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Siewe Fodjo JN, Ekome SRE, Njamnshi JNT, Njamnshi WY, Njamnshi KG, Ngarka L, Njamnshi AK. Community Perceptions of Blackfly Nuisance and Acceptability of the "Slash and Clear" Vector Control Approach in the Ntui Health District of Cameroon: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:658. [PMID: 38928904 PMCID: PMC11204025 DOI: 10.3390/ijerph21060658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/15/2024] [Accepted: 05/19/2024] [Indexed: 06/28/2024]
Abstract
Besides being vectors of the onchocerciasis parasite, blackflies are a source of nuisance in onchocerciasis-endemic communities. We investigated the experience of residents in the Ntui Health District (Cameroon) regarding blackfly nuisance and assessed their perceptions of a novel "Slash and Clear" (S&C) intervention for blackfly control. Focus group discussions were conducted before and after S&C implementation (respectively, in February 2022 and December 2023). Blackflies were known to emerge from the river areas and cause disease. To prevent blackfly bites, the population often covered their body with protective clothing and applied various substances (kerosene, oil, or lemon) to their skin. Post-intervention data showed reduced blackfly nuisance, and the willingness to sustain blackfly control in the long-term was unanimous among community leaders and members, including the village volunteers who implemented the S&C intervention. In conclusion, blackfly nuisance is evident in the Ntui onchocerciasis focus of Cameroon and led to a panoply of coping practices, some of which could be detrimental to their health. Implementing S&C for blackfly control is well accepted and could sustainably alleviate the nuisance caused by blackflies while simultaneously breaking the onchocerciasis transmission cycle.
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Affiliation(s)
- Joseph Nelson Siewe Fodjo
- Brain Research Africa Initiative (BRAIN), Yaoundé P.O. Box 25625, Cameroon; (S.R.E.E.); (J.N.T.N.); (W.Y.N.); (K.G.N.); (L.N.)
- Global Health Institute, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium
| | - Serge Raoul Ekukole Ekome
- Brain Research Africa Initiative (BRAIN), Yaoundé P.O. Box 25625, Cameroon; (S.R.E.E.); (J.N.T.N.); (W.Y.N.); (K.G.N.); (L.N.)
| | - Julius Ndi Taryunyu Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé P.O. Box 25625, Cameroon; (S.R.E.E.); (J.N.T.N.); (W.Y.N.); (K.G.N.); (L.N.)
| | - Wepnyu Yembe Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé P.O. Box 25625, Cameroon; (S.R.E.E.); (J.N.T.N.); (W.Y.N.); (K.G.N.); (L.N.)
- Division of Operational Research in Health, Ministry of Public Health, N°8 Rue 3038 quartier du Lac (Yaoundé III), Yaoundé P.O. Box 3595, Cameroon
| | - Kongnyu G. Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé P.O. Box 25625, Cameroon; (S.R.E.E.); (J.N.T.N.); (W.Y.N.); (K.G.N.); (L.N.)
| | - Leonard Ngarka
- Brain Research Africa Initiative (BRAIN), Yaoundé P.O. Box 25625, Cameroon; (S.R.E.E.); (J.N.T.N.); (W.Y.N.); (K.G.N.); (L.N.)
- Neuroscience Lab, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé 1, Yaoundé P.O. Box 1364, Cameroon
- Neurology & Clinical Neuroscience Department, Yaoundé Central Hospital, Yaoundé P.O. Box 87, Cameroon
| | - Alfred K. Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé P.O. Box 25625, Cameroon; (S.R.E.E.); (J.N.T.N.); (W.Y.N.); (K.G.N.); (L.N.)
- Neuroscience Lab, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé 1, Yaoundé P.O. Box 1364, Cameroon
- Neurology & Clinical Neuroscience Department, Yaoundé Central Hospital, Yaoundé P.O. Box 87, Cameroon
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Raheel MFS, Snoubar Y, Mosbah WS. Being female with vitiligo disease in traditional societies within North Africa. Biopsychosoc Med 2024; 18:1. [PMID: 38200533 PMCID: PMC10777494 DOI: 10.1186/s13030-024-00299-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
This study aims to assess the influence of vitiligo illness on the quality of life of female individuals residing in Ajdabiya, Libya. Through this investigation, we aim to enhance our comprehension of the potential impact of cultural norms and conventional gender roles on managing and caring for skin disorders within a North African society. Over a 20-week period, 65 female participants diagnosed with vitiligo were recruited. The participants' quality of life was assessed using the Skindex-16 scale. This validated tool measures the impact of skin disease on several aspects of an individual's life, including physical, emotional, and social well-being. The findings of this study indicate that the quality of life of women with vitiligo significantly differed with age, social and functional status, and economic status. However, the illness profoundly impacted patients' lives emotionally, with clear consequences, including diminished emotional satisfaction and reduced social participation. The results of this study highlight the negative effects that vitiligo disease can have on women's quality of life within traditional Libyan society. This investigation also indicates that cultural norms and traditional gender patterns may contribute to these effects.
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Affiliation(s)
| | - Yaser Snoubar
- Department of Social Sciences, College of Arts and Sciences, Qatar University, Doha, 2713, Qatar.
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A systematic review and an individual patient data meta-analysis of ivermectin use in children weighing less than fifteen kilograms: Is it time to reconsider the current contraindication? PLoS Negl Trop Dis 2021; 15:e0009144. [PMID: 33730099 PMCID: PMC7968658 DOI: 10.1371/journal.pntd.0009144] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/13/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Oral ivermectin is a safe broad spectrum anthelminthic used for treating several neglected tropical diseases (NTDs). Currently, ivermectin use is contraindicated in children weighing less than 15 kg, restricting access to this drug for the treatment of NTDs. Here we provide an updated systematic review of the literature and we conducted an individual-level patient data (IPD) meta-analysis describing the safety of ivermectin in children weighing less than 15 kg. METHODOLOGY/PRINCIPAL FINDINGS A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for IPD guidelines by searching MEDLINE via PubMed, Web of Science, Ovid Embase, LILACS, Cochrane Database of Systematic Reviews, TOXLINE for all clinical trials, case series, case reports, and database entries for reports on the use of ivermectin in children weighing less than 15 kg that were published between 1 January 1980 to 25 October 2019. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42017056515. A total of 3,730 publications were identified, 97 were selected for potential inclusion, but only 17 sources describing 15 studies met the minimum criteria which consisted of known weights of children less than 15 kg linked to possible adverse events, and provided comprehensive IPD. A total of 1,088 children weighing less than 15 kg were administered oral ivermectin for one of the following indications: scabies, mass drug administration for scabies control, crusted scabies, cutaneous larva migrans, myiasis, pthiriasis, strongyloidiasis, trichuriasis, and parasitic disease of unknown origin. Overall a total of 1.4% (15/1,088) of children experienced 18 adverse events all of which were mild and self-limiting. No serious adverse events were reported. CONCLUSIONS/SIGNIFICANCE Existing limited data suggest that oral ivermectin in children weighing less than 15 kilograms is safe. Data from well-designed clinical trials are needed to provide further assurance.
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Siewe Fodjo JN, Remme JHF, Preux PM, Colebunders R. Meta-analysis of epilepsy prevalence in West Africa and its relationship with onchocerciasis endemicity and control. Int Health 2020; 12:192-202. [PMID: 32141502 PMCID: PMC7320426 DOI: 10.1093/inthealth/ihaa012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/04/2020] [Accepted: 02/19/2020] [Indexed: 01/28/2023] Open
Abstract
Background A high prevalence and incidence of epilepsy has been reported in onchocerciasis-endemic regions in Central and East Africa. There is compelling epidemiological evidence suggesting that this high burden is caused by onchocerciasis-associated epilepsy (OAE). We hypothesized that OAE had also occured in West African onchocerciasis foci. Methods We searched PubMed, the African Journals Online platform and grey literature for population-based epilepsy studies in West African countries. Epilepsy and onchocerciasis prevalence data were extracted. The pre-control onchocerciasis endemicity in the study sites was estimated from historical data of onchocerciasis control programmes. The prevalence of epilepsy in different sites was analysed, taking into account onchocerciasis endemicity and the duration of control. Results The pooled prevalence of epilepsy in the West African study sites was 13.14 per 1000 (95% confidence interval 11.28–15.00). Higher pre-control endemicity and a shorter duration of onchocerciasis control were both associated with increased epilepsy prevalence (p<0.001). Two studies in Ivory Coast that provided detailed descriptions of persons with epilepsy in onchocerciasis-endemic settings revealed that most of them had features of OAE (73.7% and 83.3%, respectively). Conclusions Our findings suggest that before and during the early years of implementing onchocerciasis control in West Africa, high onchocerciasis endemicity resulted in a high prevalence of OAE and that subsequent control efforts significantly reduced the prevalence of OAE.
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Affiliation(s)
| | | | - Pierre-Marie Preux
- INSERM, University of Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, GEIST, 87000 Limoges, France
| | - Robert Colebunders
- Global Health Institute, University of Antwerp, Doornstraat 331, 2610 Antwerp, Belgium
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Frota da Rocha Morgado F, Kopp Xavier da Silveira EM, Pinheiro Rodrigues do Nascimento L, Sales AM, da Costa Nery JA, Nunes Sarno E, Illarramendi X. Psychometric assessment of the EMIC Stigma Scale for Brazilians affected by leprosy. PLoS One 2020; 15:e0239186. [PMID: 32941501 PMCID: PMC7498031 DOI: 10.1371/journal.pone.0239186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/01/2020] [Indexed: 11/26/2022] Open
Abstract
Background The Stigma Scale of the Explanatory Model Interview Catalogue (EMIC-SS) is a useful option to investigate leprosy-related stigma, but its psychometric qualities are unknown in Brazil. This study investigated the factor structure, the convergent and known-groups validity, and the reliability of the EMIC-SS for Brazilians affected by leprosy. Methodology The Brazilian Portuguese version of the EMIC-SS was validated in 180 persons affected by leprosy at a Reference Center in Rio de Janeiro. Confirmatory factorial analysis (CFA) and Cronbach alpha were used to assess the EMIC-SS internal consistency. The Construct validity was tested using Spearman Correlation, Kruskal-Wallis, and Mann-Whitney tests comparing with the Participation Scale, Rosenberg Self-esteem Scale, Beck Depression Inventory, and a Sociodemographic Questionnaire. Test-retest reliability was evaluated with intra-class correlation (ICC). Main findings CFA confirmed the one- and two-dimensional models of the scale after retaining 12 of the 15 EMIC-SS items. The 12—item EMIC-SS was consistent (α = 0.78) and reproducible (ICC = 0.751, 95% Confidence Interval = 0.657–0.822, p < 0.0001). A significant correlation was observed between the EMIC-SS and the other scales confirming convergent validity. The EMIC-SS and its factors were able to differentiate several hypothesized groups (age, change of occupation, monthly family income, communicating others about the disease, and perception of difficulty to follow treatment) confirming the scale known-groups validity, both in its one and two-dimensional models. Conclusions/Significance Our study found support for the construct validity and reliability of the EMIC-SS as a measure of stigma experienced by people affected by leprosy in Brazil. However, future studies are necessary in other samples and populations with stigmatizing conditions to determine the optimal factor structure and to strengthen the indications of the validated scale.
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Affiliation(s)
- Fabiane Frota da Rocha Morgado
- Department of Physical Education and Sports, Federal Rural University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail: (XI); (FFRM)
| | | | | | - Anna Maria Sales
- Souza Araújo Outpatient Clinic, Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - José Augusto da Costa Nery
- Souza Araújo Outpatient Clinic, Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Euzenir Nunes Sarno
- Souza Araújo Outpatient Clinic, Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ximena Illarramendi
- Souza Araújo Outpatient Clinic, Leprosy Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Center for Technological Development in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- * E-mail: (XI); (FFRM)
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Murdoch ME. Mapping the burden of onchocercal skin disease. Br J Dermatol 2020; 184:199-207. [PMID: 32302410 DOI: 10.1111/bjd.19143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 02/06/2023]
Abstract
Onchocerciasis is a neglected tropical disease caused by a nematode parasite, Onchocerca volvulus, and transmitted by bites of Simulium blackflies which breed near fast-flowing rivers. In humans, thousands of microfilariae (immature worms) migrate to the skin and eyes where they cause pathology. Historically, much research was devoted to the serious effect of blindness, from which the disease earns its alternative name of 'river blindness'. Mapping the burden of onchocercal skin disease (OSD) was expedited by the development of a clinical classification and grading system that facilitated comparison of data from different countries. After successful field testing in Nigeria, the classification scheme was used in a multicountry study in seven endemic sites, to estimate the true burden of OSD across Africa. High levels of OSD were found, affecting 28% of the population. A new control programme, the African Programme for Onchocerciasis Control (APOC) was launched in 20 countries using annual doses of ivermectin, donated by Merck & Co., Inc. The multicountry study also found a close correlation between the levels of itching and OSD with the level of endemicity, as determined by the prevalence of onchocercal nodules. This enabled APOC to use Rapid Epidemiological Mapping of Onchocerciasis, which entailed identifying likely vector breeding sites near rivers, then sampling 50 adult males in nearby villages to determine the prevalence of nodules and delineate which villages required treatment. Onchocerciasis is now targeted for elimination in Africa, and the challenge is to complete Onchocerciasis Elimination Mapping of hypoendemic areas using serology.
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Affiliation(s)
- M E Murdoch
- Department of Dermatology, West Herts Hospitals NHS Trust, Watford General Hospital, Watford, WD18 0HB, UK
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Hamill LC, Haslam D, Abrahamsson S, Hill B, Dixon R, Burgess H, Jensen K, D’Souza S, Schmidt E, Downs P. People are neglected, not diseases: the relationship between disability and neglected tropical diseases. Trans R Soc Trop Med Hyg 2019; 113:829-834. [PMID: 31111941 PMCID: PMC6903785 DOI: 10.1093/trstmh/trz036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/04/2019] [Accepted: 05/02/2019] [Indexed: 01/24/2023] Open
Abstract
People with disabilities and the neglected tropical diseases (NTDs) are separately receiving increased focus. In light of this positive development, and the similarities and intersections between the negative impacts experienced by both people with disabilities and people with NTDs, we believe now is the right time to focus attention on the overlap between the two. Both people with NTDs and people with disabilities experience a myriad of overlapping negative health, financial and socio-cultural consequences. Despite this, we believe that disability is not yet properly prioritised on the development agenda, and that there are multiple opportunities to make NTD programming more inclusive, to the benefit of those at this neglected intersection and beyond. There are both opportunities and need to scale up, integrate, and invest in inclusive, health system-focused NTD programming. Realisation of the Sustainable Development Goals, Universal Health Coverage, and the control and elimination of NTDs all rely on ensuring people with disabilities are not left behind.
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Affiliation(s)
| | - Dominic Haslam
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | | | - Becks Hill
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Ruth Dixon
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Heather Burgess
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Kimberly Jensen
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Susan D’Souza
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Elena Schmidt
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
| | - Philip Downs
- Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex, UK
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O’Neill S, Irani J, Siewe Fodjo JN, Nono D, Abbo C, Sato Y, Mugarura A, Dolo H, Ronse M, Njamnshi AK, Colebunders R. Stigma and epilepsy in onchocerciasis-endemic regions in Africa: a review and recommendations from the onchocerciasis-associated epilepsy working group. Infect Dis Poverty 2019; 8:34. [PMID: 31109376 PMCID: PMC6526597 DOI: 10.1186/s40249-019-0544-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/21/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In onchocerciasis-endemic areas, particularly in those with a sub-optimal onchocerciasis control programme, a high prevalence of epilepsy is observed. Both onchocerciasis and epilepsy are stigmatizing conditions. The first international workshop on onchocerciasis-associated epilepsy (OAE) was held in Antwerp, Belgium (12-14 October 2017) and during this meeting, an OAE alliance was established. In this paper, we review what is known about epilepsy-associated stigma in onchocerciasis-endemic regions, and present the recommendations of the OAE alliance working group on stigma. MAIN BODY For this scoping review, literature searches were performed on the electronic databases PubMed, Scopus and Science Direct using the search terms "epilepsy AND onchocerciasis AND stigma". Hand searches were also undertaken using Google Scholar, and in total seven papers were identified that addressed epilepsy-related stigma in an onchocercisasis-endemic area. Due to the limited number of published research papers on epilepsy-associated stigma in onchocerciasis-endemic areas, other relevant literature that describes important aspects related to stigma is discussed. The thematic presentation of this scoping review follows key insights on the barriers to alleviating the social consequences of stigma in highly affected onchocerciasis-endemic areas, which were established by experts during the working group on stigma and discrimination at the first international workshop on OAE. These themes are: knowledge gaps, perceived disease aetiology, access to education, marriage restrictions, psycho-social well-being, burden on the care-giver and treatment seeking behaviour. Based on the literature and expert discussions during the OAE working group on stigma, this paper describes important issues regarding epilepsy-related stigma in onchocerciasis-endemic regions and recommends interventions that are needed to reduce stigma and discrimination for the improvement of the psycho-social well-being of persons with epilepsy. CONCLUSIONS Educating healthcare workers and communities about OAE, strengthening onchocerciasis elimination programs, decreasing the anti-epileptic treatment gap, improving the care of epilepsy-related injuries, and prioritising epilepsy research is the way forward to decreasing the stigma associated with epilepsy in onchocerciasis-endemic regions.
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Affiliation(s)
- Sarah O’Neill
- CRISS – School of Public Health, Université Libre de Bruxelles and LAMC Faculté de Philosophie et de Sciences Sociales Université Libre de Bruxelles, Brussels, Belgium
| | - Julia Irani
- Department of Public health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Denis Nono
- Department of Mental Health, Austrian Partnership Programme in Higher Education and Research for Development (APPEAR) Project & AVSI Foundation, Gulu University, Gulu, Uganda
| | - Catherine Abbo
- Department of Psychiatry, Makerere University, Kampala, Uganda
| | - Yasuaki Sato
- Department of Environmental Science and Technology, Osaka Sangyo University, Osaka, Japan
| | | | - Housseini Dolo
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Maya Ronse
- Department of Public health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Alfred K. Njamnshi
- Department of Neurology, Yaoundé Central Hospital/FMBS, The University of Yaoundé I, Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon
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Sun Y, Chen G, Wang L, Li N, Srisurapanont M, Hong JP, Hatim A, Chen CH, Udomratn P, Bae JN, Fang YR, Chua HC, Liu SI, George T, Bautista D, Chan E, Rush AJ, Yang H, Su YA, Si TM. Perception of Stigma and Its Associated Factors Among Patients With Major Depressive Disorder: A Multicenter Survey From an Asian Population. Front Psychiatry 2019; 10:321. [PMID: 31156476 PMCID: PMC6529583 DOI: 10.3389/fpsyt.2019.00321] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 04/25/2019] [Indexed: 01/22/2023] Open
Abstract
Stigma of major depressive disorder (MDD) is an important public health problem. This study aimed to examine the level of perceived stigma and its associated factors in MDD patients in five Asian countries, including China, Korea, Malaysia, Singapore, and Thailand. A total of 547 outpatients with MDD were included from Asian countries. We used the stigma scale of the Explanatory Model Interview Catalogue (EMIC) to assess stigma. The Montgomery-Asberg Depression Rating Scale (MADRS), Symptoms Checklist 90-Revised (SCL-90-R), Fatigue Severity Scale (FSS), Sheehan Disability Scale (SDS), 36-Item Short-Form Health Survey (SF-36), and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess symptoms, clinical features, functional impairment, health status, and social support. The stigma scores of patients under 55 years old were significantly higher than those equal to or greater than 55 years old (P < 0.001). The stigma scores exhibited significant negative correlation with age; MSPSS scores of family, friends, and others; and SF-36 subscale of mental health, but significant positive correlation with MADRS, FSS, SDS, and SCL-90-R subscale scores of depression, interpersonal sensitivity, obsession-compulsion, psychoticism, and somatization. Multivariate regression analysis revealed that age, SCL-90-R interpersonal sensitivity, obsession-compulsion, psychoticism, MSPSS scores of friends and others, and SF-36 of mental health were significantly associated with the level of perceived stigma. These findings suggest that MDD patients who are young, have a high degree of interpersonal sensitivity and psychoticism, have low health-related quality of life, and have low social support are the target population for stigma interventions in Asia.
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Affiliation(s)
- Yan Sun
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Health Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
- Department of Psychiatry, Shanxi Dayi Hospital, Taiyuan, China
| | - Gang Chen
- Department of Psychiatry, Huai’an No.3 People’s Hospital, Jiangsu, China
| | - Li Wang
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Health Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Nan Li
- Department of Epidemiology, Peking University Third Hospital, Beijing, China
| | - Manit Srisurapanont
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Muang, Thailand
| | - Jin Pyo Hong
- Department of Psychiatry, University of Ulsan College of Medicine, Asian Medical Center, Seoul, South Korea
| | - Ahmad Hatim
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chia-hui Chen
- Department of Psychiatry, Chang Gung Medical Center and Chang Gung University, Tao-Yuan, Taiwan
| | - Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Jae Nam Bae
- Department of Psychiatry, Faculty of Medicine, Inha University Hospital, Incheon, South Korea
| | - Yi-Ru Fang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Choon Chua
- Institute of Mental Health, Woodbridge Hospital, Singapore, Singapore
| | - Shen-Ing Liu
- Department of Psychiatry, Faculty of Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tom George
- North West Specialist Centre, Everton Park, QLD, Australia
| | - Dianne Bautista
- Singapore Clinical Research Institute, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Edwin Chan
- Singapore Clinical Research Institute, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - A. John Rush
- Singapore Clinical Research Institute, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Hong Yang
- Department of Psychiatry, Shanxi Dayi Hospital, Taiyuan, China
| | - Yun-Ai Su
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Health Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Tian-Mei Si
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
- National Clinical Research Center for Mental Health Disorders and Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
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van Brakel WH, Cataldo J, Grover S, Kohrt BA, Nyblade L, Stockton M, Wouters E, Yang LH. Out of the silos: identifying cross-cutting features of health-related stigma to advance measurement and intervention. BMC Med 2019; 17:13. [PMID: 30764817 PMCID: PMC6376667 DOI: 10.1186/s12916-018-1245-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many health conditions perceived to be contagious, dangerous or incurable, or resulting in clearly visible signs, share a common attribute - an association with stigma and discrimination. While the etiology of stigma may differ between conditions and, sometimes, cultural settings, the manifestations and psychosocial consequences of stigma and discrimination are remarkably similar. However, the vast majority of studies measuring stigma or addressing stigma through interventions employ a disease-specific approach. MAIN BODY The current paper opposes this siloed approach and advocates a generic concept of 'health-related stigma' in both stigma measurement and stigma interventions. Employing a conceptual model adapted from Weiss, the current paper demonstrates the commonalities among several major stigmatized conditions by examining how several stigma measurement instruments, such as the Social Distance Scale, Explanatory Model Interview Catalogue, Internalized Stigma of Mental Illness, and Berger stigma scale, and stigma reduction interventions, such as information-based approaches, contact with affected persons, (peer) counselling, and skills building and empowerment, were used successfully across a variety of conditions to measure or address stigma. The results demonstrate that 'health-related stigma' is a viable concept with clearly identifiable characteristics that are similar across a variety of stigmatized health conditions in very diverse cultures. CONCLUSION A more generic approach to the study of health-related stigma opens up important practical opportunities - cross-cutting measurement and intervention tools are resource saving and easier to use for personnel working with multiple conditions, allow for comparison between conditions, and recognize the intersectionality of many types of stigma. Further research is needed to build additional evidence demonstrating the advantages and effectiveness of cross-condition approaches to stigma measurement and interventions.
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Affiliation(s)
| | - Janine Cataldo
- Department of Physiological Nursing, Center for Tobacco Control Research and Education, University of California San Francisco, 2 Koret Way, San Francisco, CA, 94143-0610, USA
| | | | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | | | - Melissa Stockton
- Epidemiology Department, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Edwin Wouters
- Centre for Longitudinal & Life Course Studies, University of Antwerp, Antwerp, Belgium.,Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Lawrence H Yang
- College of Global Public Health, New York University, New York, NY, USA.,Mailman School of Public Health, Columbia University, New York, NY, USA
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Garapati P, Pal B, Siddiqui NA, Bimal S, Das P, Murti K, Pandey K. Knowledge, stigma, health seeking behaviour and its determinants among patients with post kalaazar dermal leishmaniasis, Bihar, India. PLoS One 2018; 13:e0203407. [PMID: 30192805 PMCID: PMC6128567 DOI: 10.1371/journal.pone.0203407] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022] Open
Abstract
Background Lesishmaniasis is a neglected tropical disease endemic in Bihar, India. Inappropriate health seeking behaviour of post kala-azar dermal leishmaniasis (PKDL) patients may increase the disease duration, severity and transmissibility. Simultaneously, lack of knowledge and perceived stigma may also increase the length of delay in receiving treatment. This ultimately effects the kala-azar elimination program. Methods A cross sectional study was conducted in 120 confirmed PKDL patients, aged 18 years and older. Data related to knowledge and health seeking behaviour was collected by a pre-tested questionnaire. EMIC stigma scale was used for assessing the perceived stigma. Patients were personally interviewed after taking informed consent. Data analysis was done by using SPSS 16 software. Results The time between appearance of symptoms and first medical consultation (patient delay) ranged from 15 days to 5475 days (15 years) with a median of 285 days. The time between first medical consultations to onset of specific treatment (system delay) ranged from 2 to 5475 days with a median of 365 days. Many patients approached first to quacks (8.4%), homeopathic and ayurvedic practitioners (25.8%) upon recognition of symptoms. Majority of the patients (68.3%) had poor knowledge about PKDL and its vector. Type of skin lesions and gender had significant association with patient delay and system delay respectively (p<0.05). Distance to primary health centre (PHC) had significant association with patients delay as well as system delay (p<0.05). Patients with younger age, unmarried and polymorphic lesions had higher stigma (p<0.05). Patients with PKDL feel stigmatized in different areas. Conclusion PKDL treatment delays were unacceptably high and patients had poor knowledge compounded with feelings of stigmatization. To reduce the delay, a system may be evolved to establish some sort of public-private collaboration, besides awareness programs should be tailored, and implemented for improving the patient education regarding the disease and its linkage with VL.
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Affiliation(s)
- Pavan Garapati
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Biplab Pal
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Niyamat Ali Siddiqui
- Department of Biostatistics, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - Sanjiva Bimal
- Department of Immunology, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - Pradeep Das
- Department of Molecular Biology, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
| | - Krishna Murti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
- * E-mail: (KP); (KM)
| | - Krishna Pandey
- Department of Clinical Medicine, Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, India
- * E-mail: (KP); (KM)
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Hotterbeekx A, Menon S, Siewe JFN, Colebunders R. Onchocerciasis associated epilepsy: An important neglected public health problem. Seizure 2018; 60:205. [PMID: 29325732 DOI: 10.1016/j.seizure.2018.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 12/13/2022] Open
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Bleyenberg E, Stroeken K. When a rash has two names: pese sorcery and kisigo spirits at Lake Tanganyika. Anthropol Med 2017; 25:206-219. [PMID: 28875721 DOI: 10.1080/13648470.2017.1308187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This explorative and qualitative study, based on 27 interviews during two months of fieldwork, describes pese, an affliction of the skin that has conspicuously stayed under the radar of medico-anthropological research in Kigoma, a rural city in the northwest Tanzania. The condition reminds of a locally better known condition labeled kisigo, raising the question why two concepts of the same affliction exist side by side. It seems indicative that the two illness concepts stem from different cultures and that each specializes in an explanatory model: the former witchcraft (sorcery) and the latter spirit possession. Moreover, a symbiotic relation seems to exist between the healing traditions of the Bembe and the Ha. Government policies prohibiting witchcraft and targeting traditional healers seem to have created a situation where witchcraft practices and beliefs have come to represent the periphery and survive there, clandestinely.
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Shi-Jie F, Hong-Mei G, Li W, Bin-Hong W, Yi-Ru F, Gang W, Tian-Mei S. Perceptions of stigma and its correlates among patients with major depressive disorder: A multicenter survey from China. Asia Pac Psychiatry 2017; 9. [PMID: 27807927 DOI: 10.1111/appy.12260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 08/10/2016] [Accepted: 09/07/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The stigma of major depressive disorder (MDD) is an important public health problem. This study evaluated stigma in MDD patients in China using explanatory model interview catalogue (EMIC) questionnaire and the demographic and clinical symptom factors associated with the stigma of these patients. METHODS A total of 158 MDD patients from domestic 3 mental health centers were surveyed. We used the EMIC questionnaire to assess stigma of these patients, Montgomery and Asberg depression rating scale (MADRS) to assess depressive severity, self-reporting inventory (SCL-90) to assess mental health level, Sheehan disability scale (SDS) to assess social function, and fatigue severity scale (FSS) to assess degree of fatigue. RESULTS The stigma scores were significantly higher in the 18- to 30-year-old (z = 2.875, P = .024) and 31- to 40-year-old (z = 3.204, P = .008) groups than the 51- to 65-year-old group; in the full-time employment group than the retired group (z = 3.163, P = .016). The stigma scores exhibited significant negative correlation with age (r = -0.169, P = .034) but positive correlations with the scores of MADRS (r = .212, P = .007), total scores (r = .273, P = .001) and subscales of interpersonal sensitivity (r = .233, P = .003), depression (r = .336, P < .001), and anxiety (r = .228, P = .004) of SCL-90, scores of FSS (r = .230, P = .004), and SDS (r = .254, P = .001). Multivariate regression analysis revealed that depression subscale of SCL-90 and FSS were independently correlated with stigma. CONCLUSION The age, employment status, fatigue, and depressive severity are closely associated with the perceived stigma of MDD patients and may be important factors considered for stigma interventions of MDD in China.
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Affiliation(s)
- Feng Shi-Jie
- Psychiatric department, Shanxi Mental Health Center (Taiyuan Psychiatric Hospital), Taiyuan, China
| | - Gao Hong-Mei
- Psychiatric department, Shanxi Mental Health Center (Taiyuan Psychiatric Hospital), Taiyuan, China
| | - Wang Li
- Peking University the Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Health Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Wang Bin-Hong
- Psychiatric department, Shanxi Mental Health Center (Taiyuan Psychiatric Hospital), Taiyuan, China
| | - Fang Yi-Ru
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wang Gang
- Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Si Tian-Mei
- Peking University the Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Health Disorders & Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
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Murdoch ME, Murdoch IE, Evans J, Yahaya H, Njepuome N, Cousens S, Jones BR, Abiose A. Pre-control relationship of onchocercal skin disease with onchocercal infection in Guinea Savanna, Northern Nigeria. PLoS Negl Trop Dis 2017; 11:e0005489. [PMID: 28355223 PMCID: PMC5386293 DOI: 10.1371/journal.pntd.0005489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 04/10/2017] [Accepted: 03/13/2017] [Indexed: 01/22/2023] Open
Abstract
Background Onchocerca volvulus infection can result in blindness, itching and skin lesions. Previous research concentrated on blindness. Methods A clinical classification system of the cutaneous changes in onchocerciasis was used for the first time in this study within the context of an early ivermectin drug trial in the savanna region of Kaduna State, northern Nigeria. Skin examinations were performed in 6,790 individuals aged 5+ years in endemic communities and 1,343 individuals in nonendemic communities. Results / Discussion There was increased risk for all forms of onchocercal skin disease in endemic communities with the most common finding being the presence of nodules (1,438 individuals, 21.2%), followed by atrophy (367, 6.1% of those < 50 years), acute papular onchodermatitis, APOD (233, 3.4%), depigmentation (216, 3.2%) and chronic papular onchodermatitis, CPOD (155, 2.3%). A further 645 individuals (9.5%) complained of pruritus but had completely normal skin. APOD was more common in males whereas atrophy, hanging groin and nodules were more common in females. After controlling for age and sex, microfilarial positivity was a risk factor for CPOD, depigmentation, hanging groin and nodules (OR 1.54, p = 0.046; OR 2.29, p = 0.002; OR 2.18, p = 0.002 and OR 3.80, p <0.001 respectively). Comparable results were found using presence of nodules as the marker for infection. Microfilarial load showed similar, though weaker, results. A total of 2621(38.6%) endemic residents had itching with normal skin, or had one or more types of onchocercal skin disease including nodules, which may be considered as a composite index of the overall prevalence of onchocercal skin disease. Conclusion Significant levels of onchocercal skin disease were documented in this savanna area, which subsequently resulted in a reassessment of the true burden of skin disease in onchocerciasis. This paper represents the first detailed report of the association of onchocercal skin disease with markers for onchocercal infection. Onchocerciasis is a tropical parasitic infection caused by the nematode worm Onchocerca volvulus. The disease mainly occurs across tropical Africa and infection can result in blindness, debilitating itching and a variety of skin changes. Initial research concentrated mainly on the problem of blindness. A number of studies on onchocercal skin disease were performed but were difficult to interpret and compare because of the use of inconsistent terminology. Within the setting of one of the early trials of ivermectin in a savanna area of northern Nigeria, where there were known high rates of onchocercal blindness, we used a novel clinical classification of the skin changes in onchocerciasis. We identified significant levels of itching and various forms of onchocercal skin disease within these endemic communities. A positive skin-snip result proved to be a significant risk factor for the presence of chronic papular onchodermatitis (CPOD), depigmentation, hanging groin and onchocercal nodules. Comparable results were found when the presence of nodules was used as the marker for infection and similar, though weaker odds ratios were found with microfilarial load per se. The findings triggered a reassessment of the true burden of skin disease in onchocerciasis. It is the first detailed report of the association between onchocercal skin disease and markers of infection.
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Affiliation(s)
- Michele E. Murdoch
- St. John's Institute of Dermatology, London, United Kingdom
- Department of Dermatology, Watford General Hospital, West Herts Hospitals NHS Trust, Watford, Herts., United Kingdom
- * E-mail:
| | - Ian E. Murdoch
- Department of Ophthalmology, Ahmadu Bello University Hospital, Kaduna, Nigeria
- International Centre for Eye Health, Institute of Ophthalmology, London, United Kingdom
| | - Jennifer Evans
- Department of Ophthalmology, Ahmadu Bello University Hospital, Kaduna, Nigeria
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Haliru Yahaya
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria
| | - Ngozi Njepuome
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria
| | - Simon Cousens
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Barrie R. Jones
- Department of Ophthalmology, Ahmadu Bello University Hospital, Kaduna, Nigeria
- International Centre for Eye Health, Institute of Ophthalmology, London, United Kingdom
| | - Adenike Abiose
- Department of Ophthalmology, Ahmadu Bello University Hospital, Kaduna, Nigeria
- National Eye Centre, Kaduna, Nigeria
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Onchocerciasis in the Democratic Republic of Congo: Survey of knowledge, attitude and perception in Bandundu province. J Infect Public Health 2017; 10:600-607. [PMID: 28215917 DOI: 10.1016/j.jiph.2017.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/16/2017] [Accepted: 01/28/2017] [Indexed: 11/23/2022] Open
Abstract
A community-directed treatment with ivermectin (CDTI) for fighting onchocerciasis was started in 2003 in the hyperendemic province of Bandundu, Democratic Republic of Congo (DRC); such initiative was supported by the African Programme for Onchocerciasis Control (APOC). As the APOC stopped at the end of 2015, there was an urgent need to assess the sustainability of an ivermectin treatment. A cross-sectional survey of knowledge, attitude and perception was conducted to determine the awareness level of local population regarding the disease. A multi-stage random sampling technique allowed the selection of 450 heads of households. Most respondents (96.9%) knew about onchocerciasis as a disease. The black-fly was viewed as the causing agent of onchocerciasis by 49.9% of respondents. The most commonly cited clinical manifestations were nodules (34.4%) and pruritus (31.1%), while blindness was the most frequently reported complication (90.7%). Approximately 55.1% of respondents had a good knowledge of onchocerciasis and CDTI. Overall, only 37% of participants had a favourable attitude and 46% a positive perception. Good knowledge was associated with school attendance (adjusted OR=1.9, 95%CI: 1.3-2.8, p=0.001), while education and continuation of treatment were related with good attitude (adjusted OR=9.7, 95%CI:4.8-19.5 and adjusted OR=19.8, 95%CI: 9.7-40.6, respectively, both with p<0.001). Good perception was associated with being at least 46 years old, non-Catholic and continuing the treatment (adjusted OR=3.2, 95%CI:1.2-9.1; adjusted OR=29.6, 95%CI:14.1-62.2 and adjusted OR=5.1, 95%CI:1.6-16.0 respectively, all with p<0.001). A good level of knowledge, attitude and perception is needed for a massive adherence of population to onchocerciasis control programmes. In the area of study (Moanza, DRC), good attitude and perception motivated the continuation of treatment in the population. In the future, different plans should focus on educational strategies to maintain a massive adherence and reduce onchocerciasis prevalence.
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Hofstraat K, van Brakel WH. Social stigma towards neglected tropical diseases: a systematic review. Int Health 2016; 8 Suppl 1:i53-70. [PMID: 26940310 DOI: 10.1093/inthealth/ihv071] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND People affected by neglected tropical diseases (NTDs) are frequently the target of social stigmatization. To date not much attention has been given to stigma in relation to NTDs. The objective of this review is to identify the extent of social stigma and the similarities and differences in the causes, manifestations, impact of stigma and interventions used between the NTDs. METHODS A systematic review was conducted in Pubmed, ScienceDirect, PsycINFO and Web of Knowledge. The search encompassed 17 NTDs, including podoconiosis, but not leprosy as this NTD has recently been reviewed. However, leprosy was included in the discussion. RESULTS The 52 selected articles provided evidence on stigma related to lymphatic filariasis (LF), podoconiosis, Buruli ulcer, onchocerciasis, schistosomiasis, leishmaniasis, Chagas disease, trachoma, soil-transmitted helminthiasis (STH) and human African trypanosomiasis. The similarities predominated in stigma related to the various NTDs; only minimal differences in stigma reasons and measures were found. CONCLUSION These similarities suggest that joint approaches to reduce stigmatization may be feasible. Lessons from leprosy and other stigmatized health conditions can be used to plan such joint approaches. Further research will be necessary to study the efficacy of joint interventions and to investigate stigma related to NTDs for which no evidence is available yet.
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Affiliation(s)
- Karlijn Hofstraat
- Netherlands Leprosy Relief, Wibautstraat 137k, 1097 DN Amsterdam, The Netherlands
| | - Wim H van Brakel
- Netherlands Leprosy Relief, Wibautstraat 137k, 1097 DN Amsterdam, The Netherlands
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18
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Wagbatsoma VA, Okojie OH. Psychosocial effects of river blindness in a rural community in Nigeria. ACTA ACUST UNITED AC 2016; 124:134-6. [PMID: 15195454 DOI: 10.1177/146642400412400315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Onchocerciasis (river blindness) is a serious public health problem with important socioeconomic consequences. The presence of onchocercal skin lesions is unsightly and has a psychosocial effect on the affected. This cross-sectional study was undertaken to assess the perception and social implication of onchocerciasis in the village of Apana in Nigeria. Apana is a rural community, hyper-endemic for onchocerciasis and currently receiving ivermectin treatment. The village is one of the ten communities of Uzairue district of Etsako West Local Government Area (LGA), Edo State, Nigeria. There are many water streams in the community which serve the domestic needs of the inhabitants but also provide the breeding sites for the vector flies of onchocerciasis. Multi-stage sampling methods were used to select the 385 respondents that participated after informed consent was obtained. A structured researcher-administered questionnaire was the tool for data collection. Of the 385 respondents that participated in the survey, 240 (62.3%) were male while 145 (37.7%) were female. The awareness of the disease among the respondents was fair. They were aware of the nuisance value of blackflies (‘Uja-ini’) and associated the bite with itching. The signs and symptoms of onchocerciasis were recognised as specific diseases with specific local names. They called itching and rashes ‘Erhue’, nodules and leopard skin ‘Evbiomu-Ogui’, worm in the eye ‘Okogho-Ikpalo’ and blindness ‘Orunalo’. The attitude of the non-affected towards the affected was partially discriminatory and suspicious. The affected were socially withdrawn, probably due to the frustration of their health condition. There is a need to improve people’s attitude towards the disease and improve disease awareness through appropriate health education, which will encourage the acceptance of ivermectin as adequate treatment and compliance to the treatment regimen to reduce morbidity and promote self-esteem.
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Affiliation(s)
- V A Wagbatsoma
- Department of Community Health, School of Medicine, College of Medical Sciences, University of Benin, Benin City, Nigeria.
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Korsaga/Somé N, Salissou L, Tapsoba GP, Ouédraogo MS, Traoré F, Doulla M, Barro/Traoré F, Niamba P, Traoré A. [Ichthyosis and social stigma in Burkina Faso]. Ann Dermatol Venereol 2016; 143:554-8. [PMID: 27133359 DOI: 10.1016/j.annder.2016.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/07/2016] [Accepted: 03/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Through the story of two families presenting ichthyosis, we report the support and social integration difficulties inherent in these genetic diseases. PATIENTS AND METHODS Family No. 1: a 38-year-old shepherd and his wife of 25 years both had lamellar ichthyosis that had been present continually since childhood. They had had 2 stillborn infants as well as a live newborn that were all presenting lamellar ichthyosis. Family No. 2: a 45-year-old housewife was seen at our consultation with her 3 youngest children aged 8 years, 6 years and 18 months. According to the mother, at birth, all 3 children were covered with a membrane resembling plastic that crackled during movement, and they had red eyes. Examination of the 3 children revealed a clinical picture of lamellar ichthyosis with ectropion, malformed ears and brachydactyly. Although they presented delayed growth and weight development, psychomotor development was normal. There was no consanguinity between the parents. DISCUSSION In both families, the visible nature of the dermatosis resulted in discrimination and ostracism. The precarious living conditions of the parents and the high cost of treatment in an African setting resulted in degradation of quality of life with exacerbation of the difficulties of social integration, resulting in a lack of schooling and a bleak future for these children.
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Affiliation(s)
- N Korsaga/Somé
- Service de dermatologie-vénéreologie, CHU Yalgado Ouédraogo, Kadiogo 10 BP 269, Ouagadougou, Burkina Faso.
| | - L Salissou
- Service de dermatologie-vénéreologie, CHU Yalgado Ouédraogo, Kadiogo 10 BP 269, Ouagadougou, Burkina Faso
| | - G P Tapsoba
- Service de dermatologie-vénéreologie, CHU Yalgado Ouédraogo, Kadiogo 10 BP 269, Ouagadougou, Burkina Faso
| | - M S Ouédraogo
- Service de dermatologie-vénéreologie, CHU Yalgado Ouédraogo, Kadiogo 10 BP 269, Ouagadougou, Burkina Faso
| | - F Traoré
- Service de dermatologie-vénéreologie, CHU Yalgado Ouédraogo, Kadiogo 10 BP 269, Ouagadougou, Burkina Faso
| | - M Doulla
- Service de dermatologie-vénéreologie, CHU Yalgado Ouédraogo, Kadiogo 10 BP 269, Ouagadougou, Burkina Faso
| | - F Barro/Traoré
- Service de dermatologie-vénéreologie, CHU Yalgado Ouédraogo, Kadiogo 10 BP 269, Ouagadougou, Burkina Faso
| | - P Niamba
- Service de dermatologie-vénéreologie, CHU Yalgado Ouédraogo, Kadiogo 10 BP 269, Ouagadougou, Burkina Faso
| | - A Traoré
- Service de dermatologie-vénéreologie, CHU Yalgado Ouédraogo, Kadiogo 10 BP 269, Ouagadougou, Burkina Faso
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Bailey TC, Merritt MW, Tediosi F. Investing in justice: ethics, evidence, and the eradication investment cases for lymphatic filariasis and onchocerciasis. Am J Public Health 2015; 105:629-36. [PMID: 25713967 DOI: 10.2105/ajph.2014.302454] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
It has been suggested that initiatives to eradicate specific communicable diseases need to be informed by eradication investment cases to assess the feasibility, costs, and consequences of eradication compared with elimination or control. A methodological challenge of eradication investment cases is how to account for the ethical importance of the benefits, burdens, and distributions thereof that are salient in people's experiences of the diseases and related interventions but are not assessed in traditional approaches to health and economic evaluation. We have offered a method of ethical analysis grounded in theories of social justice. We have described the method and its philosophical rationale and illustrated its use in application to eradication investment cases for lymphatic filariasis and onchocerciasis, 2 neglected tropical diseases that are candidates for eradication.
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Affiliation(s)
- Theodore C Bailey
- Theodore C. Bailey is with the Division of Infectious Diseases, Johns Hopkins Hospital, Baltimore, MD, and the Johns Hopkins Berman Institute of Bioethics, Baltimore. Maria W. Merritt is with the Johns Hopkins Berman Institute of Bioethics and the Department of International Health, Bloomberg School of Public Health, Baltimore. Fabrizio Tediosi is with the Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
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Peters RMH, Dadun, Van Brakel WH, Zweekhorst MBM, Damayanti R, Bunders JFG, Irwanto. The cultural validation of two scales to assess social stigma in leprosy. PLoS Negl Trop Dis 2014; 8:e3274. [PMID: 25376007 PMCID: PMC4222778 DOI: 10.1371/journal.pntd.0003274] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 09/16/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Stigma plays in an important role in the lives of persons affected by neglected tropical diseases, and assessment of stigma is important to document this. The aim of this study is to test the cross-cultural validity of the Community Stigma Scale (EMIC-CSS) and the Social Distance Scale (SDS) in the field of leprosy in Cirebon District, Indonesia. METHODOLOGY/PRINCIPLE FINDINGS Cultural equivalence was tested by assessing the conceptual, item, semantic, operational and measurement equivalence of these instruments. A qualitative exploratory study was conducted to increase our understanding of the concept of stigma in Cirebon District. A process of translation, discussions, trainings and a pilot study followed. A sample of 259 community members was selected through convenience sampling and 67 repeated measures were obtained to assess the psychometric measurement properties. The aspects and items in the SDS and EMIC-CSS seem equally relevant and important in the target culture. The response scales were adapted to ensure that meaning is transferred accurately and no changes to the scale format (e.g. lay out, statements or questions) of both scales were made. A positive correlation was found between the EMIC-CSS and the SDS total scores (r=0.41). Cronbach's alphas of 0.83 and 0.87 were found for the EMIC-CSS and SDS. The exploratory factor analysis indicated for both scales an adequate fit as unidimensional scale. A standard error of measurement of 2.38 was found in the EMIC-CSS and of 1.78 in the SDS. The test-retest reliability coefficient was respectively, 0.84 and 0.75. No floor or ceiling effects were found. CONCLUSIONS/SIGNIFICANCE According to current international standards, our findings indicate that the EMIC-CSS and the SDS have adequate cultural validity to assess social stigma in leprosy in the Bahasa Indonesia-speaking population of Cirebon District. We believe the scales can be further improved, for instance, by adding, changing and rephrasing certain items. Finally, we provide suggestions for use with other neglected tropical diseases.
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Affiliation(s)
- Ruth M. H. Peters
- Athena Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Dadun
- Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | | | | | - Rita Damayanti
- Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Joske F. G. Bunders
- Athena Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - Irwanto
- Centre for Disability Studies, Faculty of Social and Political Sciences, Universitas Indonesia, Depok, Indonesia
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Tora A, Franklin H, Deribe K, Reda AA, Davey G. Extent of podoconiosis-related stigma in Wolaita Zone, Southern Ethiopia: a cross-sectional study. SPRINGERPLUS 2014; 3:647. [PMID: 25485190 PMCID: PMC4233027 DOI: 10.1186/2193-1801-3-647] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/28/2014] [Indexed: 11/30/2022]
Abstract
Studies have indicated that social stigma related to podoconiosis (endemic non-filarial elephantiasis) has a major impact on the psychosocial wellbeing of patients. However, little effort has been made so far to quantify the level of both felt and enacted stigma in a range of domains of life. We used a recently developed podoconiosis stigma assessment scale to measure levels of stigma as recalled over the previous 12 months. One hundred and fifty patients with podoconiosis rated the levels of stigma they perceived and experienced in ‘interpersonal interactions’, ‘major life areas’ and ‘community, social and civic life’. High levels of stigma were observed on both felt and enacted stigma scales. The overall average stigma score was 40.7 (range 0 to 96). Enacted stigma was scored higher than felt stigma (mean score 21.2 vs. 19.5, respectively). The mean enacted stigma score was higher in ‘major life areas’, and ‘community, social and civic life’ than ‘interpersonal interactions’, while felt stigma was experienced most at the interpersonal level. Over half of patients reported that they had considered suicide in response to discrimination and prejudice, particularly in interpersonal interactions. Forced divorce, dissolution of marriage plan, insults and exclusion at social events were some of the most commonly mentioned forms of enacted stigma reported by affected individuals. Scores for overall level of stigma and enacted stigma increased significantly with stage of podoconiosis while the association observed in relation to felt stigma was only marginally significant (p = 0.085). Appropriate stigma reduction strategies must be identified and implemented in communities highly endemic for podoconiosis.
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Affiliation(s)
- Abebayehu Tora
- Department of Sociology, Wolaita Sodo University, Sodo, Ethiopia
| | | | | | - Ayalu A Reda
- Population Studies and Training Center, Brown University, 68 Waterman St, Providence, RI USA
| | - Gail Davey
- Brighton and Sussex Medical School, Brighton, UK
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Baum S, Greenberger S, Pavlotsky F, Solomon M, Enk CD, Schwartz E, Barzilai A. Late-onset onchocercal skin disease among Ethiopian immigrants. Br J Dermatol 2014; 171:1078-83. [PMID: 24673403 DOI: 10.1111/bjd.13005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Onchocerciasis is an infectious disease caused by the filaria Onchocerca volvulus. Very little is known regarding onchocerciasis imported from endemic to nonendemic areas. OBJECTIVES To evaluate pruritic dermatitis simulating atopic dermatitis in Ethiopian immigrants in Israel. PATIENTS AND METHODS A retrospective study of 27 Ethiopian immigrants to Israel was conducted. Demographics and clinical and laboratory data were collected. RESULTS Of the group of 27 patients, 10 (37%) were men and 17 (63%) were women. The average age at referral was 29 years. All of the patients emigrated from Kuwara, Ethiopia. Diagnosis was done by either positive skin snip test or immunoglobulin (Ig) G4 serology of onchocerciasis in 14 patients. The most common presentation was a combination of lichenified onchodermatitis with atrophy and depigmentation (36%). Eosinophilia and elevated IgE levels were common. Seventeen patients were treated with a single administration of oral ivermectin 200 μg mg(-1). Thirteen patients responded to the treatment. CONCLUSIONS Immigrants from endemic regions to developed countries presenting with pruritic diseases, especially those with a clinical picture suggestive of atopic dermatitis, should be evaluated for possible onchocerciasis infection. Ivermectin, a relatively safe and low-cost treatment, should be considered even in the absence of a proven disease. Physicians should have a high index of suspicion in patients with the corresponding residential history.
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Affiliation(s)
- S Baum
- Department of Dermatology, Chaim Sheba Medical Center, Tel Hashomer, Israel; The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Makenga Bof JC, Maketa V, Bakajika DK, Ntumba F, Mpunga D, Murdoch ME, Hopkins A, Noma MM, Zouré H, Tekle AH, Katabarwa MN, Lutumba P. Onchocerciasis control in the Democratic Republic of Congo (DRC): challenges in a post-war environment. Trop Med Int Health 2014; 20:48-62. [PMID: 25302560 DOI: 10.1111/tmi.12397] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate onchocerciasis control activities in the Democratic Republic of Congo (DRC) in the first 12 years of community-directed treatment with ivermectin (CDTI). METHODS Data from the National Programme for Onchocerciasis (NPO) provided by the National Onchocerciasis Task Force (NOTF) through the annual reports of the 21 CDTI projects for the years 2001-2012 were reviewed retrospectively. A hypothetical-inputs-process-outputs-outcomes table was constructed. RESULTS Community-directed treatment with ivermectin expanded from 1968 communities in 2001 to 39 100 communities by 2012 while the number of community-directed distributors (CDD) and health workers (HW) multiplied. By 2012, there were ratios of 1 CDD per 262 persons and 1 HW per 2318 persons at risk. More than 80% of the funding came from the fiduciary funds of the African Programme for Onchocerciasis Control. The cost of treatment per person treated fell from US$ 1.1 in 2001 to US$ 0.1 in 2012. The therapeutic coverage increased from 2.7% (2001) to 74.2% (2012); the geographical coverage, from 4.7% (2001) to 93.9% (2012). Geographical coverage fell in 2005 due to deaths in loiasis co-endemic areas, and the therapeutic coverage fell in 2008 due to insecurity. CONCLUSIONS Challenges to CDTI in DRC have been serious adverse reactions to ivermectin in loiasis co-endemic areas and political conflict. Targets for personnel or therapeutic and geographical coverages were not met. Longer term funding and renewed efforts are required to achieve control and elimination of onchocerciasis in DRC.
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Affiliation(s)
- J-C Makenga Bof
- Faculty of Public Health, Université Catholique de Louvain, Brussels, Belgium
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Stigma towards a neglected tropical disease: felt and enacted stigma scores among podoconiosis patients in Northern Ethiopia. BMC Public Health 2013; 13:1178. [PMID: 24330684 PMCID: PMC3878751 DOI: 10.1186/1471-2458-13-1178] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 12/11/2013] [Indexed: 01/08/2023] Open
Abstract
Background Podoconiosis, or non-filarial elephantiasis, is a neglected tropical disease (NTD) characterised by swelling of the lower legs. When left untreated, this disfiguring condition has a significant social impact. This study aimed to describe the stigma experience among podoconiosis patients in Dembecha, Northern Ethiopia and assess potential associations between stigma and sociodemographic determinants. Methods The study was conducted in May 2012 in Northern Ethiopia. A questionnaire-based cross-sectional study design was used and stigma was assessed using a validated podoconiosis stigma scale including 'felt’ and 'enacted’ stigma domains. Enacted stigma includes the experience of discrimination such as abuse, loss of employment or prejudicial attitudes, while felt stigma is the perceived fear of enacted stigma. A multivariable linear regression model was used to explore determinants that may be associated with stigma. Results A total of 346 clinically confirmed podoconiosis patients participated in the study. The total mean score of all stigma scale items was 30.7 (Range = 0 to 96). There was a higher mean score of scale items in domains of felt stigma (21.7; Range = 0 to 45) as compared to enacted stigma (9.0; Range = 0 to 51). The total mean score of all stigma scale items appeared to increase with disease stage. A final adjusted linear regression model found an association between stigma and factors including monthly income, duration lived in the current residence, and disease stage, after controlling for confounders. Conclusion Podoconiosis is a stigmatized disease with a clear social impact. This paper documented the burden of podoconiosis-related stigma and identified associated factors. Programs aimed at preventing and treating podoconiosis should incorporate interventions to mitigate both felt and enacted stigma. Interventions targeting patients should prioritize those with advanced disease.
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The cost of annual versus biannual community-directed treatment of onchocerciasis with ivermectin: Ghana as a case study. PLoS Negl Trop Dis 2013; 7:e2452. [PMID: 24069497 PMCID: PMC3777881 DOI: 10.1371/journal.pntd.0002452] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 08/13/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It has been proposed that switching from annual to biannual (twice yearly) mass community-directed treatment with ivermectin (CDTI) might improve the chances of onchocerciasis elimination in some African foci. However, historically, relatively few communities have received biannual treatments in Africa, and there are no cost data associated with increasing ivermectin treatment frequency at a large scale. Collecting cost data is essential for conducting economic evaluations of control programmes. Some countries, such as Ghana, have adopted a biannual treatment strategy in selected districts. We undertook a study to estimate the costs associated with annual and biannual CDTI in Ghana. METHODOLOGY The study was conducted in the Brong-Ahafo and Northern regions of Ghana. Data collection was organized at the national, regional, district, sub-district and community levels, and involved interviewing key personnel and scrutinizing national records. Data were collected in four districts; one in which treatment is delivered annually, two in which it is delivered biannually, and one where treatment takes place biannually in some communities and annually in others. Both financial and economic costs were collected from the health care provider's perspective. PRINCIPAL FINDINGS The estimated cost of treating annually was US Dollars (USD) 0.45 per person including the value of time donated by the community drug distributors (which was estimated at USD 0.05 per person per treatment round). The cost of CDTI was approximately 50-60% higher in those districts where treatment was biannual than in those where it was annual. Large-scale mass biannual treatment was reported as being well received and considered sustainable. CONCLUSIONS/SIGNIFICANCE This study provides rigorous evidence of the different costs associated with annual and biannual CDTI in Ghana which can be used to inform an economic evaluation of the debate on the optimal treatment frequency required to control (or eliminate) onchocerciasis in Africa.
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Amazigo UV, Nnoruka E, Maduka C, Bump J, Benton B, Sékétéli A. Ivermectin improves the skin condition and self-esteem of females with onchocerciasis: a report of two cases. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2013; 98:533-7. [PMID: 15257804 DOI: 10.1179/000349804225003505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- U V Amazigo
- African Programme for Onchocerciasis Control (APOC), 01 B. P. 549, Ouagadougou, Burkina Faso.
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Franklin H, Tora A, Deribe K, Reda AA, Davey G. Development of a scale to measure stigma related to podoconiosis in Southern Ethiopia. BMC Public Health 2013; 13:298. [PMID: 23556435 PMCID: PMC3637122 DOI: 10.1186/1471-2458-13-298] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 03/18/2013] [Indexed: 11/12/2022] Open
Abstract
Background Health-related stigma adds to the physical and economic burdens experienced by people suffering from neglected tropical diseases (NTDs). Previous research into the NTD podoconiosis showed significant stigma towards those with the disease, yet no formal instrument exists by which to assess stigma or interventions to reduce stigma. We aimed to develop, pilot and validate scales to measure the extent of stigma towards podoconiosis among patients and in podoconiosis-endemic communities. Methods Indicators of stigma were drawn from existing qualitative podoconiosis research and a literature review on measuring leprosy stigma. These were then formulated into items for questioning and evaluated through a Delphi process in which irrelevant items were discounted. The final items formed four scales measuring two distinct forms of stigma (felt stigma and enacted stigma) for those with podoconiosis and those without the disease. The scales were formatted as two questionnaires, one for podoconiosis patients and one for unaffected community members. 150 podoconiosis patients and 500 unaffected community members from Wolaita zone, Southern Ethiopia were selected through multistage random sampling to complete the questionnaires which were interview-administered. The scales were evaluated through reliability assessment, content and construct validity analysis of the items, factor analysis and internal consistency analysis. Results All scales had Cronbach’s alpha over 0.7, indicating good consistency. The content and construct validity of the scales were satisfactory with modest correlation between items. There was significant correlation between the felt and enacted stigma scales among patients (Spearman’s r = 0.892; p < 0.001) and within the community (Spearman’s r = 0.794; p < 0.001). Conclusion We report the development and testing of the first standardised measures of podoconiosis stigma. Although further research is needed to validate the scales in other contexts, we anticipate they will be useful in situational analysis and in designing, monitoring and evaluating interventions. The scales will enable an evidence-based approach to mitigating stigma which will enable implementation of more effective disease control and help break the cycle of poverty and NTDs.
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Attah SK, Ayeh-Kumi PF, Sittie AA, Oppong IV, Nyarko AK. Extracts of Euphorbia hirta Linn. (Euphorbiaceae) and Rauvolfia vomitoria Afzel (Apocynaceae) demonstrate activities against Onchocerca volvulus microfilariae in vitro. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 13:66. [PMID: 23506674 PMCID: PMC3606627 DOI: 10.1186/1472-6882-13-66] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 03/13/2013] [Indexed: 11/10/2022]
Abstract
Background Onchocerciasis transmitted by Onchocerca volvulus is the second major cause of blindness in the world and it impacts negatively on the socio-economic development of the communities affected. Currently, ivermectin, a microfilaricidal drug is the only drug recommended for treating this disease. There have been speculations, of late, concerning O. volvulus resistance to ivermectin. Owing to this, it has become imperative to search for new drugs. World-wide, ethnomedicines including extracts of Euphorbia hirta and Rauvolfia vomitoria are used for treating various diseases, both infectious and non-infectious. Method In this study extracts of the two plants were evaluated in vitro in order to determine their effect against O. volvulus microfilariae. The toxicity of the E. hirta extracts on monkey kidney cell (LLCMK2) lines was also determined. Results The investigations showed that extracts of both plants immobilised microfilariae at different levels in vitro and, therefore, possess antifilarial properties. It was found that all the E. hirta extracts with the exception of the hexane extracts were more effective than those of R. vomitoria. Among the extracts of E. hirta the ethyl acetate fraction was most effective, and comparable to that of dimethanesulphonate salt but higher than that of Melarsoprol (Mel B). However, the crude ethanolic extract of E. hirta was found to be the least toxic to the LLCMK2 compared to the fractionated forms. Conclusions Extracts from both plants possess antifilarial properties; however, the crude extract of E. hirta was found to be least toxic to LLCMK2.
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Tchounkeu YFL, Onyeneho NG, Wanji S, Kabali AT, Manianga C, Amazigo UV, Amuyunzu-Nyamongo M. Changes in stigma and discrimination of onchocerciasis in Africa. Trans R Soc Trop Med Hyg 2012; 106:340-7. [DOI: 10.1016/j.trstmh.2012.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 10/01/2011] [Accepted: 02/29/2012] [Indexed: 10/28/2022] Open
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Ibekwe PU, Ogunbiyi AO, Ogun OG, George AO. Social stigmatization of two sisters with lamella ichthyosis in Ibadan, Nigeria. Int J Dermatol 2012; 51:67-8. [PMID: 22182380 DOI: 10.1111/j.1365-4632.2011.05060.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Perpetua U Ibekwe
- Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität München, München, Germany.
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Schuster A, Lesshafft H, Talhari S, Guedes de Oliveira S, Ignatius R, Feldmeier H. Life quality impairment caused by hookworm-related cutaneous larva migrans in resource-poor communities in Manaus, Brazil. PLoS Negl Trop Dis 2011; 5:e1355. [PMID: 22087341 PMCID: PMC3210737 DOI: 10.1371/journal.pntd.0001355] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 08/28/2011] [Indexed: 11/28/2022] Open
Abstract
Background Hookworm-related cutaneous larva migrans (CLM) is a common but neglected tropical skin disease caused by the migration of animal hookworm larvae in the epidermis. The disease causes intense pruritus and is associated with important morbidity. The extent to which CLM impairs skin disease-associated life quality has never been studied. Methods A modified version of the Dermatology Life Quality Index (mDLQI) was used to determine skin disease-associated life quality in 91 adult and child patients with CLM, living in resource-poor communities in Manaus, Brazil. Symptoms and signs were documented and skin disease-associated life quality was semi-quantitatively assessed using mDLQI scores. The assessment was repeated two and four weeks after treatment with ivermectin. Results Ninety-one point five percent of the study participants showed a considerable reduction of skin disease-associated life quality at the time of diagnosis. The degree of impairment correlated with the intensity of infection (rho = 0.76, p<0.001), the number of body areas affected (rho = 0.30; p = 0.004), and the presence of lesions on visible areas of the skin (p = 0.002). Intense pruritus, sleep disturbance (due to itching) and the feeling of shame were the most frequent skin disease-associated life quality restrictions (reported by 93.4%, 73.6%, and 64.8% of the patients, respectively). No differences were observed in skin disease-associated life quality restriction between boys and girls or men and women. Two weeks after treatment with ivermectin, skin disease-associated life quality improved significantly. After four weeks, 73.3% of the patients considered their disease-associated life quality to have returned to normal. Conclusions CLM significantly impaired the skin disease-associated life quality in child and adult patients living in urban slums in North Brazil. After treatment with ivermectin, life quality normalised rapidly. Hookworm-related cutaneous larva migrans (CLM) is a parasitic skin disease common in developing countries with hot climates. In resource-poor settings, CLM is associated with considerable morbidity. The disease is caused by animal hookworm larvae that penetrate the skin and migrate aimlessly in the epidermis as they cannot penetrate the basal membrane. Particularly in the rainy season, the intensity of infection is high with up to 40 larval tracks in an affected individual. Tracks are very itchy and are surrounded by a significant inflammation of the skin. Bacterial superinfection is common and intensifies the inflammation. The psychosocial consequences caused by CLM have never been investigated. We showed that CLM causes skin disease-associated life quality impairment in 91 patients with CLM. Skin disease-associated life quality was significantly impaired. The degree of impairment correlated to the intensity of infection and the number of body areas affected. After treatment with ivermectin, life quality was rapidly restored.
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Affiliation(s)
- Angela Schuster
- Institute of Microbiology and Hygiene, Charité Universitätsmedizin Berlin, Germany.
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Amuyunzu-Nyamongo M, Tchounkeu YFL, Oyugi RA, Kabali AT, Okeibunor JC, Manianga C, Amazigo UV. Drawing and interpreting data: Children's impressions of onchocerciasis and community-directed treatment with ivermectin (CDTI) in four onchocerciasis endemic countries in Africa. Int J Qual Stud Health Well-being 2011; 6:QHW-6-5918. [PMID: 21637349 PMCID: PMC3105904 DOI: 10.3402/qhw.v6i2.5918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2011] [Indexed: 11/14/2022] Open
Abstract
Although the depiction of a child leading a blind man is the most enduring image of onchocerciasis in Africa, research activities have hardly involved children. This paper aims at giving voice to children through drawings and their interpretation. The study was conducted in 2009 in Cameroon, Democratic Republic of Congo (DRC), Nigeria and Uganda. Children aged 6-16 years were asked to draw their perceptions of onchocerciasis and community-directed treatment with ivermectin (CDTI) in their communities. A total of 50 drawings were generated. The drawings depicted four main aspects of onchocerciasis: (1) the disease symptoms, (2) the negative consequences of onchocerciasis among children and in the community generally, (3) the ivermectin distribution process, and (4) the benefits or effects of taking ivermectin. Out of the 50 drawings, 30 were on symptoms, 7 on effects of the disease on children, 8 on distribution process, and 5 represented multiple perceptions on symptoms, drug distribution processes, benefits, and effects of treatment. The lack of clarity when treatment with ivermectin can be stopped in endemic areas requires working with children to ensure continued compliance with treatment into the future. Children's drawings should be incorporated into health education interventions.
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Okeibunor JC, Amuyunzu-Nyamongo M, Onyeneho NG, Tchounkeu YFL, Manianga C, Kabali AT, Leak S. Where would I be without ivermectin? Capturing the benefits of community-directed treatment with ivermectin in Africa. Trop Med Int Health 2011; 16:608-21. [DOI: 10.1111/j.1365-3156.2011.02735.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
PURPOSE OF REVIEW This review is timely because awareness of the burden of disease from onchodermatitis has increased significantly over recent years. Recent progress in the field is reviewed with emphasis on publications within the past 2 years. RECENT FINDINGS Advances have been made in understanding immunopathogenesis and in diagnosis and treatment. The World Bank/WHO African Programme for Onchocerciasis Control (APOC), which uses annual community-directed treatment with ivermectin (CDTI) via the Mectizan Donation Programme, now covers 19 African countries. Development of ivermectin resistance is a concern. Unlike ivermectin, which is a microfilaricide, doxycycline, which targets Wolbachia endosymbiotic bacteria, sterilizes adult female worms and has a macrofilaricidal effect. Moxidectin, which sterilizes or kills adult worms has started a phase III trial with ivermectin. Additional primary healthcare interventions have been successfully integrated with CTDI. In Latin America, transmission has been interrupted in half of the original endemic foci and Colombia is the first nation to have achieved countrywide interruption of transmission. The first report of elimination using ivermectin in an African setting is a milestone. Two African foci using vector control plus CDTI have reported vector elimination. SUMMARY Results of the longer-term impact of large-scale ivermectin distribution by the APOC are awaited. Research is needed into new drug targets within Wolbachia's metabolic pathways. Elimination of transmission of disease is on the horizon but more research is needed on when and where ivermectin treatment can be stopped.
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Muela Ribera J, Peeters Grietens K, Toomer E, Hausmann-Muela S. A word of caution against the stigma trend in neglected tropical disease research and control. PLoS Negl Trop Dis 2009; 3:e445. [PMID: 19859533 PMCID: PMC2761539 DOI: 10.1371/journal.pntd.0000445] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Dimomfu BL, Lubeji DK, Noma M, Sékétéli A, Boussinesq M. African Programme for Onchocerciasis Control (APOC): sociological study in three foci of central Africa before the implementation of treatments with ivermectin (Mectizan®). Trans R Soc Trop Med Hyg 2007; 101:674-9. [PMID: 17433391 DOI: 10.1016/j.trstmh.2007.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 03/07/2007] [Accepted: 03/07/2007] [Indexed: 10/23/2022] Open
Abstract
The African Programme for Onchocerciasis Control (APOC) has put in place a study to assess the long-term impact of the community-directed treatments with ivermectin on various clinical and entomological indicators of onchocerciasis. As the results obtained would depend on community participation in the treatments, surveys were also conducted at the study sites to assess the people's knowledge, attitudes and practices regarding onchocerciasis and its treatment. This article presents the anthropological observations made before the implementation of the treatments in three sites: one in the Central African Republic, and two in the Democratic Republic of Congo. The information collected shows that the populations have a relatively poor knowledge of the manifestations and mode of transmission of onchocerciasis. The communities' attitudes towards those individuals afflicted with the disease vary from one site to another. Regarding treatment, the populations use both traditional and 'modern' treatments, but the beneficial effects of ivermectin are not well known. The differences recorded between the sites surveyed demonstrate that the messages to be delivered to the populations before the distributions should take into account the local epidemiological and socio-anthropological context.
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Affiliation(s)
- Bruno Lapika Dimomfu
- Centre de coordination des recherches et de la documentation en sciences sociales pour l'Afrique sub-saharienne (CERDAS), Université de Kinshasa, BP 836, Kinshasa IX, République Démocratique du Congo
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Amazigo U, Okeibunor J, Matovu V, Zouré H, Bump J, Seketeli A. Performance of predictors: evaluating sustainability in community-directed treatment projects of the African programme for onchocerciasis control. Soc Sci Med 2007; 64:2070-82. [PMID: 17383061 DOI: 10.1016/j.socscimed.2007.01.018] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Indexed: 10/23/2022]
Abstract
The predictors of sustainability of community-directed treatment with ivermectin (CDTI) at four implementation levels were evaluated in 41 African Programme for Onchocerciasis Control (APOC) projects, encompassing 492 communities in 10 countries. A model protocol provided information on indicators corresponding to nine aspects of a project that is likely to be sustainable at community level after the cessation of external support. Six of the nine aspects had components of community ownership as predictors of project sustainability. Quantitative and qualitative assessments were used to obtain individual community scores and an overall sustainability score for each project graded on a scale of 0-4. Of the 41 projects evaluated, 70% scored "satisfactorily" to "highly sustainable" at the community level. We found variations among countries and that health system weaknesses could hamper community efforts in sustaining a project, such as when ivermectin was delivered late. Community ownership was of primary importance to the community score, and the community-level scores correlated with overall project sustainability. The therapeutic coverage achieved in each project correlated with the ratio of volunteer ivermectin distributors per population served. Surprisingly, the performance of these distributors was not affected by the direct incentives offered, and coverage appeared to be highest when cash or in-kind compensation was not given at all. Although further research is required, anecdotal evidence pointed to diverse indirect benefits for distributors-political goodwill, personal satisfaction and altruistic fulfillment. The results demonstrate that community ownership is among the important determining factors of sustainability of community-based programmes.
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Affiliation(s)
- Uche Amazigo
- World Health Organization, Ouagadougou, Burkina Faso.
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Abstract
Stigma related to chronic health conditions such as HIV/AIDS, leprosy, tuberculosis, mental illness and epilepsy is a global phenomenon with a severe impact on individuals and their families, and on the effectiveness of public health programmes. To compare stigma measurement in different disciplines, a literature review was conducted. References were obtained through a search of literature databases and through examining relevant bibliographies. Sixty-three papers were selected that addressed the issue of measurement of stigma or related constructs and that contained a sample of the instrument or items used. Five unpublished studies were also included in the review. The aspects of health-related stigma used for assessment can be grouped in five categories. First, the experience of actual discrimination and/or participation restrictions on the part of the person affected; second, attitudes towards the people affected; third, perceived or felt stigma; fourth, self or internalized stigma; and fifth, discriminatory and stigmatizing practices in (health) services, legislation, media and educational materials. Within each of these areas, different research methods have been used, including questionnaires, qualitative methods, indicators and scales. The characteristics of the instruments considered most promising are described and compared. The purpose of stigma assessment is to increase our understanding of stigma and its determinants and dynamics, to determine its extent or severity in a given setting or target group and to monitor changes in stigma over time. The conclusions from this review are that (a) the consequences of stigma are remarkably similar in different health conditions, cultures and public health programmes; (b) many instruments have been developed to assess the intensity and qualities of stigma, but often these have been condition-specific; and (c) development of generic instruments to assess health-related stigma may be possible. To achieve this aim, existing instruments should be further validated, developed or adapted for generic use, where possible.
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Affiliation(s)
- Wim H Van Brakel
- Royal Tropical Institute, Leprosy Unit, Amsterdam, The Netherlands.
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Hubley J, Gilbert C. Eye health promotion and the prevention of blindness in developing countries: critical issues. Br J Ophthalmol 2006; 90:279-84. [PMID: 16488944 PMCID: PMC1856969 DOI: 10.1136/bjo.2005.078451] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This review explores the role of health promotion in the prevention of avoidable blindness in developing countries. Using examples from eye health and other health topics from developing countries, the review demonstrates that effective eye health promotion involves a combination of three components: health education directed at behaviour change to increase adoption of prevention behaviours and uptake of services; improvements in health services such as the strengthening of patient education and increased accessibility and acceptability; and advocacy for improved political support for blindness prevention policies. Current eye health promotion activities can benefit by drawing on experiences gained by health promotion activities in other health topics especially on the use of social research and behavioural models to understand factors determining health decision making and the appropriate choice of methods and settings. The challenge ahead is to put into practice what we know does work. An expansion of advocacy-the third and most undeveloped component of health promotion-is essential to convince governments to channel increased resources to eye health promotion and the goals of Vision 2020.
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Affiliation(s)
- J Hubley
- School of Health and Community Care, Leeds Metropolitan University, 21 Arncliffe Road, Leeds LS16 5AP, UK.
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Abstract
Onchocerciasis control has been very successful in Africa and research has played a critical role. An overview of the main epidemiological and implementation research activities undertaken over the last 20 years in collaboration with the African onchocerciasis control programmes and of the impact this research had on control is given. The research included the development of epidemiological modelling and its application in programme evaluation and operational planning, research on disease patterns and disease burden in different bioclimatic zones to justify and guide control operations, community trials of ivermectin to determine its safety for large-scale use and its impact on transmission, rapid assessment methods to identify target communities for treatment and community-directed treatment for sustained drug delivery. Lessons learned during this unique collaboration between research and control are discussed.
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Affiliation(s)
- Jan H F Remme
- Intervention Development and Implementation Research, UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland.
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Tielsch JM, Beeche A. Impact of ivermectin on illness and disability associated with onchocerciasis. Trop Med Int Health 2004; 9:A45-56. [PMID: 15078278 DOI: 10.1111/j.1365-3156.2004.01213.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The Onchocerciasis Control Program (OCP), one of the most successful vertical disease control programs in the history of public health, came to an end in 2003 with devolvement of responsibilities for control program activities passed to the countries affected. Fortunately, 15 years ago the Mectizan Distribution Program (MDP) was founded to provide a complementary approach to controlling the disabling consequences of this parasitic infection. With over 250 million doses of ivermectin distributed over the past 15 years, the MDP is well on its way to both solidifying the progress made by the OCP and extending program reach well beyond the boundaries of the OCP. Through the extensive clinical testing protocols implemented in a variety of countries in Aftica, ivermectin has been proven to be a safe and highly effective treatment for onchocerciasis. Regular distribution to populations living in endemic areas has demonstrated significant reductions in blinding ocular complications, transmission, and disability caused by onchocercal skin disease. As yet undocumented, are the likely significant impact regular population dosing with ivermectin has on intestinal helminth infections, lymphatic filariasis, and human scabies infection. While there are significant barriers to continued program success, focussed attention on expanding and improving community-directed ivermectin distribution is likely to lead to further progress against this resilient infection.
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Affiliation(s)
- James M Tielsch
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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Kipp W, Bamuhiiga J, Rubaale T. Simulium neavei-transmitted onchocerciasis: HIV infection increases severity of onchocercal skin disease in a small sample of patients. Trans R Soc Trop Med Hyg 2003; 97:310-1. [PMID: 15228250 DOI: 10.1016/s0035-9203(03)90157-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Onchocercal skin disease was measured in 72 onchocerciasis patients from western Uganda, where Simulium neavei is the main transmitting vector of Onchocerca volvulus. The onchocerciasis patients who were HIV-positive had a higher onchocercal skin score compared with those who were HIV-negative (33.7 vs. 19.4, P < 0.001).
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Affiliation(s)
- Walter Kipp
- Department of Public Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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Murdoch ME, Asuzu MC, Hagan M, Makunde WH, Ngoumou P, Ogbuagu KF, Okello D, Ozoh G, Remme J. Onchocerciasis: the clinical and epidemiological burden of skin disease in Africa. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2002; 96:283-96. [PMID: 12061975 DOI: 10.1179/000349802125000826] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
An attempt was made to assess the true public-health importance of onchocercal skin disease throughout the African region and hence provide an objective basis for the rational planning of onchocerciasis control in the area. The seven collaborative centres that participated in the study (three in Nigeria and one each in Ghana, Cameroon, Tanzania and Uganda) were all in areas of rainforest or savannah-forest mosaic where onchocercal blindness is not common. A cross-sectional dermatological survey was undertaken at each site following a standard protocol. At each site, the aim was to examine at least 750 individuals aged 5 years and living in highly endemic communities and 220-250 individuals aged 5 years and living in a hypo-endemic (control) community. Overall, there were 5459 and 1451 subjects from hyper-and hypo-endemic communities, respectively. In the highly endemic communities, the prevalence of itching increased with age until 20 years and then plateaued, affecting 42% of the population aged 20 years. There was a strong correlation between the prevalence of itching and the level of endemicity (as measured by the prevalence of nodules; r=0.75; P<0.001). The results of a multivariate logistic regression analysis showed that, at the individual level, the presence of onchocercal reactive skin lesions (acute papular onchodermatitis, chronic papular onchodermatitis and/or lichenified onchodermatitis) was the most important risk factor for pruritus, with an odds ratio (OR) of 18.3 and 95% confidence interval (CI) of 15.19-22.04, followed by the presence of palpable onchocercal nodules (OR=4.63; CI=4.05-5.29). In contrast, non-onchocercal skin disease contributed very little to pruritus in the study communities (OR=1.29; CI=1.1-1.51). Onchocercal skin lesions affected 28% of the population in the endemic villages. The commonest type was chronic papular onchodermatitis (13%), followed by depigmentation (10%) and acute papular onchodermatitis (7%). The highest correlation with endemicity was seen for the prevalence of any onchocercal skin lesion and/or pruritus combined (r=0.8; P<0.001). Cutaneous onchocerciasis was found to be a common problem in many endemic areas in Africa which do not have high levels of onchocercal blindness. These findings, together with recent observations that onchocercal skin disease can have major, adverse, psycho-social and socio-economic effects, justify the inclusion of regions with onchocercal skin disease in control programmes based on ivermectin distribution. On the basis of these findings, the World Health Organization launched a control programme for onchocerciasis, the African Programme for Onchocerciasis Control (APOC), that covers 17 endemic countries in Africa.
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Affiliation(s)
- M E Murdoch
- Department of Biology, Imperial College of Science, Technology and Medicine, Prince Consort Road, London SW7 2BB, UK.
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Clemmons L, Amazigo UV, Bissek AC, Noma M, Oyene U, Ekpo U, Msuya-Mpanju J, Katenga S, Sékétéli A. Gender issues in the community-directed treatment with ivermectin (CDTI) of the African Programme for Onchocerciasis Control (APOC). ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2002; 96 Suppl 1:S59-74. [PMID: 12081252 DOI: 10.1179/000349802125000655] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This paper reviews the issues relating to compliance and participation among the men and women of three countries within the remit of the African Programme for the Control of Onchocerciasis (APOC): Cameroon, Nigeria and Tanzania. Project-monitoring data from 109 focus-group discussions, 6069 household-survey respondents and 89 interviews with ivermectin distributors were analysed to gain an insight into the attitudes and behaviours of men and women in relation to ivermectin treatment and their participation in the programme. Although there are no statistically significant gender differences in coverages for ivermectin treatment, culturally prescribed gender relationships influence the ways in which men and women express and experience treatment-related behaviours. Gender roles also affect participation in the programme. Decision-making in communities on the selection of distributors tends to follow socio-cultural hierarchies based upon patriarchy and gerontocracy. Relatively few ivermectin distributors (21%) are women. Although they receive less support than their male counterparts, the female distributors are just as willing to continue ivermectin distribution in the community, and they perform as well or better than men in this regard. The terms 'community-directed', 'community participation' and even 'compliance' obfuscate important gender differences that are inherent in the implementation of onchocerciasis control. Development of strategies that recognize these gender differences will have important implications for long-term adherence to treatment and for the overall quality and sustainability of the programme.
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Affiliation(s)
- L Clemmons
- Department of Anthropology, University of Pennsylvania, Philadelphia 19104, USA
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Sékétéli A, Adeoye G, Eyamba A, Nnoruka E, Drameh P, Amazigo UV, Noma M, Agboton F, Aholou Y, Kale OO, Dadzie KY. The achievements and challenges of the African Programme for Onchocerciasis Control (APOC). ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2002; 96 Suppl 1:S15-28. [PMID: 12081247 DOI: 10.1179/000349802125000628] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The main strategy of APOC, of community-directed treatment with ivermectin (CDTI), has enabled the programme to reach, empower and bring relief to remote and under-served, onchocerciasis-endemic communities. With CDTI, geographical and therapeutic coverages have increased substantially, in most areas, to the levels required to eliminate onchocerciasis as a public-health problem. Over 20 million people received treatment in 2000. APOC has also made effective use of the combination of the rapid epidemiological mapping of onchocerciasis (REMO) and geographical information systems (GIS), to provide information on the geographical distribution and prevalence of the disease. This has led to improvements in the identification of CDTI-priority areas, and in the estimates of the numbers of people to be treated. A unique public-private-sector partnership has been at the heart of APOC's relative success. Through efficient capacity-building, the programme's operations have positively influenced and strengthened the health services of participating countries. These laudable achievements notwithstanding, APOC faces many challenges during the second phase of its operations, when the full impact of the programme is expected to be felt. Notable among these challenges are the sustainability of CDTI, the strategy's effective integration into the healthcare system, and the full exploitation of its potential as an entry point for other health programmes. The channels created for CDTI, could, for example, help efforts to eliminate lymphatic filariasis (which will feature on the agenda of many participating countries during APOC's Phase 2). However, these other programmes need to be executed without compromising the onchocerciasis-control programme itself. Success in meeting these challenges will depend on the continued, wholehearted commitment of all the partners involved, particularly that of the governments of the participating countries.
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Affiliation(s)
- A Sékétéli
- African Programme for Onchocerciasis Control (APOC), Ouagadougou, Burkina Faso.
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Brieger WR, Kale OO, Ososanya OO. Development of reactive onchocercal skin lesions during a placebo-controlled trial with ivermectin among persons without lesions at baseline. Trop Doct 2001; 31:96-8. [PMID: 11321284 DOI: 10.1177/004947550103100214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical trials of the effects of ivermectin on onchocercal skin disease have documented reduction in itching, but a less than clear benefit on reactive skin lesions. It has been suggested that one of the positive effects might be the prevention of new lesions. A study among a rural adult farming population in southwestern Nigeria provided ivermectin in three treatment groups and a placebo to community members who were examined and treated at 3-monthly intervals over a 15-month period. Among the 1206 people recruited for the study, 627 (52%) had no lesions at baseline examination. Atotal of 291 participants without baseline lesions attended all five follow-up examinations, and only their results were analysed. Members of all four groups developed new lesions, but those receiving ivermectin had a consistently lower proportion of lesions than the placebo group. This difference reached statistical significance at the 5% level in three of the five periods and was below the 10% level at the other two periods. These findings are suggestive of an inhibiting effect of ivermectin among those without lesions at the beginning of a community treatment programme, and justify community treatment as a way of limiting morbidity and social stigma associated with these lesions.
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Affiliation(s)
- W R Brieger
- Department of Preventive and Social Medicine, University of Ibadan, Nigeria.
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Vlassoff C, Weiss M, Ovuga EB, Eneanya C, Nwel PT, Babalola SS, Awedoba AK, Theophilus B, Cofie P, Shetabi P. Gender and the stigma of onchocercal skin disease in Africa. Soc Sci Med 2000; 50:1353-68. [PMID: 10741573 DOI: 10.1016/s0277-9536(99)00389-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This paper reports results from a multicenter study of gender differences in the stigma associated with onchocercal skin disease (OSD) in five African sites: Cameroon, Ghana, Nigeria (Awka and Ibadan) and Uganda. The studies used a common protocol to compare affected and unaffected respondents, that is, men and women with onchodermatitis in highly endemic areas and respondents from communities with low endemicity or no onchocerciasis. The methods were both quantitative and qualitative, allowing for the comparison of stigma scores and people's verbal descriptions of their experiences and attitudes. Questions to the unaffected were asked after providing them with photographs and short descriptions (vignettes) depicting typical cases. We found that stigma was expressed more openly by the unaffected, who perceived OSD as something foreign or removed from themselves, whereas the affected tended to deny that they experienced stigma as a result of the condition. Gender differences in stigma scores were not significantly different for men and women, but qualitative data revealed that stigma was experienced differently by men and women, and that men and women were affected by it in distinctive ways. Men were more concerned about the impact of the disease on sexual performance and economic prospects, whereas women expressed more concern about physical appearance and life chances, especially marriage. Similar trends were found in the different sites in the responses of affected and unaffected respondents, and differences between them, despite geographical and cultural variations.
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Affiliation(s)
- C Vlassoff
- Policy Branch, Canadian International Development Agency, Hull, Que.
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Brieger WR, Awedoba AK, Eneanya CI, Hagan M, Ogbuagu KF, Okello DO, Ososanya OO, Ovuga EB, Noma M, Kale OO, Burnham GM, Remme JH. The effects of ivermectin on onchocercal skin disease and severe itching: results of a multicentre trial. Trop Med Int Health 1998; 3:951-61. [PMID: 9892280 DOI: 10.1046/j.1365-3156.1998.00339.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effects of ivermectin in annual, 3-monthly and 6-monthly doses on onchocercal skin p6isease (OSD) and severe itching. METHOD A multicentre, double-blind placebo controlled trial was conducted among 4072 residents of rural communities in Ghana, Nigeria and Uganda. Baseline clinical examination categorized reactive skin lesions as acute papular onchodermatitis, chronic papular onchodermatitis and lichenified onchodermatitis. Presence and severity of itching was determined by open-ended and probing questions. Clinical examination and interview took place at baseline and each of 5 subsequent 3-monthly follow-up visits. RESULTS While prevalence and severity of reactive lesions decreased for all 4 arms, those receiving ivermectin maintained a greater decrease in prevalence and severity over time. The difference between ivermectin and placebo groups was significant for prevalence at 9 months and for severity at 3 months. Differences between placebo and ivermectin groups were much more pronounced for itching. From 6 months onward, the prevalence of severe itching was reduced by 40-50% among those receiving ivermectin compared to the trend in the placebo group. CONCLUSION This is an important effect on disease burden as severe itching is for the affected people the most troubling complication of onchocerciasis. The difference among regimens was not significant, and the recommended regimen of annual treatment for the control of ocular onchocerciasis appears also the most appropriate for onchocerciasis control in areas where the skin manifestations predominate. The final determination of the effect on skin lesions requires a longer period of study.
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Affiliation(s)
- W R Brieger
- Department of Preventive and Social Medicine, University of Ibadan, Nigeria
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