The WHO Department of Control of Neglected Tropical Diseases (WHO-NTD) and TDR have joined forces with the National Buruli Ulcer Control and Yaws Eradication and National Leprosy Control Programmes in Ghana to improve basic healthcare services for neglected tropical diseases of the skin (skin NTDs) in low-resource settings. Under the umbrella of the Access and Delivery Partnership (ADP), research was conducted towards adopting a gendered approach to tackle skin NTDs, with further plans to evaluate the use of a mobile phone application (app), the WHO SkinNTDs app, by frontline healthcare workers in Ghana to facilitate skin NTD diagnosis.

In 2021 the World Health Organization (WHO) launched its road map for neglected tropical diseases (NTDs), laying out global ambitions towards the control, elimination and eradication of NTDs by 2030. 

NTDs comprise 20 conditions or group of diseases which disproportionately affect impoverished communities in tropical and subtropical regions of the world. More than half of these conditions present with skin manifestations (skin NTDs). Among other goals the WHO-NTD road map stipulates the eradication of the skin NTD yaws, which is endemic in Ghana alongside several other such conditions including Buruli ulcer disease (BUD), cutaneous leishmaniasis, leprosy, lymphatic filariasis (LF), onchocerciasis and scabies.

In addition to associated deformities and/or disability if left untreated, individuals affected by skin NTDs are subject to loss of education and income and associated socioeconomic disadvantages as well as stigmatization and psychological problems.

Women and girls suffer a greater NTD burden due to their higher levels of poverty, lower education and social status; the psychological and social consequences of NTDs tend to be aggravated for women. This calls for a gender-based approach to healthcare provision and uptake for skin NTDs in regions where these diseases are prevalent.

Through the ADP project and with the support of TDR, a team from the National Buruli Ulcer Control & Yaws Eradication and National Leprosy Control Programmes in Ghana conducted an exploratory study on gender-related factors affecting care of skin NTDs in three districts in the central region of Ghana. 

The study highlighted that while women had better knowledge of the causes and symptoms of skin NTDs than men and would seek treatment at hospitals preferentially over herbalists (the opposite to the treatment-seeking behaviour of men), women’s treatment-seeking behaviour was strongly influenced by men due to unequal power relations, gender roles and access to resources. Dr Kotey, a physician, programme manager and the principal investigator of the study based in Accra, Ghana, states: “Applying a gender lens to service delivery for skin NTDs will improve gender equity in our attempt of achieving universal health coverage”. 

Advances in digital technology present opportunities for the integration of cost-effective interventions into basic healthcare services in low-resource settings. One such approach of using mobile phone technology is the WHO SkinNTDs app, which allows the recognition of NTDs through changes on the skin. Launched in 2020, the SkinNTDs app builds on a training guide on skin NTDs for frontline healthcare workers. 

An integrated beta version 4 of the SkinNTDs app was developed in collaboration with the international nongovernmental organization until No Leprosy Remains (formerly Netherlands Leprosy Relief; NLR) and Universal Doctor. This version 4 of the SkinNTDs app is now available for testing before public release. It facilitates the recognition of 30 skin conditions and includes an integrated feature allowing the assessment of signs of skin disease through their visible characteristics by uploading photographs and running an artificial intelligence (AI) algorithm for four out of the 30. 

Dr José A. Ruiz-Postigo, from the WHO-NTD department stated: “With the high penetration of smartphones, we expect that this app will make access to medical information faster and easier, allowing frontline health workers to make better decisions”.

Plans are now underway, again under the umbrella of the ADP and with TDR support, for a study to assess the feasibility and acceptability of use of the SkinNTDs app by frontline healthcare workers and community-based surveillance volunteers to recognize and manage skin diseases in Ghana. The study will generate pilot implementation data to inform future strategies towards the possible rollout of this digital tool into basic healthcare services in Ghana and other low-resource settings. 

Collectively, the adoption of a gender-equitable approach and integration of cost-effective mobile technology to skin NTD health service delivery could result in a step change for the management of such conditions and their sequelae in low- and middle-income country settings. Ultimately, this work strives towards achieving goals set out in the WHO-NTD road map in the context of universal health coverage by having guidelines for management of NTD-related disabilities within national health systems and including NTD interventions in essential health services.

For more information, please contact:
Dr Corinne Merle (TDR)
Dr Jose Antonio Ruiz Postigo (WHO-NTD)
Dr Branwen Hennig (TDR)

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