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McCollum R, Barrett C, Zawolo G, Johnstone R, Godwin-Akpan TG, Berrian H, Chowdhury S, Kollie J, Kollie K, Rogers E, Parker C, Phillip M, Sempe L, Seekles M, Smith JS, Seekey W, Wickenden A, Zaizay Z, Theobald S, Dean L. 'The Lost Peace': Evidencing the Syndemic Relationship between Neglected Tropical Diseases and Mental Distress in Liberia. Trop Med Infect Dis 2024; 9:183. [PMID: 39195621 PMCID: PMC11359536 DOI: 10.3390/tropicalmed9080183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/12/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024] Open
Abstract
Neglected Tropical Diseases (NTDs) are a group of chronic infectious diseases of poverty affecting over one billion people globally. Intersections of NTDs, disability, and mental ill-health are increasingly evidenced but are rarely studied from a mixed-methods perspective. Here, we advance syndemic understandings by further assessing and contextualising the syndemic relationship between NTDs (particularly their associated disability) and mental distress in Liberia. Participatory qualitative methods, including body mapping (56 participants), social mapping (28 participants), and in-depth interviews (12) provided space for persons affected by NTDs to narrate their experiences. Simultaneously, 201 surveys explored experiences of common mental health conditions among persons affected by skin NTDs. An intersectionality approach was applied within the analysis for both qualitative and quantitative methods informed by Meyer's minority stress model, adapted for NTDs. Qualitative data was analysed thematically and gender-disaggregated, univariable and multivariable analyses were applied to survey data for the outcome measures depression (PHQ-9) and anxiety (GAD-7). Disability was associated with higher levels of depression and anxiety (p < 0.001). An interaction between disability and being a women increased incidence risk ratio of depression (p < 0.001). In alignment with qualitative findings, persons affected experienced additional generalised (financial concerns), external (experience of stigma) and internal (experience of pain and physical symptoms) minority stressors, to varying degrees, which contributed towards their mental distress, and mental health conditions. These findings were used to co-develop a syndemic-informed person-centred health system response to address the suffering associated with NTDs and mental distress, including a focus on strengthening relationships between formal and informal community health actors and the broader health system.
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Affiliation(s)
- Rosalind McCollum
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Carrie Barrett
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Georgina Zawolo
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia 1000, Liberia
| | - Rachel Johnstone
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | | | - Hannah Berrian
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia 1000, Liberia
| | - Shahreen Chowdhury
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Jerry Kollie
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia 1000, Liberia
| | - Karsor Kollie
- Department of Health Services, Ministry of Health-Liberia, Congo Town Back Road, Monrovia 1000, Liberia
| | - Emerson Rogers
- Department of Health Services, Ministry of Health-Liberia, Congo Town Back Road, Monrovia 1000, Liberia
| | - Colleen Parker
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia 1000, Liberia
| | - Maneesh Phillip
- International Programs Department, Effect Hope, 200-90 Allstate Pkwy, Markham, ON L3R 6H3, Canada
| | - Lucas Sempe
- The Institute for Global Health and Development Division, Queen Margaret University, Edinburgh EH21 6UU, UK
| | - Maaike Seekles
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - John Solunta Smith
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia 1000, Liberia
| | - Wede Seekey
- Pacific Institute for Research and Evaluation, University of Liberia, Monrovia 1000, Liberia
| | - Anna Wickenden
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
- International Programs Department, Effect Hope, 200-90 Allstate Pkwy, Markham, ON L3R 6H3, Canada
| | - Zeela Zaizay
- Action Transforming Lives, Congo Town Backroad, Monrovia 1000, Liberia
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK
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Barrett C, Chiphwanya J, Matipula DE, Douglass J, Kelly-Hope LA, Dean L. Addressing the Syndemic Relationship between Lymphatic Filariasis and Mental Distress in Malawi: The Potential of Enhanced Self-Care. Trop Med Infect Dis 2024; 9:172. [PMID: 39195610 PMCID: PMC11360657 DOI: 10.3390/tropicalmed9080172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
Lymphatic filariasis (LF) causes disfiguring and disabling lymphoedema, which can lead to mental distress and requires life-long self-care treatment. This study applies syndemic theory to understand the biosocial relationship between LF and mental distress in Malawi. Using in-depth qualitative methods, we critically evaluate experiences of mental distress and LF through 21 life-history interviews, to narrate experiences from the perspective of persons affected by LF, and to understand how enhanced self-care (ESC) for lymphoedema management disrupts the syndemic relationship. Complementary key informant interviews with Ministry of Health LF programme staff were conducted to further understand intervention and health system delivery. All interviews were recorded, transcribed, and translated, and then subject to thematic analysis. Our findings suggest that for persons affected by LF in Malawi, before being trained in ESC, absent referral pathways, inequalities in healthcare provision or available treatment, and limited knowledge of the condition (LF) drove the syndemic of LF and mental distress. Distress was often exacerbated by stigma and social exclusion, and shaped by intersections of gender, generation, poverty, and extreme climate conditions. We argue that addressing the syndemic suffering associated with LF and mental distress through interventions which center the needs of persons affected is critical in effective and equitable LF care delivery.
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Affiliation(s)
- Carrie Barrett
- Centre for Neglected Tropical Disease, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - John Chiphwanya
- National Lymphatic Filariasis Elimination Programme, Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi
| | - Dorothy E. Matipula
- National Lymphatic Filariasis Elimination Programme, Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi
| | - Janet Douglass
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, 1 James Cook Drive, Douglas, QLD 4811, Australia
| | - Louise A. Kelly-Hope
- Centre for Neglected Tropical Disease, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, 146 Brownlow Hill, Liverpool L3 5RF, UK
| | - Laura Dean
- Centre for Neglected Tropical Disease, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Dean L, Eaton J. People, power and participation: strategic directions for integrated person-centred care for NTDs and mental health. Int Health 2024; 16:i1-i4. [PMID: 38547347 PMCID: PMC10977956 DOI: 10.1093/inthealth/ihae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Julian Eaton
- Community Mental Health, CBM Global, Cambridge, UK
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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