Exploring the potential role of telemedicine in the early diagnosis of skin neglected tropical diseases in remote areas in Afghanistan through the perceptions and experiences of skin NTD health professionals: a qualitative study

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OBJECTIVE: Skin neglected tropical diseases (NTDs) are a subset of NTDs that can lead to disability, stigmatisation and socioeconomic problems. Timely diagnosis of skin NTDs is important to prevent morbidity and mortality. The Afghan healthcare system currently faces serious challenges, including gender equity issues that complicate access to healthcare and the diagnosis of skin NTDs. This research aimed to explore the potential role of telemedicine for the diagnosis of skin NTDs in remote areas in Afghanistan. DESIGN: We conducted a qualitative study using semi-structured interviews and thematic analysis to explore experiences and perspectives of key informants working in the field of NTDs in Afghanistan. SETTING: Non-governmental organisations and Afghan health centres. PARTICIPANTS: Twelve potential key informants were contacted, and eight took part in the study. Entry criteria required a minimum of 20 years of professional experience in Afghanistan's NTD field. Participants with less experience or those unable to provide informed consent were excluded. RESULTS: Thematic analysis identified four themes: challenges in diagnosing skin-related NTDs, access to healthcare, the role of telemedicine and the implementation of telemedicine in Afghanistan. Participants highlighted the lack of a national diagnostic framework, inadequate dermatological knowledge, uninformed prescribing of medication and stigmatisation as the main challenges in the diagnosis of skin NTDs. Geographic barriers and gender issues were mentioned as additional challenges to accessing healthcare and diagnosing skin NTDs in Afghanistan. Although participants perceived telemedicine as a promising avenue for improving access to care through knowledge and image exchange, they highlighted challenges including the absence of physical examination and infrastructure limitations. CONCLUSION: While the potential use of telemedicine could help improve access to healthcare and the diagnosis of skin NTDs in the Afghan context, telemedicine should not be the sole method used in diagnosing skin NTDs.

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