Factors associated with the management of people affected by disabilities in communities endemic to Skin Neglected Tropical Diseases in Benin and Côte d'Ivoire

Yévèdo Borel TOSSOU ^1* Fifamin Noël Christelle GBAGUIDI ¹ Sonagnon Inès Elvire AGBO ¹ Sètondji Diane Edwige ZANVO ¹ Karine CODJO SEIGNON ^1* Paule Héléna BIAKA ² Fernand Aimé GUEDOU ¹ Kouakou Jerôme KOUADIO ² Sèdjro Gimatal Esaï ANAGONOU ¹ Franck MIGNANWANDE ¹ DJOSSOU Parfait ¹ Brunelle Vanessa YEMADJE ¹ Flora Sylvie HOUNDJREBO ¹ Jeanne d’Arc Natacha Lessanh ARRAWO ¹ Yvette FAIHOUN ¹ Harvey JOHNSON ¹ Ghislain Emmanuel SOPOH ³ Jean Gabin HOUEZO ⁴ Mamadou KALOGA ⁵ Agui Sylvestre DIZOE ⁶ Mark NICHTER ⁷ Cristina JUAN JIMENEZ ⁸ Anna Giné-March ⁸ Roch Christian JOHNSON ^1,9

• ¹ Interfaculty Center for Training and Research in the Environment for Sustainable Development, University of Abomey-Calavi, Abomey Calavi, Benin
• ² Institut des Sciences Anthropologiques de Développement, Université Félix Houphouet Boigny de Cocody, Côte d’Ivoire, Abidjan, Côte d'Ivoire
• ³ Institut Regional de Santé Publique, Université d'Abomey-Calavi, Ouidah, Atlantique, Benin
• ⁴ Programme National de Lutte contre la Lèpre et l’Ulcère de Buruli, Benin, Cotonou, Benin
• ⁵ Programme National de lutte contre l’Ulcère de Buruli, Côte d’Ivoire, Abidjan, Côte d'Ivoire
• ⁶ Programme National d'Elimination de la Lèpre, Côte d’Ivoire, Abidjan, Côte d'Ivoire
• ⁷ School of Anthropology University of Arizona, Arizona, United States
• ⁸ Anesvad Foundation, Bilbao, Spain, Bilbao, Basque Country, Spain
• ⁹ Fondation Raoul Follereau, Paris, France, Paris, France

Healthcare systems and social services in developing countries are often illequipped to provide comprehensive care for people with disabilities (PWD). As a result, the quality of life for people with disabilitiesPWD frequently deteriorates. Comprehensive health care includes five key components: access to diagnosis, treatment, rehabilitation, psychosocial support, and prevention with follow-up. This study aimed to document those segments of the disabled population and factors most associated with inadequate care in regions of Benin and Côte d'Ivoire endemic to neglected tropical diseases (NTDs).Methods: An exploratory cross-sectional study of PWD was conducted in 2022 in Benin and Côte d'Ivoire, using a combination of quantitative and qualitative approaches. Sample included 841 PWD, 29 caregivers, and 51 family members. Disability management was evaluated using a scoring system ranging from 0 to 5, classifying management into three categories: good management (score4-5), inadequate management (score1-3), and no management (score0). Quantitative data were analyzed using SPSS version 25.5, with a p-value of <5% considered statistically significant. Open-ended interviews were carried out with a subsample of PWD, family members, and caretakers to provide further insights into what forms of care were and were not being provided.Results: Among PWD, 98 (11.6%) experienced disability associated with Skin neglected tropical diseases (Skin-NTD). Of the total, 158 (18.8%) received good management, 532 (63.3%) inadequate management, and 151 (18.0%) no management at all. The median age of the sample was 38 years (22; 52), and the male-to-female sex ratio was 1.45. The key factors associated with the quality of disability management (expressed as odds ratios [OR] with 95% confidence intervals [CI] and p-values) were: age 30 to 44 years (OR 0.29 [0.16-0.54], p<0.000), occupation-saleswoman/housewife (OR 0.32 [0.12-0.81], p=0.017), farmer , p=0.000), other occupations ), monthly income over 76 euros , p=0.003), and cause of disability, specifically Skin-NTD .09], p=0.000). The interviews highlighted the need for medical interventions, social and economic support.Comprehensive and sustainable interventions are needed to improve the well-being of people affected by disabilities. These need to be built into public health programs for Skin-NTDneglected tropical skin diseases.