or disagreement between the two full-text asses- a PRISMA-ScR flowchart on Fig. 1, and the detail profile sors was resolved by consensus through consultation of the included article is presented as an additional file of senior authors (A. F. and T. M.). Study screening and (Additional file 3). selection were guided by the PRISMA-ScR flowchart [15] (Fig. 1). Evidence on burden of NTDs in Ethiopia We identified 31 articles that report the burden of pri- Measurement of outcome and exposure oritized NTDs in Ethiopia [3, 10, 11, 20–47]. Most were The burden of the neglected tropical diseases, access to systematic reviews and meta-analyses on trachoma diagnostics, medicine (drug/therapeutics), and/or care [20], leishmaniasis [21–25], soil-transmitted helmin- were considered as primary outcomes. The key barriers thiasis (STH) [26–30], schistosomiasis [30–33], scabies to access to diagnostic, medicine and/or care, and identi- [34], lymphatic filariasis (LF) and podoconiosis [35–38], fied key policy recommendation to prevent and control review on onchocerciasis [40], and historical review NTDs in Ethiopia were consider as exposure. of the overall NTDs in Ethiopia (1941–2019) [39]. Tra- choma, podoconiosis and leishmaniasis [3, 11], oncho- Data charting and summary of results cerciasis, LF, schistosomiasis, STH, and scabies [3] are The selection process was guided by existing methodol- three common NTDs in Ethiopia. The government of ogy recommendations [19]. Data charting (extraction) Ethiopia has prioritized nine NTDs for intervention [10]. Semahegn et al. Systematic Reviews (2023) 12:140 Page 4 of 13 Fig. 1 Study selection process (NTD, neglected tropical disease; LF, lymphatic filariasis; STH, soil-transmitted helminthiasis) The STHs are common among both adults and school alkalic clay soil [49, 50]. The prevalence of podoconio- children in Ethiopia [26, 39, 41–44]. One-third of infants sis in Ethiopia shows marked regional variation, as high in Ethiopia are affected by STHs (specifically ascaria- as 8.3% in SNNP, 4.0% in Oromia, and 3.9% in Amhara sis) [11]. Podoconiosis and trachoma are also common region [10]. In addition, there was disparity in the bur- in Ethiopia, mainly in Amhara, Oromia, and Southern den of podoconiosis by gender where prevalence was Nation, Nationalities and Peoples (SNNP) regions [45]. higher among women (3.7%) than men (2.4%) [51]. Leg The distributions of NTDs at country level have been lymphedema has a significant negative socio-economic mapped and endemic areas identified and prioritized impact on people affected by podoconiosis and LF and [36, 46, 47]. their caregivers in co-endemic districts of Ethiopia [56] and also increases mortality [55]. Podoconiosis and lymphatic filariasis (LF) Both podoconiosis and LF are among the prioritized NTDs in Ethiopia [10]. Thirteen relevant articles were Trachoma identified [10, 35, 37, 48–56], which report the burden Five studies were identified on the burden of trachoma of podoconiosis and/or LF in Ethiopia [35, 52, 53]. The in Ethiopia [20, 57–60]. The overall prevalence of active burden of podoconiosis is widespread in Africa which trachoma among children in Ethiopia was 26.9%, and ranged from 0.1 to 8.1%, where Ethiopia registered the was highest in SNNP (35.8%) followed by 30.2% in second highest prevalence rate (7.5%) next to Cameroon Amhara and 20.2% in Oromia [20]. Studies conducted (8.1%) [10, 37, 38, 48, 50]. Podoconiosis has gained atten- in Amhara region (152–160) have shown that 28% of tion recently in Ethiopia after evidence emerged that districts had trachoma, with prevalence ranging from it is a preventable noninfectious geochemical form of 8.5 to 36% [57, 58]. A high burden of trachoma was also lymphedema caused by exposure of bare feet to irritant reported in studies conducted in Wolayita Zone [59, 60]. S emahegn et al. Systematic Reviews (2023) 12:140 Page 5 of 13 Soil‑transmitted helminthiasis (STH) onchocerciasis affects millions of people in wide geo- Systematic reviews and meta-analyses identified STH graphic area, and the transmission of onchocerciasis in burden [27–30, 41, 43, 61, 62]. In five studies, the prev- many districts has remained persistent, Ethiopia envis- alence of STH in Ethiopia ranged from 13 to 52.4% aged to interrupt onchocerciasis transmission by 2020 [27–30, 39, 41]. Of these, Ascaris lumbricoides (8.8 to and to be certified free from onchocerciasis by 2025 [40]. 14.0%) [27, 28, 30, 41, 43], hookworm (9.5 to 12.5%) In one study, the mean microfilaremia (mf) of onchocer- [28–30, 41], Trichuris trichiura [30, 41], and Strongy- ciasis in Ethiopia was 4.7% (village range 1.1–11.0%) [71]. loides stercoralis (5.6%) [29] were the most common STHs in Ethiopia. The burden of parasite among preg- Evidence on access to diagnostics and its challenges nant women was 29% in Ethiopia [43]. Furthermore, Leishmaniasis the prevalence of Strongyloides stercoralis in Ethiopia Peripheral blood microscopy [72], kinetoplast deoxyri- ranged from 1.8 to 11.1% in adults [61, 62], from 0.3 bonucleic acid (kDNA) polymerase chain reaction (PCR) to 20.7% in children, and 1.5 to 17.3% in HIV-positive method [73], quantitative real-time kinetoplast deoxy- adults [62]. ribonucleic acid (qRT-kDNA) PCR [74], diagnosis of leishmaniasis based on rK39 immunochromatographic Schistosomiasis (rK39-ICT) [75, 76], in-house liquid direct agglutina- Overall, the prevalence of schistosomiasis varies across tion test (AQ-DAT) antigen [77], microculture method regions of Ethiopia from 39.8 to 41.5% in SNNP [31, 32], (MCM), traditional culture method (TCM) and smear 41% in Amhara, 31.4% in Tigray, 28.9% in Oromia [32], microscopy [78], and molecular diagnosis [25] are avail- and 15% in Afar [31]. In four studies, the prevalence of able diagnostic procedures for leishmaniasis in Ethiopia. schistosomiasis was as high as 73.9% in some districts of Visceral leishmaniasis can be ruled in with peripheral Ethiopia and with lower figures 2% [31–33, 39]. Among blood microscopy in a substantial number of suspected school-age children, males were 58% more likely to be cases and may reduce the number of tissue aspirations infected with schistosomiasis than females [31]. Hepato- performed. However, more sensitive and logistically fea- splenic schistosomiasis is another ignored morbidity in sible methods than light microscopy are needed to detect Ethiopia [63]. the parasites in the blood [72]. The kDNA PCRs showed excellent performance for diagnosis of Leishmania aethi- Leishmaniasis opica. The dry blood sample (DBS) can be used for PCR Leishmaniasis is another prioritized NTD with a report in microscopy is negative, where kDNA PCR method is of high morbidity and mortality in Ethiopia [10]. Five available [73]. studies reported the prevalence of leishmaniasis [21–25]. The qRT-kDNA PCR is a highly sensitive test [74], The prevalence of leishmaniasis in high burden areas of but the sensitivity of rK39-ICT is low, and its specific- Ethiopia was between 9.1% and 19% [21, 25]. The prev- ity is poor in Ethiopia as compared with splenic aspi- alence of leishmaniasis was 39.1% in Amhara region, ration as a gold standard test. So the rK39-ICT needs followed by 23% in Tigray region [21]. Visceral leishma- improvement for clinical use for visceral leishmaniasis niasis was one of the common HIV co-infections (5.2%) in Ethiopia [75, 76]. In-house AQ-DAT is an accessible [24]. Being male was associated with an increased risk of diagnostic method that minimizes intermittent stock leishmaniasis diagnosis [21]. outs and could strengthen the national visceral leishma- niasis control program [77]. In addition, the microculture Scabies method (MCM) is a more sensitive and rapid culturing The prevalence of scabies is documented in several stud- method for the isolation of Leishmania aethiopica than ies in Ethiopia [34, 64–67]. In one systematic review, the traditional culture method (TCM) and smear microscopy overall prevalence of scabies infestation in Ethiopia was [78]. The molecular diagnostic method has significantly 14.5% [34]. Scabies was more common among people lower prevalence than microscopic examination [25]. who have frequent contact with people with active sca- bies at home, who do not use soap/detergent for hand- Trachoma washing, and move from non-endemic to endemic areas In addition to clinical evaluation, three studies reported [68]. Scabies has a strong relationship with malnutrition diagnostic methods for trachoma [79–81]. Photo evalu- among orphan children in Ethiopia [69]. ation (standard 3D images) is the chief diagnostic approach for trachomatous trichiasis (TT) [79], while Onchocerciasis Chlamydia trachomatis deoxyribonucleic acid (DNA) Onchocerciasis has been known in Ethiopia since 1939 [80] and putative attractants [81] were the diagnos- and listed as a priority NTD in 2013 [9, 10, 70]. Although tic methods for active trachoma. Trachoma can also Semahegn et al. Systematic Reviews (2023) 12:140 Page 6 of 13 be detected using Chlamydia trachomatis DNA on Podoconiosis and LF the hands, faces, or clothing of the individuals living Clinical history, physical examination, and tests to rule with ocular-positive household members [80]. In addi- out other forms of lymphedema together make up the tion, putative attractants may play a role in identifying important diagnosis algorithm that has been validated short-chain fatty acids and aromatic compounds that are for identification of podoconiosis [85]. In addition, a new detected by the antennae of M. sorbens. Further work is tool (3D imaging) for mapping LF was piloted in Ethiopia required to optimize chemical blends and release rates, and found to benefit national LF programs by confirming to produce a synthetic lure to which the behavioral where LF is endemic, therefore saving time and resources responses of M. sorbens can be investigated [81]. by preventing mass drug administration (MDA) where there is no evidence of ongoing LF transmission [86]. Soil‑transmitted helminthiasis (STH) Evidence on access to medicine and care for NTDs Combinations of formol-ether concentration, Baer- in Ethiopia mann concentration, and molecular methods, Kato- Leishmaniasis Katz, direct saline microscopy, and formol ether Available evidence shows that sodium stibogluconate concentration methods [61] are available in Ethiopia. (SSG), liposomal-amphotericin B (L-AMB), a combina- Kato-Katz, McMaster, and Mini Parasep® SF were used tion of SSG with paromomycin [22], antimonials with to diagnose schistosomiasis [82], while quantitative pol- paromomycin in combination or pentamidine [87], and ymerase chain reaction (qPCR) [83], serology, and PCR a combination of AmBisome and miltefosine [88] were are diagnostic test for strongyloidiasis [62]. Kato-Katz available treatments for leishmaniasis. The overall treat- thick smear, Kato-Katz thick smear and formol-ether ment success rate was 82.6%. The treatment success concentration, and triple urine-circulating cathodic rates using SSG were 81.5%, that of multiple doses of antigen (CCA)-cassette are the diagnostic test for S. liposomal-amphotericin B (L-AMB) was 96.7%, and the mansoni [32]. Direct wet mount microscopy (DWMM) combination of SSG with paromomycin (90.1%) [22]. Kato-Katz, McMaster, and Mini-FLOTAC are used to Antimonials with paromomycin in combination or pen- diagnose both trichuris and hookworms [84]. tamidine are an effective treatment options for diffused The sensitivity of Mini Parasep® SF, Kato-Katz, and cutaneous leishmaniasis [87]. In addition, the combina- McMaster tests for detecting at least one species of tion of AmBisome and miltefosine is effective strategy to parasites was 90.2%, 62.4%, and 80.0%, respectively. The treat visceral leishmaniasis in HIV-co-infected patients in specificity of these tests was 44.5%, 55.2%, and 26.5%, Ethiopia [88]. respectively. The Mini Parasep® SF fecal parasite concen- trator technique showed better performance than Kato- Trachoma Katz and McMaster techniques in detecting STHs in A blended approach of latrine promotion and MDA with stool samples, particularly for S. mansoni and A. lumbri- ® azithromycin has been proven to prevent trachoma in coides. Hence, Mini Parasep SF could be used as one of Ethiopia [89]. Mass drug administrations of azithromy- the suitable fecal examination methods for surveillance, cin are the predominant approach to prevent trachoma monitoring, and evaluation of preventive chemotherapy in Ethiopia [90–93]. Other intervention includes doxycy- of schistosomiasis [82]. cline for postoperative trichiasis cases [94], TT surgery Likewise, qPCR is the method used in the monitor- [94–96], and hygiene measures including facial cleanli- ing and evaluation to confirm cessation of program [83]. ness and environmental improvement (SAFE) [57]. The Serology and PCR diagnostic tests have four times the overall MDA coverage of azithromycin ranged from 79.5 capacity for diagnostics of strongyloidiasis than micros- to 93.3% in Ethiopia, which is higher than the minimum copy techniques [62]. Kato-Katz thick smear; Kato-Katz WHO set criteria of 80% [91, 92]. Misconceptions and thick smear and formol-ether concentration, and triple poor mobilization were common challenges [91]. urine-CCA cassette are the commonly used diagnos- tic methods for S. mansoni among children in Ethiopia [32]. The diagnostic sensitivity of DWMM was com- Soil‑transmitted helminthiasis (STH) pared to a composite reference standard (CRS) consist- Chemotherapy using mebendazole [97, 98] and MDA ing of Kato-Katz, McMaster, and Mini-FLOTAC for the campaigns [92, 99] are used to prevent and treat STHs. diagnosis of STHs. The sensitivity of DWMM was 73.8% Chemotherapy against STH is crucial, and its cover- for Ascaris but was around 17% for both trichuris and age was 71% in Ethiopia [97]. MDA mobilization and hookworms [84]. awareness creation campaigns targeted head of house- hold, those in poorer health, and older age groups [92]. S emahegn et al. Systematic Reviews (2023) 12:140 Page 7 of 13 Access to water sanitation and hygiene (WASH) pro- access to medicine for leishmaniasis treatment in Ethio- gram is an important public health intervention for pia [123]. These were compounded by very poor access to STHs [27, 99]. Access to WASH reduced infestation of diagnosis and, consequently, significantly delayed access parasites by 54% [27]. to treatment for visceral leishmaniasis [124]. Similarly, the podoconiosis elimination program has been affected Schistosomiasis by lack of necessities including footwear and health edu- Overall treatment coverage of praziquantel against schis- cation [109]. Social stigma has an immense impact on tosomiasis was 75.5% in Ethiopia [100]. Praziquantel was podoconiosis care and support in Ethiopia [114]. The a drug of choice for the treatment for Schistosoma man- MDA with ivermectin monotherapy did not interrupt soni in Ethiopia [100–102]. LF transmission, but adding albendazole and improving treatment coverage are recommended to improve LF pre- Podoconiosis and LF care vention [44, 71]. In terms of prevention, foot hygiene in areas of irritant Gender inequity has significant impact on women’s soil is [49]. Shoe-wearing norms are progressively chang- healthcare seeking and access to medicine and/or care in ing due to secular change in Ethiopia [103]. Ivermectin Ethiopia [113]. In addition, stigmatized attitudes towards MDA coverage for LF was 81.5% which is higher than the patients with podoconiosis influence patients’ seeking minimum recommended level of coverage (65%) [104]. care. More than half (52.7%) of youths had stigmatizing Nevertheless, 75 Woredas were newly identified endemic attitudes towards patients with podoconiosis. Of these, for LF, and only 3.4% of the LF patients had received 59.3% of them were female [117]. Furthermore, social and treatment [52]. A simple and inexpensive package of financial pressures placed on podoconiosis cases affected lymphedema self-care comprising information about families and caregivers [111]. foot hygiene, skin care, bandaging, exercises to improve MDA intervention has been used to control scabies for lymph drainage, and use of socks and shoes has shown many years [122]. Scabies MDA that recently employed effect to reduce occurrence of acute attacks [105]. Minor in response to a massive outbreak in Amhara region surgical intervention (nodulectomy) [49, 105–107], foot was affected by failure to follow-up, shortage of medi- hygiene and footwear [37, 49, 103, 108, 109], economic cine, and lack of leadership effective prioritization [122]. empowerment and life skill programs [49, 53, 107–112], Likewise, MDA program coverage for onchocerciasis transformation of rigid inequity gender norms [110, 111, was significantly high among in-school adolescents with 113, 114], awareness creation, and psychosocial support treatment offering and swallowing status [119]. Hence, for stigma minimization [53, 109, 111, 113, 115–117] school absenteeism was the main reason for not being were crucial component of care for people affected by offered ivermectin (40.9%) and not knowing about MDA podoconiosis and LF. Several articles have documented (25.3%) [119]. the integrated morbidity management for podoconiosis and LF [49, 104, 106, 108, 109, 118]. Family-based inter- Strategies to improve access to medicine vention had played a key role in preventing impairments The national plan for NTD prevention and control has and reducing stigma through self-management of disa- been put forward through three consecutive national bilities and improving family quality of life [112]. Among strategic documents or master plans, the first covering 363 health facilities surveyed, podoconiosis and LF were 2013–2015, second 2016–2020, third roadmap 2021– the major causes of lymphedema in Ethiopia, but only 2025 [9, 10, 70], and NTD elimination district-level 24% of LF and 12% of podoconiosis patients had received coordination toolkit [12]. Comprehensive prevention care from the health facilities [106]. strategies, promotion of footwear, and personal hygiene are highly needed interventions [37]. Raising commu- Onchocerciasis nity awareness about NTDs, particularly podoconiosis Onchocerciasis is targeted for elimination, and the cov- and LF, to transform inequitable gender norms is vital to erage of community-directed treatment (ivermectin) improve access to healthcare [113, 116]. Integration of coverage of onchocerciasis has been around 80% and up the care package into routine healthcare in Ethiopia may to 85.9% in some districts in Ethiopia [40, 119–122]. Vec- be effective in improving health-related quality of life tor control was also an important prevention and control and disability and reducing time out of economic activ- intervention [40]. ity due to podoconiosis and LF [115]. Sustainable aware- ness creation will have a crucial contribution to minimize Challenges in access to medicine and care in Ethiopia stigma and make patients resilient through psychosocial Lack of adequate resource for drug discovery, and/or and life skill interventions [53]. Similarly, community low-purchasing capacity, were common challenge for engagement is essential in the success of MDA program, Semahegn et al. Systematic Reviews (2023) 12:140 Page 8 of 13 alongside strong political commitment, and guideline interrupt disease transmissions and improve quality of adherence [122]. In one systematic review, vaccine devel- life of NTD-affected people. opment was identified as an emerging science for the We used comprehensive evidence, both published prevention of schistosomiasis, but this has not yet been and unpublished literature including policy documents realized. A vaccination strategy would be an ideal tool for related to NTD burden, access to medicine, and its bar- a significant and sustainable reduction in the transmis- riers in Ethiopia, which is the strength of this scoping sion and disease burden of schistosomiasis [125]. review. This scoping review considers all NTDs prior- itized by the government of Ethiopia that made the find- ings very broad which is the known weakness of scoping Discussion review. Therefore, this scoping review contributes to This scoping review mapped the volume of available inform the NTD elimination global policy in the Sustain- evidence on the burden of the priority NTDs in Ethio- able Development Goals by 2030 [126, 127] and evidence pia, access to diagnostic, and treatment gaps. It covered uptake for NTD policy and program design in Ethiopia. studies undertaken on burden, access to diagnostic, Furthermore, the findings from this scoping review are medicine/drug and/or care for NTDs, and key program crucial to organize stakeholder consultative meetings implementation challenges in Ethiopia. We found sys- to put a foundation for evidence to health policymak- tematic reviews, geospatial mapping, national surveys, ing translation platform and suggest future health care, scoping reviews, primary studies, and national strategic health policy research direction, and evidence to policy plan or roadmaps on NTDs. The geographical coverage strategies in Ethiopia. of NTD prevention and control has increased over time [44], with bolder strategies. Nevertheless, the evidence suggests that, despite high burden of NTDs in Ethiopia, Conclusions the implementation of prevention and control programs The scoping review has found substantial level of evi- still lags. dence to inform neglected tropical diseases policymak- This scoping review was guided by the prioritized ing and practice in Ethiopia. Articles identified have NTDs in the three master plans of Ethiopia [5, 9, 10]. shown the burden of NTDs, diagnostic approaches, and Other evidence has documented that up-to-date diag- treatment coverage in Ethiopia. There is relatively strong nostic data is highly valuable for programmatic decision evidence on podoconiosis, trachoma, soil-transmitted and reframing of diagnostic methods. Nonetheless, there helminthiasis, and leishmaniasis but much less on sca- is limited availability of diagnostic tool for many NTDs. bies, guinea-worm, and onchocerciasis. It is vital that Therefore, creation guiding framework is critical to stim- available research findings are taken up to inform poli- ulate investment on research and diagnostic support for cymaking and practice. Although some primary studies NTDs [13]. Strong private–public partnerships, donation reported diagnostic methods for the NTDs, there is lit- by pharmaceutical companies, and increased budget allo- tle high-quality evidence on the sensitivity and specific- cation for the NTD program are very crucial to improve ity of these diagnostic methods. Similarly, preventive access chemotherapies to eliminate NTD [3]. Neverthe- chemotherapy coverage of mass drug administration less, lack of service integration and WASH are still the is widespread, but access to medicine and/or care for challenges of NTD prevention and control programs intensive diseases management is very limited. Access to [44]. The fact that strengthening stakeholder engage- diagnostics, medicine, and/or care has been affected by ment, service integration and coordination of evidence- gender inequality, attitude towards footwear, stigma and informed interventions are crucial strategies to synergize discrimination, and economic status of the most vulner- NTD elimination programs in Ethiopia [44]. able group of population. Evidence on access to timely In addition, integrated NTD control, mapping, rapid and proven diagnostics, medicine, and/or care for NTD scale-up of interventions, and shifting from operational is very scarce in Ethiopia. We suggest that available evi- research into implementation of intervention packages dence from nationwide surveys, mapping exercise, and are very crucial to eliminate NTDs in Ethiopia [11]. Inter- systematic review and meta-analyses should be regularly ventions such as deworming for school children, access to reviewed and used to inform policymaking and imple- improved personal and environmental hygiene in school mentation strategies or practice in Ethiopia in the future. [99], community mobilization and uniform training cam- paign for trachoma prevention and control [91], poverty Abbreviations reduction to attitude transformation to minimize stigma AQ-DAT In-house liquid direct agglutination test and discriminations, and mental distress among podo- CCA Circulating cathodic antigenCDT-Africa Centre for Innovative Drug Development and Therapeutic coniosis-affected people [109] should be emphasized to Trials for Africa S emahegn et al. Systematic Reviews (2023) 12:140 Page 9 of 13 DWMM D irect wet mount microscopy Consent for publication kDNA K inetoplast deoxyribonucleic acid NA. LF L ymphatic filariasis MDA M ass drug administration Competing interests MDG M illennium Development Goal The authors declare that they have no competing interests. NTDs N eglected tropical diseases PCR P olymerase chain reaction Author details qPCR Q uantitative polymerase chain reaction 1 Centre for Innovative Drug Development and Therapeutic Trials for Africa qRT-kDNA Q uantitative real-time kinetoplast deoxyribonucleic acid (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, PRISMA-ScR P referred Reporting Items for Systematic Review and Meta- Ethiopia. 2 College of Health and Medical Sciences, Haramaya University, Analysis extension for Scoping Review Harar, Ethiopia. 3 Department of Population, Family and Reproductive Health, rK39-ICT R K39 immunochromatographic School of Public Health, Unversity of Ghana, Accra, Ghana. 4 Health Econom- SDG S ustainable development goal ics and Policy Research Unit, Wolfson Institute of Population Health, Queen SNNP S outhern Nation, Nationality and People Mary University of London, London, UK. 5 Department of Economics, Faculty STH S oil-transmitted helminthiasis of Arts and Social Sciences, The Open University, Milton Keynes, UK. 6 Ministry SSG S odium stibogluconate of Health of Ethiopia, Addis Ababa, Ethiopia. 7 Global Health & Infection WHO W orld Health Organization Department, Brighton and Sussex Medical School, Brighton, UK. 8 School of Public Health, College of Health Science, Addis Ababa University, Addis Supplementary Information Ababa, Ethiopia. 9 Science Policy Research Unit, University of Sussex, Brighton, UK. 10 College of Business and Economics, Addis Ababa University, Addis The online version contains supplementary material available at https://d oi. Ababa, Ethiopia. 11 Policy Studies Institute, Addis Ababa, Ethiopia. 12 Centre org/ 10. 1186/ s13643- 023- 02302-5. for Global Mental Health, Health Service and Population Research Depart- ment, Institute of Psychiatry, Psychology and Neuroscience, King’s College Additional file 1. Preferred Reporting Items for Systematic reviews and London, London, UK. 13 Department of Psychiatry, WHO Collaborating Centre Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. for Mental Health Research and Capacity Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. Additional file 2. Search strategy. Additional file 3: Table 1. Description of relevant evidence included in Received: 11 October 2022 Accepted: 28 July 2023 scoping review of neglected tropical diseases (NTDs) burden in Ethiopia (Additional file 3). Acknowledgements References This work was supported by the Wellcome Trust (Grant ID 221576/Z/20/Z). 1. WHO. 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