Understanding influences on health-seeking behaviours among persons cured of leprosy in the Godokpe community, Volta Region of Ghana: A qualitative descriptive study

Redeemer Joy Duboh, Dickson Kweku Delali and Emmanuel Manu

PLOS Neglected Tropical Diseases, 2026, vol. 20, issue 9, 1-19

Abstract: Background: Leprosy, a curable neglected tropical disease, continues to affect vulnerable populations in low-resource settings despite global control efforts. In Ghana, although leprosy has been eliminated as a public health problem, new cases continue to be detected, and persons cured of leprosy (PCLs) continue to face long-term stigma, disability, and barriers to healthcare in segregated communities. This qualitative descriptive study aimed to understand the knowledge of leprosy, sources of healthcare, and challenges shaping health-seeking behaviours among PCLs in Godokpe, Ho Municipality, Volta Region, Ghana. Methodology: This qualitative descriptive study explored the knowledge, healthcare sources, and challenges shaping health-seeking behaviours among PCLs. Purposive sampling recruited 20 participants to reach saturation. Semi-structured, face-to-face, in-depth interviews lasting 20–30 minutes were conducted in Godokpe, audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis in Atlas.ti version 7.5.0, following COREQ guidelines. Results: This study revealed four central themes. Knowledge of Leprosy showed predominant supernatural attributions, including bewitchment, ancestral curses, and contaminated food, alongside rare bacterial recognition, with signs such as skin lesions, ulcers, nodules, limb deformities, loss of sensation, and body pain. Social Treatment and Stigma reflected two distinct patterns: ongoing, unevenly resolved interpersonal avoidance by family and community, contrasted with a documented shift toward equal treatment of PCLs at health facilities over time. Health-Seeking Behaviour reflected a pluralistic pattern, drawing on biomedical facilities such as the Ho Polyclinic and Ho Teaching Hospital, herbal remedies, self-medication, and spiritual or church-based healing based on perceived severity. Challenges Influencing Health-Seeking encompassed logistical barriers such as distance, transport costs, drug unavailability, and informal charging for nominally free medication; physical limitations such as mobility impairment, painful or wounded legs, and visual loss; and socioeconomic constraints such as unemployment, financial hardship, low allowances, donor dependence, and the prioritisation of food over healthcare. Conclusion: This study revealed persistent supernatural attributions of leprosy, an uneven trajectory of stigma reduction, pluralistic health-seeking, and layered barriers, including a documented gap between free-care entitlements and informal charging in practice, among PCLs in Godokpe. Addressing these gaps requires verification of fee-exemption entitlements at the facility level alongside sustained family- and community-level engagement, advancing Sustainable Development Goal (SDG) 1 on poverty reduction, SDG 3 on good health and well-being, and SDG 10 on reduced inequalities. Author summary: Leprosy remains an important public health concern in many low-resource settings, even after successful treatment. In this study, we explored how persons cured of leprosy living in Godokpe, a settlement in Ghana’s Volta Region, seek healthcare and the challenges and support they experience after cure. Through in-depth interviews, we found that many participants still associated leprosy with spiritual causes such as curses and bewitchment, while only one participant understood that it is caused by bacteria. Participants used different forms of healthcare, including hospitals, herbal medicine, self-medication, and church-based healing, depending on their beliefs, finances, and health conditions. We also found that how persons cured of leprosy are treated by others has changed over time in important ways. While some participants still experience being avoided by family or community members, several independently described being treated equally to other patients at health facilities today, a marked change from being seated separately or treated last in the past. At the same time, poverty, unemployment, disability, transportation difficulties, and drug shortages, including being unexpectedly charged for medication that was expected to be free, continued to strongly influence healthcare access. Some participants struggled to walk to health facilities because of wounds, pain, or visual impairment, while others prioritised food over healthcare because of financial hardship. Our findings show that the effects of leprosy continue long after medical treatment is completed, alongside real progress in how affected persons are treated within the health system. We believe this study highlights the need for stronger post-cure support, continued family- and community-level stigma reduction, verification of free-care entitlements, disability care, and social protection programmes to improve the wellbeing and inclusion of persons cured of leprosy.

Date: 2026
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DOI: 10.1371/journal.pntd.0014753

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