Treatment experiences of adults with cutaneous leishmaniasis in Ethiopia: A hospital-based phenomenological study

Background Early treatment for cutaneous leishmaniasis (CL) is effective but remains restricted to specialised hospitals in Ethiopia. We explored the experiences of CL-affected people receiving treatment at Boru Meda and ALERT hospitals to understand their perspectives on issues that may require specific interventions. Methods We interviewed 22 adults receiving care for complicated CL and observed the culture of service delivery in both settings. Results Care-seeking was driven by failure of traditional remedies, recommendations from former patients, or referrals from other health facilities. However, treatment initiation was delayed by drug stockouts, insufficient bed capacity and the financial costs of treatment monitoring tests. CL-affected people’s lack of prior knowledge about the requirement for prolonged hospital admission and unclear communication about treatment by hospital staff contributed to initial confusion and anxiety. The daily intramuscular injections of sodium stibogluconate were experienced as extremely painful. Despite this, participants expressed optimism in hospital-based CL treatment. Healthcare staff compassion and support from other CL in-patients were positive experiences associated with hospital-based treatment. 13/18 people rated their lesions as ‘better’ after treatment. Individuals with poor outcomes attributed lack of healing to taboo behaviors said to exacerbate CL (sexual intercourse, agricultural work and social mixing) and delayed care-seeking. Conclusion Strengthening community engagement may reduce treatment delays and suffering by improving access to culturally appropriate information through trusted channels, enhance provider–patient communication by incorporating community feedback into services, and reduce out-of-pocket expenses by increasing awareness of free or subsidized care. However, better tolerated, non-hospital-based CL treatments remain essential.