Integration and scale-up of a primary healthcare-based chronic wound care package for persons affected by skin-NTDs and other conditions in Ethiopia: a protocol for an implementation research study
Authors: Kinfe M , Semrau M , Mengiste A , Ali O , Ajeme T , Bremner SA , Hounsome N , Anagnostopoulou V , Brewster M , Rugema L , Ahmed Eiman Siddig , Semahegn Agumasie , Fekadu A , Davey G 
Published: June 2024

ABSTRACTIntroductionThe profound impact of wounds on the quality of life of those affected is often underestimated. Chronic wounds impose substantial burdens on individuals and communities in terms of disability, mental distress, stigma, and economic productivity losses. To effectively address these challenges, an integrated and comprehensive approach to primary healthcare-based chronic wound care prevention and management is essential. This implementation research study aims to assess the integration and scale-up of a comprehensive package of primary healthcare-based wound care and psycho-social support for persons affected by chronic wounds caused by neglected tropical diseases (NTDs) and other conditions in selected districts in Ethiopia.MethodsThe study will be implemented in Central Ethiopia in three stages, utilizing a mixed-methods approach to co-develop a comprehensive care package and progressively implement the care package building on learnings from successive stages of implementation. Stage 1 will encompass the co-development of a holistic wound care package and strategies for its integration into routine health services. Stage 2 will involve a pilot study in one sub-district, to establish the care package adoption, feasibility, acceptability, fidelity, potential effectiveness, readiness for scale-up, and costs. Stage 3 will involve the scale-up of the wound care package and its evaluation in several districts.Ethics and disseminationEthics approval was obtained for the study from the relevant authorities in both the UK (Ref no: ER-BSMS9D79-6) and Ethiopia [Reference no. 013/23/CDT]. The results of the study will be disseminated through a variety of channels, including publications in scientific journals, conference presentations, policy briefs, and workshops. This will ensure that the findings are disseminated widely to the scientific community, policymakers, and the public.Strengths and limitations of this studyStrengthsThis study will address a critical gap in Ethiopia, where there is a significant health burden due to chronic wounds from skin-NTDs and other conditions, for which primary healthcare integration of wound care could improve accessibility and outcomes for affected persons, their families and communities.The study will use implementation research methods to examine the integration and scale-up of a primary healthcare-based package for wound care and psychosocial support, which is crucial for wider adoption and sustainability.The use of a mixed-methods design will enable a comprehensive understanding of the care package’s feasibility and effectiveness.LimitationsLack of a comparison group (i.e. control group).Whilst the study will include provision of essential medical supplies to bridge local shortages and support disadvantaged patients, provision of care after the study period is beyond the scope of this study. However, the study team will work closely with the local health administration and the Ministry of Health to ensure the sustainability of services.