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There is increasing attention to the impacts of stigma and discrimination related to mental health on quality of life and access to and quality of healthcare. Effective strategies for stigma reduction exist, but most evidence comes from high-income settings. Recent reviews of stigma research have identified gaps in the field, including limited cultural and contextual adaptation of interventions, a lack of contextual psychometric information on evaluation tools, and, most notably, a lack of multi-level strategies for stigma reduction. The Indigo Partnership research programme will address these knowledge gaps through a multi-country, multi-site collaboration for anti-stigma interventions in low- and middle-income countries (LMICs) (China, Ethiopia, India, Nepal, and Tunisia). The Indigo Partnership aims to: (1) carry out research to strengthen the understanding of mechanisms of stigma processes and reduce stigma and discrimination against people with mental health conditions in LMICs; and (2) establish a strong collaborative research consortium through the conduct of this programme. Specifically, the Indigo Partnership involves developing and pilot testing anti-stigma interventions at the community, primary care, and mental health specialist care levels, with a systematic approach to cultural and contextual adaptation across the sites. This work also involves transcultural translation and adaptation of stigma and discrimination measurement tools. The Indigo Partnership operates with the key principle of partnering with people with lived experience of mental health conditions for the development and implementation of the pilot interventions, as well as capacity building and cross-site learning to actively develop a more globally representative and equitable mental health research community. This work is envisioned to have a long-lasting impact, both in terms of the capacity building provided to participating institutions and researchers, and the foundation it provides for future research to extend the evidence base of what works to reduce and ultimately end stigma and discrimination in mental health.

Background Lower limb disorders including lymphoedema create a huge burden for affected persons in their physical and mental health, as well as socioeconomic and psychosocial consequences for them, their families and communities. As routine health services for the integrated management and prevention of lower limb disorders are still lacking, the ‘Excellence in Disability Prevention Integrated across Neglected Tropical Diseases’ (EnDPoINT) study was implemented to assess the development and delivery of an integrated package of holistic care–including physical health, mental health and psychosocial care–within routine health services for persons with lower limb disorders caused by podoconiosis, lymphatic filariasis and leprosy. Methodology/Principal findings This study was part of the first of three phases within EnDPoINT, involving the development of the integrated care package. Focus group discussions and key informant interviews were undertaken with 34 participants between January–February 2019 in Awi zone, Ethiopia, in order to assess the draft care package’s feasibility, acceptability and appropriateness. Persons affected by lower limb disorders such as lymphoedema experience stigma, exclusion from families, communities and work as well as physical and financial hardship. Beliefs in disease causation inhibit affected persons from accessing care. Ignorance was a barrier for health care providers as well as affected persons. Training and education of affected persons, communities and caregivers is important in improving care access. It also requires time, space, materials and financial resources. Both top-down and grass roots input into service development are key, as well as collaboration across stakeholders including charities, community leaders and “expert patients”. Conclusions/Significance This study highlighted the need for the EnDPoINT integrated care package and provided suggestions for solutions according to its three aspects of integrated care (integration into routine care; integration of mental health and psychosocial care; and integration of care across the three diseases), thereby giving support for its feasibility, acceptability and appropriateness., Author summary Lower limb disorders including lymphoedema are prevalent in Ethiopia as a common endpoint of varying causes such as podoconiosis, leprosy and lymphatic filariasis. This study involved the development of a comprehensive integrated and holistic care package for lower limb disorders into routine health care services. It used interviews and focus groups to assess feasibility, acceptability and appropriateness of the draft care package. We found that persons affected by lower limb disorders had many negative experiences due to their condition, especially related to stigma, that included physical, financial and psychological sequelae. Neglect was paramount, with financial neglect in central budgets, a lack of knowledge by care givers and a lack of awareness among affected persons and their communities, all contributing to inadequate care provision and access. Affected persons, communities and caregivers may benefit from provision of learning opportunities about the prevention and treatment of lower limb disorders; and resources are crucial in engendering change, including material goods, time to provide care, and collaborative work to create a culture shift and address stigma.

Additional file1. Consolidated criteria for reporting qualitative studies (COREQ): 32-item checklist

Needs assessment is essential in the humanitarian response, and perceived needs can be associated with the levels of health in populations affected by humanitarian emergencies. This study aimed to evaluate the reliability and feasibility of The Humanitarian Emergency Settings Perceived Needs Web (HESPER Web) in a humanitarian context and to compare perceived needs of a random walk study sample with a self-selected study sample recruited though social media. The study context was the Dadaab refugee camp in Kenya. An alternate forms reliability evaluation and a feasibility evaluation was conducted. In total, 308 refugees participated in the study. HESPER Web was found to be reliable and usable for assessing needs, with an intraclass correlation coefficient (ICC) of 0.88, Cohen’s κ between 0.43 and 1.0 and a first priority need rating match of 81%. The HESPER Web was positively experienced, and the self-recruited study sample reported similar levels of needs and similar demographics as the randomized sample. The participants reported several unmet needs. HESPER Web offers a reliable tool for needs assessment in humanitarian emergencies where web-based surveys are considered as practical and suitable. It offers new possibilities for conducting remote assessments and research studies that include humanitarian populations that are rarely included in such evaluations.

Additional file 1. Topic guide questions english version.

Additional file 2: Table S2. Additional search strategies used to identify relevant drug-drug interactions. Search terms specific to potential drug-drug interactions identified in each PICO question.

Additional file 4. PRISMA 2009 Checklist

Additional file 3: Table S3. Overview of systematic review searches. Overview of search strategies detailing number of reviews identified.