Stigma and illness management among podoconiosis patients in rural Ethiopia: an intersectional-hermeneutic study

Podoconiosis, a neglected tropical skin disease causing lower-limb lymphedema, disproportionately affects rural populations in low-income countries and has profound physical and psychosocial consequences. Despite its significant impact, the interplay between stigma and illness management in podoconiosis remains under-explored. This study examines the lived experiences of stigma and illness management pathways among patients in rural Ethiopia, highlighting the complex social determinants shaping these processes.

Using an intersectional-hermeneutic framework, we conducted in-depth interviews with 21 purposively selected patients representing diverse genders, ages, and disease stages. Data were analysed iteratively following Gadamer's interpretive approach.

Three key phases of patients' journeys emerged from the findings: overlooking initial symptoms; disfigurement, disease re-branding, stigma, and active resistance; and despair and acceptance. These phases demonstrate the dynamic trajectory of stigma and illness management as patients employ varied coping strategies throughout disease progression. The findings reveal significant disparities in stigma experiences and management strategies mediated by intersecting social determinants of health.

This study advances the understanding of podoconiosis' complex psychosocial dimensions and offers actionable insights for designing contextually appropriate public health interventions. It underscores the urgent need for targeted interventions to address the root causes of stigma and the barriers to care. Community-based education to dispel misconceptions, improved healthcare accessibility, and culturally adapted support systems could improve care practices and mitigate the multifaceted impacts of podoconiosis on marginalized populations.