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Schurer JM, Bayisenge U, Hakizimana D, Rafferty E. 'My feet cannot stand on their own': podoconiosis patient healthcare expenditures and income impacts in Rwanda. Trans R Soc Trop Med Hyg 2024:trae006. [PMID: 38456460 DOI: 10.1093/trstmh/trae006] [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: 10/03/2023] [Revised: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Podoconiosis is a progressive and debilitating form of tropical lymphoedema endemic to Rwanda. Although the physical and psychological consequences are well known, few studies have evaluated the financial burden of podoconiosis. METHODS This cross-sectional, quantitative study aimed to characterize direct treatment costs and impacts on annual earnings among individuals living with podoconiosis. Participants from two highly endemic districts were invited to complete a survey focused on health-seeking history, insurance status, out-of-pocket costs and income changes. Direct treatment costs included medical expenditures (consultation, diagnostics, medication) and non-medical expenditures (food, transportation, accommodation). RESULTS Overall, 226 adults (≥18 y of age) diagnosed with podoconiosis participated. Most had access to community-based health insurance (91.6%) but were unable to work (71.7%). Respondents sought care from health centres/posts (61.9%), hospitals (25.1%), traditional healers (5.8%) and/or community health workers (4.0%). On average, study participants paid US$32.50 (range US$0-779.23) annually, or 11.7% of their household salary, on podoconiosis treatments. CONCLUSIONS This study demonstrates the significant financial burden of podoconiosis on individuals and their communities. Increased attention on integrating podoconiosis management into primary care systems and testing cost-effective solutions is needed to protect those who are most vulnerable.
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Affiliation(s)
- Janna M Schurer
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
- Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA
| | - Ursin Bayisenge
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Dieudonne Hakizimana
- Institute of Global Health, University of Global Health Equity, Kigali, Rwanda
- University of Washington, Department of Global Health, Seattle, WA, USA
| | - Ellen Rafferty
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Thapa DK, Dahal HR, Chaulagain DR, Karki A, Sharma N, Baral B, Nepal C, Paudel P, Thapa J. Stigma, depression and quality of life among people affected by neglected tropical diseases in Nepal. Int Health 2023; 15:iii79-iii86. [PMID: 38118156 PMCID: PMC10732665 DOI: 10.1093/inthealth/ihad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/28/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Stigma and poor mental health are important factors influencing the quality of life (QOL) of people with neglected tropical diseases (NTDs). This study examines the relationship between stigma, depression and QOL among people affected by leprosy and lymphatic filariasis (LF) in Nepal. METHODS A cross-sectional community-based survey was conducted among 102 NTD-affected persons (70 leprosy and 32 LF) using interview-administered questionnaires measuring the level of stigma (5-QSI-AP), symptoms of depression (PHQ-9) and QOL (WHOQOL-8). Three different regression models were developed, each using the ordinary least squares and Poisson regression to evaluate the association between stigma and QOL, depression and QOL, and stigma and depression. RESULTS The mean scores were 21.8±4.4 for QOL, 6.6±5.6 for depression and 3.0±2.8 for stigma. Almost 17% reported the prevalence of depression symptoms. Both stigma (β=-0.65, p<0.001) and depression (β=-0.32, p<0.001) were associated with lower scores for QOL, while there was a significant positive relationship between stigma and depression (β=0.92, p<0.001). Similar results were obtained from the Poisson regression models. CONCLUSIONS The study showed a considerable burden of depression, stigma and poor QOL among study participants with leprosy and LF in Nepal. A holistic package of care that addresses the physical, mental and psychological well-being of people with NTD is required. CONTEXTE La stigmatisation et la mauvaise santé mentale sont des facteurs importants qui influencent la qualité de vie des personnes atteintes de maladies tropicales négligées (MTN). Cette étude examine la relation entre la stigmatisation, la dépression et la qualité de vie chez les personnes atteintes de lèpre et de filariose lymphatique au Népal. MÉTHODES UTILISÉES Une enquête communautaire transversale a été menée auprès de 102 personnes atteintes de MTN (70 de la lèpre et 32 de la filariose lymphatique) à l'aide de questionnaires administrés par entretien mesurant le niveau de stigmatisation (5-QSI-AP), les symptômes de dépression (PHQ-9) et la qualité de vie (WHOQOL-8). Trois modèles de régression différents ont été développés, chacun utilisant les moindres carrés ordinaires et la régression de Poisson pour évaluer l'association entre : (i) la stigmatisation et la QV; (ii) la dépression et la QV; et (iii) la stigmatisation et la dépression. RÉSULTATS Les scores moyens étaient de 21,8±4,4 pour la QV, 6,6±5,6 pour la dépression, et 3,0±2,8 pour la stigmatisation. Près de 17% des personnes interrogées ont signalé la prévalence de symptômes dépressifs. La stigmatisation (β = -0,65, p<0 001) et la dépression (β = -0,32, p<0 001) ont été associées à des scores plus faibles pour la qualité de vie, tandis qu'il existait une relation positive significative entre la stigmatisation et la dépression (β = 0,92, p<0 001). Des résultats similaires ont été obtenus à partir des modèles de régression de Poisson. CONCLUSIONS L'étude a montré une incidence importante de dépression, de stigmatisation et d'une mauvaise qualité de vie parmi les participants atteints de lèpre et de FL au Népal. Il convient donc de mettre en place un ensemble de soins holistiques pour ces patients qui prendrait en compte le bien-être physique, mental et psychologique des personnes atteintes de MTN. ANTECEDENTES La estigmatización y la mala salud mental son factores importantes que influyen en la calidad de vida de las personas con enfermedades tropicales desatendidas. las personas con enfermedades tropicales desatendidas (ETD). Este estudio examina la relación entre el estigma, la depresión y la CdV entre las personas afectadas por lepra y lepra y la filariasis linfática en Nepal. MÉTODOS Se realizó una encuesta comunitaria transversal entre 102 personas afectadas por ETD (70 de lepra y 32 de filariasis linfática) utilizando cuestionarios entrevistas para medir el nivel de estigma (5-QSI-AP), los síntomas de depresión (PHQ- 9) y la CdV (OMS- 9). 9) y la calidad de vida (WHOQOL-8). Se desarrollaron tres modelos de regresión diferentes regresión de Poisson para evaluar la asociación entre: (i) el estigma y (ii) la depresión. entre: (i) estigma y CdV; (ii) depresión y CdV; y (iii) estigma y depresión. RESULTADOS Las puntuaciones medias fueron 21,8±4,4 para la CdV, 6,6±5,6 para la depresión y 3,0±2,8 para el estigma. Casi el 17% informó de la prevalencia de síntomas de depresión. Tanto el estigma (β = -0,65, p<0 001), como la depresión (β = -0,32, p<0 001) se asociaron con puntuaciones más bajas para la CdV, mientras que hubo una relación positiva significativa entre el estigma y la depresión (β = 0,92, p<0 001). Se obtuvieron resultados similares en los modelos de regresión de Poisson. CONCLUSIONES El estudio mostró una carga considerable de depresión, estigma y mala CdV entre los participantes del estudio con lepra y FL en Nepal. Se requiere un paquete holístico de atención que aborde el bienestar físico, mental y psicológico de las personas con ETD.
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Affiliation(s)
- Deependra K Thapa
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, INUSA
| | - Harsha R Dahal
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | | | - Anjalina Karki
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | | | | | - Chiranjibi Nepal
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | - Prakriti Paudel
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
| | - Janak Thapa
- Nepal Public Health Research and Development Center, Kathmandu, Nepal
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Nkwetta DL, Fuen BR, Yenban NF, Mbiatong N, Nchanji GT, Bonekeh J, Ndzeshang BL, Gandjui NVT, Fombad FF, Klarmann-Schulz U, Esum ME, Njouendou AJ, Cho JF, Hoerauf A, Ritter M, Wanji S. Phenotypical characterization, and antibiotics susceptibility patterns of skin bacteria found in podoconiosis patients in the North West Region of Cameroon. BMC Microbiol 2023; 23:189. [PMID: 37460950 PMCID: PMC10351198 DOI: 10.1186/s12866-023-02923-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Podoconiosis, a non-infectious disease originating from long-term exposure of bare feet to irritant red clay soil is a lifelong, disabling disease with no specific diagnostic tool, classified into 5 stages based on the severity of leg swelling (lymphoedema). Secondary bacterial infections have been suggested to cause acute dermatolymphangioadenitis (ADLA) attacks and drive disease progression. Although the North West Region of Cameroon has a proven history of podoconiosis endemicity, the bacterial composition of lymphoedema due to this condition has not been studied. Thus, this study investigated the leg bacterial diversity of patients who suffered from the lymphoedema and their susceptibility pattern to selected antibiotics. METHODS A cross-sectional study was carried out in which podoconiosis affected and non-lymphoedema individuals living in the same community were purposively selected. Samples were collected by swabbing the skin between the toes and around the anklebone, then cultured and sub-cultured on nutrient agar to obtain pure isolates. The cultured isolates were then morphologically and biochemically classified using microscopy and analytic profile index test kits, respectively. The disk diffusion technique was used to determine antibiotic susceptibility. RESULTS Thirty-three participants were recruited, and 249 bacterial isolates were characterized into 29 genera, 60 species; with 30 (50%) being gram positive rods, 19 (31.7%) gram positive cocci, and 11 (18.3%) gram negative rods. Thirteen gram positive rods, fifteen gram positive cocci, and eight gram negative rods of bacterial species were found only in podoconiosis individuals among which Cellulomonas spp / Microbacterium spp. (2.8%), Staphylococcus lentus (3.3%), and Burkholderia cepacia (4.0%) dominated. 90% (90%) of the bacterial isolates were sensitive to doxycycline, whereas ampicillin had a high level of intermediate resistance, and penicillin G had the greatest resistant profile. CONCLUSION Our findings show that 94 (37.8%) out of 249 described bacterial isolates were exclusively found in the legs of podoconiosis individuals, and their susceptibility pattern to antibiotics was similar to that of others.
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Affiliation(s)
- Derick Lekealem Nkwetta
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Bangsi Rose Fuen
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Njodzeka Flora Yenban
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Nancielle Mbiatong
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Gordon Takop Nchanji
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - John Bonekeh
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Bertrand Lontum Ndzeshang
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Narcisse Victor Tchamatchoua Gandjui
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
| | - Fanny Fri Fombad
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Ute Klarmann-Schulz
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
- German Centre for Infection Research (DZIF), Neglected Tropical Disease, partner site, Bonn- Cologne, Bonn, Germany
| | - Mathias Eyong Esum
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
| | - Abdel Jelil Njouendou
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
- Department of Biomedical Sciences, University of Buea, P.O. Box 63, Buea, Cameroon
| | - Jerome Fru Cho
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon
| | - Achim Hoerauf
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
- German-West African Centre for Global Health and Pandemic Prevention (G-WAC), Partner Site, Bonn, Bonn, Germany
| | - Manuel Ritter
- Institute for Medical Microbiology, Immunology and Parasitology (IMMIP), University Hospital Bonn (UKB), Bonn, Germany
| | - Samuel Wanji
- Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon.
- Research Foundation for Tropical Diseases and the Environment (REFOTDE), P.O. Box 474, Buea, Cameroon.
- The Peoples' Hope Medical Care Centre (PHOMECC), Bamenda, Cameroon.
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Nuwangi H, Agampodi TC, Price HP, Shepherd T, Weerakoon KG, Agampodi SB. The stigma associated with cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL): A protocol for a systematic review. PLoS One 2023; 18:e0285663. [PMID: 37167276 PMCID: PMC10174477 DOI: 10.1371/journal.pone.0285663] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 03/29/2023] [Indexed: 05/13/2023] Open
Abstract
Leishmaniasis is a neglected tropical disease with three main clinical types; cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL), and visceral leishmaniasis (VL). CL and MCL are considered to be highly stigmatizing due to potentially disfiguring skin pathology. CL and MCL-associated stigma are reported across the world in different contexts assimilating different definitions and interpretations. Stigma affects people with CL, particularly in terms of quality of life, accessibility to treatment, and psycho-social well-being. However, evidence on CL- and MCL-associated stigma is dispersed and yet to be synthesized. This systematic review describes the types, measurements, and implications of the stigma associated with CL and MCL and identifies any preventive strategies/interventions adopted to address the condition. This study was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement which is registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols PROSPERO (ID- CRD42021274925). We will perform an electronic search in MEDLINE, Embase, Scopus, PubMed, EBSCO, Web of Science, Global Index Medicus, Trip, and Cochrane Library databases, and in Google Scholar, using a customized search string. Any article that discusses any type of CL- and/or MCL-associated stigma in English, Spanish and Portuguese will be included. Articles targeting veterinary studies, sandfly vector studies, laboratory-based research and trials, articles focusing only on visceral leishmaniasis, and articles on diagnostic or treatment methods for CL and MCL will be excluded. Screening for titles and abstracts and full articles and data extraction will be conducted by two investigators. The risk of bias will be assessed through specific tools for different study types. A narrative synthesis of evidence will then follow. This review will identify the knowledge gap in CL-associated stigma and will help plan future interventions.
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Affiliation(s)
- Hasara Nuwangi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Thilini Chanchala Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Helen Philippa Price
- School of Life Sciences, Keele University, Newcastle-under-Lyme, Staffordshire, United Kingdom
| | - Thomas Shepherd
- School of Medicine, Keele University, Newcastle-under-Lyme, Staffordshire, United Kingdom
| | - Kosala Gayan Weerakoon
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Suneth Buddhika Agampodi
- Department of Internal Medicine, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, United States of America
- International Vaccine Institute, Seoul, Republic of Korea
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Abebaw A, Atnafu A, Worku N, Hagos A. Health-related quality of life and associated factors among adult podoconiosis patients in Debre Elias district Northwest, Ethiopia. PLoS Negl Trop Dis 2022; 16:e0010673. [PMID: 36054193 PMCID: PMC9477424 DOI: 10.1371/journal.pntd.0010673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/15/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Podoconiosis is endemic non-filarial elephantiasis and non-infective neglected tropical disease. It has a wide impact on the physical, social and psychological aspects of the well-being of a person. However, limited information is available about the disease burden on health-related quality of life and associated factors in Ethiopia. Objective This study aimed is to determine health-related quality of life and associated factors among adult podoconiosis patients in Debre Elias district, Northwest, Ethiopia. Methods A community-based cross-sectional study was conducted from February 1 to March 30, 2020 in the Debre Elias district. A multi-stage stratified; systematic random sampling technique was employed to select 403 podoconiosis patients. The data were collected through an interviewer-administered questionnaire. Data were entered into Epi data version 4.6 and exported to STATA version 14 for analysis. After the assumption check for the linear regression model, simple and multiple regression was done to see the association between the predictor and outcome variables. Predictor variables that had p-value <0.2 at simple linear regression were taken into multiple linear regression. β coefficient with 95% CI and p-value of <0.05 was considered as statistically significant variables in multiple linear regression analysis. Result The overall mean quality of life score among podoconiosis patients was 61.93±17.14. The mean quality of life score for the physical, psychological, social, and environmental domains were 75.57±21.86, 60.43±18.58, 30.34±10.46, and 81.38±22.77 respectively. Foot care had a statically significant association with all domains. Higher quality of life podoconiosis patients was associated with foot care. Lower quality of life was associated with the presence of anxiety, advanced stage of the disease, and frequent adenolymphangitis attack. Conclusion Social and psychological domains of quality of life were lowest as compared to physical and environmental domains of quality of life. Early medical treatment, psychosocial support, and home-based foot care should be encouraged to improve the quality of life in podoconiosis patients. Podoconiosis: is a disease that affects the lymph vessels of the lower extremities and is caused by a person’s foot exposed to minerals found in red clay soil. Podoconiosis has been identified in 32 countries and globally 4 million people are affected with this disease. The disease is characterized by prominent swelling) of the lower extremities, it can be prevented through keeping good foot hygiene, wearing clean socks and shoes daily and covering floor in the home to avoid contact with irritant soil. Patients with podoconiosis significantly challenged by physical disability, poor mental health and social discrimination. This study identified quality of life and associated factors among adult podoconiosis patients in Debre Elias district Northwest, Ethiopia. Specifically, we addressed quality of life score for physical, psychological, social and environmental domain. We found from this study foot care had statically significant association with all domains. Lower quality of life was associated with presence of anxiety, advanced stage of the disease and frequent adenolymphangitis attack. Social and psychological domains of quality of life were lowest as compared to physical and environmental domains of quality of life. Therefore, this study encouraged early medical treatment, home-based foot care and psychosocial support to improve quality of life in podoconiosis patient.
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Affiliation(s)
- Abraham Abebaw
- Debre Elias district health office, East Gojjam Zone, Amhara Regional National State, Bahir Dar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nigusu Worku
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asebe Hagos
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
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An analysis of social dimensions of podoconiosis and leprosy on affected households in endemic health districts of the North West Region of Cameroon. SSM Popul Health 2022; 19:101187. [PMID: 36016588 PMCID: PMC9396218 DOI: 10.1016/j.ssmph.2022.101187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Background Podoconiosis and leprosy are Neglected Tropical Diseases associated with low quality of life, social stigma and isolation of affected people and families. Despite the substantial social burden it imposes, podoconiosis has largely been ignored in the global health literature until recently unlike leprosy. This study assessed and compared the quality of life and social impact of podoconiosis with that of leprosy among affected households and neighborhoods in North West Cameroon. Methods A comparative cross-sectional design was used. Eighty-six households: 43 podoconiosis and 43 leprosy, plus household neighbours were enrolled from July and August 2015 from three health districts. Podoconiosis patients living in households within Batibo and Ndop health districts were sequentially sampled using a list of confirmed podoconioisis cases from previous studies. Leprosy patients living within communities in Mejang Health Area were sequentially sampled using the Mbingo treatment center register. WHO BREF tool was used to assess quality of life. Franklin Stigma Scale was adapted to assess felt and enacted stigma. Mann-Whitney U test was used to compare differences in stigma and QoL. Results Physical domain showed a significant difference in the distribution in quality of life between groups (p < 0.05, median:70; U:635, r = 0.2). Overall enacted stigma revealed significant differences with p < 0.05 and r = 0.4. Overall stigma from family members (median:17, U:627 and r = 0.3) and neighbours (median:67, U:336 and r = 0.5) showed significant differences with p < 0.05 in the distribution of scores for both diseases. Sex and age showed significant associations with QoL and stigma. Conclusion This study reveals the quality of life and stigma associated with podoconiosis on affected households to be comparable to that experienced by households with a leprosy patient. There is need for intensified preventive, management and control schemes to fight podoconiosis in Cameroon, just like leprosy. Podoconiosis and leprosy are NTDs linked with low quality of life, stigma and isolation of affected people and families. The social consequences include difficulties in finding employment, gaining education and getting married. Podoconiosis impairs similar social burden on its victims like leprosy, yet remains neglected in Cameroon unlike leprosy. This disparity in attention may be due to lack of evidence on the social impact of Podoconiosis likened to leprosy. This paper creates scientific basis on the social effects of Podoconiosis in Cameroon to inform health policy actions.
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Ali O, Kinfe M, Semrau M, Tora A, Tesfaye A, Mengiste A, Davey G, Fekadu A. A qualitative study on the implementation of a holistic care package for control and management of lymphoedema: experience from a pilot intervention in northern Ethiopia. BMC Health Serv Res 2021; 21:1065. [PMID: 34625080 PMCID: PMC8501530 DOI: 10.1186/s12913-021-07088-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 09/21/2021] [Indexed: 01/02/2023] Open
Abstract
Background Neglected Tropical Diseases (NTDs) such as podoconiosis, lymphatic filariasis (LF) and leprosy mainly affect communities in low resource settings. These diseases are associated with physical disability due to lymphoedema as well as poor mental health and psychosocial outcomes. Integration of care across these NTDs at primary health care level, which includes mental health and psychosocial care alongside physical health care, is increasingly recommended. Methods A holistic integrated care package was developed and piloted as part of the EnDPoINT project in Gusha district, Awi zone, Ethiopia. The intervention was conducted at the health care organization, health facility and community levels. To assess the impact of the care package in terms of acceptability, scalability, sustainability and barriers to implementation, a qualitative study was conducted in January 2020. This included four focus group discussions (29 participants) and ten key informant interviews with decision makers, health professionals, patients, and community representatives. Results The integrated lymphoedema care package was found to be efficient compared to vertical programs in saving time and resources. It also resulted in improved awareness of the causes, treatment and prevention of lymphoedema, in marked improvements in the lymphoedema, and in reduced stigma and discrimination. The care package was found to be acceptable to patients, health professionals and decision makers. The barriers to integrated care were unrealistic patient expectations, inadequate dissemination across health workers, and poor transportation access. Health professionals, decision makers and patients believed the integrated lymphoedema care package to be scalable and sustainable. Conclusion The integrated holistic care package was found to be acceptable to patients, health professionals and decision makers. We recommend its scale-up to other endemic districts. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07088-7.
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Affiliation(s)
- Oumer Ali
- CDT-Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. .,Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, University of Sussex, Brighton, BN1 9PX, UK.
| | - Mersha Kinfe
- CDT-Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maya Semrau
- Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, University of Sussex, Brighton, BN1 9PX, UK
| | - Abebayehu Tora
- CDT-Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Sociology, Wolaita Sodo University, Sodo, Ethiopia
| | - Abraham Tesfaye
- CDT-Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Asrat Mengiste
- CDT-Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, University of Sussex, Brighton, BN1 9PX, UK.,College of Health Sciences, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- CDT-Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.,Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, University of Sussex, Brighton, BN1 9PX, UK
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8
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Deribe K, Negussu N, Newport MJ, Davey G, Turner HC. The health and economic burden of podoconiosis in Ethiopia. Trans R Soc Trop Med Hyg 2021; 114:284-292. [PMID: 32055853 PMCID: PMC7139123 DOI: 10.1093/trstmh/traa003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/31/2019] [Accepted: 01/10/2019] [Indexed: 12/11/2022] Open
Abstract
Background Podoconiosis is one of the leading causes of lymphoedema-related morbidity in low-income settings, but little is known about the scale of its health and economic impact. This information is required to inform control programme planning and policy. In this study, we estimated the health and economic burden of podoconiosis in Ethiopia. Methods We developed a model to estimate the health burden attributed to podoconiosis in terms of the number of disability-adjusted life years (DALYs) and the economic burden. We estimated the economic burden by quantifying the treatment and morbidity-management costs incurred by the healthcare system in managing clinical cases, patients' out-of-pocket costs and their productivity costs. Results In 2017, there were 1.5 million cases of podoconiosis in Ethiopia, which corresponds to 172 073 DALYs or 182 per 100 000 people. The total economic burden of podoconiosis in Ethiopia is estimated to be US$213.2 million annually and 91.1% of this resulted from productivity costs. The average economic burden per podoconiosis case was US$136.9. Conclusions The national cost of podoconiosis is formidable. If control measures are scaled up and the morbidity burden reduced, this will lead to Ethiopia saving millions of dollars. Our estimates provide important benchmark economic costs to programme planners, policymakers and donors for resource allocation and priority setting.
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Affiliation(s)
- Kebede Deribe
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.,School of Public Health, College of Health Sciences, Addis Ababa University, P.O.Box 9086, Addis Ababa, Ethiopia
| | - Nebiyu Negussu
- Federal Ministry of Health, P.O.Box 1234, Addis Ababa, Ethiopia
| | - Melanie J Newport
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK
| | - Gail Davey
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, BN1 9PX, UK.,School of Public Health, College of Health Sciences, Addis Ababa University, P.O.Box 9086, Addis Ababa, Ethiopia
| | - Hugo C Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, OX3 7LG, Oxford, UK.,Oxford University Clinical Research Unit, Wellcome Africa Asia Programme, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam
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9
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Kuper H. Disability, mental health, stigma and discrimination and neglected tropical diseases. Trans R Soc Trop Med Hyg 2021; 115:145-146. [PMID: 33313930 PMCID: PMC7842108 DOI: 10.1093/trstmh/traa160] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 01/14/2023] Open
Abstract
The neglected tropical disease (NTD) agenda should include a focus on disability when ‘planning for the next decade of progress’. Millions of people are currently living with the disabling consequences of NTDs and mental health conditions are frequent among people living with NTDs. Stigma around NTDs is also common. However, these aspects of NTDs are often ignored by programmes that focus on infectious disease control. NTD programmes must broaden in scope to include provision of rehabilitation and linkages to mental health support and tackling stigma through demystifying NTDs. These efforts will promote the inclusion and well-being of people living with NTDs.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, London, UK
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10
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Berhe B, Legese H, Mardu F, Tesfay K, Adhanom G, Kahsay T, Belay G, Negash H. Epidemiology and sex differences of podoconiosis in Ethiopia: A systemic review and meta-analysis. Heliyon 2021; 7:e05446. [PMID: 33981868 PMCID: PMC8082554 DOI: 10.1016/j.heliyon.2020.e05446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/10/2020] [Accepted: 11/03/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Podoconiosis is a poorly understood neglected tropical disease which results in a high socio-economic burden. In Ethiopia, despite the high prevalence, morbidity, and socio-economic impacts, little information is available about the disease. Thus, this review aimed to assess the effect of sex differences and pooled prevalence of podoconiosis in Ethiopia. STUDY SETTING Ethiopia is a country located in East Africa. METHODS Published literature on the prevalence of podoconiosis in Ethiopia was searched through MEDLINE/PubMed, Cochrane Library, Goggle scholar, and Global Health. Studies conducted in humans, open access, and met 50% threshold on the quality assessment checklist score adopted from Joanna Briggs Institute were eligible for inclusion. Data were extracted using first author, year of publication, participants' population, setting (urban/rural), study design, podoconiosis infection among males, the total number of males, podoconiosis infection among females, the total number of females, and context using Microsoft™ Excel. R statistical software version 3.6.1 was utilized to carry out the meta-analysis. The protocol of this review is registered in the PROSPERO international prospective register of systematic reviews and assigned a registration number of CRD 42020154697. RESULTS We performed heterogeneity, sensitivity, and publication bias analysis for the included articles. We identified 229 records, of which 11 studies met the inclusion criteria. The pooled prevalence of podoconiosis in Ethiopia was 6% [95% CI: 5%; 6%]. Subgroup analysis by setting indicated slightly higher prevalence in rural settings. The odds of podoconiosis infection among female is 1.15 times that of males" The effect of sex on podoconiosis was sub-grouped by study setting and the odds of females were 1.29 times at increased risk of acquiring podoconiosis than males (p < 0.01) in rural settings. CONCLUSIONS The prevalence of podoconiosis in Ethiopia is high. This review suggested that females are at higher risk of developing podoconiosis than males, particularly in rural communities which has health promotion and awareness implications regarding protective wear.
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Affiliation(s)
- Brhane Berhe
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, P.O. Box: 50, Adigrat, Ethiopia
| | - Haftom Legese
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, P.O. Box: 50, Adigrat, Ethiopia
| | - Fitsum Mardu
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, P.O. Box: 50, Adigrat, Ethiopia
| | - Kebede Tesfay
- Unit of Medical Parasitology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, P.O. Box: 50, Adigrat, Ethiopia
| | - Gebre Adhanom
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, P.O. Box: 50, Adigrat, Ethiopia
| | - Tsega Kahsay
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, P.O. Box: 50, Adigrat, Ethiopia
| | - Getachew Belay
- Unit of Clinical Chemistry, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, P.O. Box: 50, Adigrat, Ethiopia
| | - Hadush Negash
- Unit of Medical Microbiology, Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, P.O. Box: 50, Adigrat, Ethiopia
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11
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Fowler K, Wampande LN, Gebreselassie A, Bayisenge U, Uwase C, de Oliveira A, Schurer JM. 'Far from the views of decision-makers': podoconiosis instruction at medical schools across endemic countries in Africa. Trans R Soc Trop Med Hyg 2020; 114:899-907. [PMID: 33169131 DOI: 10.1093/trstmh/traa089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/04/2020] [Accepted: 08/26/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Podoconiosis is a neglected tropical disease that causes significant physical, emotional and financial suffering, especially among impoverished rural farmers. Sufficient physician training is integral to optimizing patient outcomes through timely diagnosis and appropriate management. Therefore we sought to characterize podoconiosis instruction offered to medical students in endemic African countries. METHODS We invited faculty from 170 medical schools in all podoconiosis-endemic African countries to provide information about podoconiosis inclusion in medical curricula. Surveys were available in French and English and captured podoconiosis knowledge, quantity/quality of instruction, ranking of importance relative to other diseases and barriers for improvement. Respondents voluntarily shared responses online or by telephone. RESULTS Study participants provided information about curricula at 97 medical schools across 14 countries. In total, 42.6% of schools across nine countries offered podoconiosis-specific instruction; most respondents felt that the quality (60.4%) and quantity (61.5%) of instruction was insufficient. Common barriers to sufficient training included exclusion from government curricula, prioritization according to caseload and scarce epidemiological data. CONCLUSIONS Our study demonstrates widespread neglect in podoconiosis training for physicians in endemic countries. Government support is needed to ensure curricula match the needs of health workers practicing in rural, low-income regions.
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Affiliation(s)
- Kelly Fowler
- Department of Public Health and Community Medicine, Tufts University, Boston, USA
| | | | | | - Ursin Bayisenge
- Center for One Health, University of Global Health Equity, Kigali, Rwanda
| | - Chany Uwase
- Center for One Health, University of Global Health Equity, Kigali, Rwanda
| | | | - Janna M Schurer
- Center for One Health, University of Global Health Equity, Kigali, Rwanda
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12
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Van't Noordende AT, Aycheh MW, Schippers AP. An exploration of family quality of life in persons with leprosy-, lymphatic filariasis- and podoconiosis-related disabilities and their family members in Ethiopia. Trans R Soc Trop Med Hyg 2020; 114:1003-1012. [PMID: 33169139 PMCID: PMC7738662 DOI: 10.1093/trstmh/traa090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 12/03/2022] Open
Abstract
Background Leprosy, podoconiosis and lymphatic filariasis (LF) may adversely affect the social, economic and psychological well-being of persons affected and their families. The objectives of this study were to assess and compare family quality of life of persons affected and their family members, explore the relationship between family quality of life and perceived stigma and activity limitations and explore what factors influence family quality of life. Methods A cross-sectional quantitative study was conducted in the Awi zone in Ethiopia. Persons affected and their family members were selected using purposive sampling. Three questionnaires were used: the Beach Center Family Quality of Life (FQOL) scale (range 25–125, with higher scores denoting higher family quality of life), the SARI Stigma Scale (range 0–63, with higher scores denoting higher levels of stigma) and the Screening of Activity Limitation and Safety Awareness (SALSA) scale (range 0–80, with higher scores denoting more activity limitations). Data analysis consisted of simple descriptive analysis and regression analysis. Results A total of 95 persons affected and 117 family members were included. The overall mean of the family quality of life score was 71.7. Persons affected had significantly higher mean family quality of life scores than family members on all domains. Female gender, a smaller family size and occupation were associated with lower family quality of life. We found a mean SARI Stigma score of 22.3 and a mean SALSA score of 37.6. There was no association between the FQOL and SARI scores or between the FQOL and SALSA scores. Conclusions Family quality of life is an important area to address because neglected tropical diseases often affect the whole family. It is therefore important in order to provide appropriate support for persons affected and their family members. Efforts to improve the quality of life of families in which a family member is affected by leprosy, podoconiosis or LF should give priority to women and families with a smaller family size.
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Affiliation(s)
- Anna T Van't Noordende
- Programme Department, Stichting Disability Studies in Nederland, p/a Marelaan 61, 3454 GB De Meern, The Netherlands.,Technical Department, NLR, Wibautstraat 137K, 1097 DN Amsterdam, The Netherlands.,Department of Public Health, Erasmus Medical Center, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Moges Wubie Aycheh
- Department of Public Health, Debre Markos University, A3, Debre Markos, Ethiopia
| | - Alice P Schippers
- Programme Department, Stichting Disability Studies in Nederland, p/a Marelaan 61, 3454 GB De Meern, The Netherlands.,Amsterdam University Medical Centre, VU Medical Center, De Boelelaan 1117-1118, 1081 HV Amsterdam, The Netherlands
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13
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Engdawork K, Davey G, Ayode D, McBride CM, Tadele G. A cross-sectional survey to assess the risk factors associated with stigmatizing attitudes towards patients with podoconiosis among rural youth in southern Ethiopia. Trans R Soc Trop Med Hyg 2020; 114:995-1002. [PMID: 33169168 PMCID: PMC7738651 DOI: 10.1093/trstmh/traa091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/31/2020] [Accepted: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many health conditions are associated with stigma due to beliefs about their causes and the physical changes experienced by patients. Among such conditions are several neglected tropical diseases (NTDs). Podoconiosis, classified as an NTD, is a form of lymphoedema caused by the co-influence of genetic and environmental factors. It is a major public health problem in Ethiopia and is associated with intense stigma. Despite this, little is known about the factors contributing to stigmatizing attitudes against patients with the disease. METHODS A cross-sectional survey was conducted in southern Ethiopia to analyse the attitudes of rural youth and associated risk factors for stigmatizing attitudes towards patients with podoconiosis, with the aim of informing stigma reduction strategies. RESULTS The survey included 336 randomly selected youth. Of the 177 (52.7%) youth who held more stigmatizing attitudes toward patients with podoconiosis, 105 (59.3%) were females and 171 (96.6%) did not have affected friends. Accurate knowledge about gene-environment influences and rejection of infectious causes of podoconiosis were associated with less stigmatizing attitudes. CONCLUSIONS Improving understanding of the gene-environment interaction and dispelling beliefs about infectious causes may reduce negative attitudes about podoconiosis. Affected youth may play an important role as agents of change to spread non-stigmatizing messages.
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Affiliation(s)
- Kibur Engdawork
- Department of Sociology, College of Social Sciences, Addis Ababa University, Addis Ababa, 1176, Ethiopia
| | - Gail Davey
- Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
| | - Desta Ayode
- Department of Sociology, College of Social Sciences, Addis Ababa University, Addis Ababa, 1176, Ethiopia
| | - Colleen M McBride
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Getnet Tadele
- Department of Sociology, College of Social Sciences, Addis Ababa University, Addis Ababa, 1176, Ethiopia
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14
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van ‘t Noordende AT, Aycheh MW, Schippers A. The impact of leprosy, podoconiosis and lymphatic filariasis on family quality of life: A qualitative study in Northwest Ethiopia. PLoS Negl Trop Dis 2020; 14:e0008173. [PMID: 32155158 PMCID: PMC7083326 DOI: 10.1371/journal.pntd.0008173] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/20/2020] [Accepted: 02/26/2020] [Indexed: 01/13/2023] Open
Abstract
Background Several studies have shown that leprosy, podoconiosis and lymphatic filariasis impact individual quality of life. In contrast, family quality of life has not received as much attention despite evidence that families are also affected. This is especially relevant given the crucial role of the family in most societies around the world. This study looks at the impact of leprosy, podoconiosis and lymphatic filariasis on family quality of life. Methodology The study used a cross-sectional design with a qualitative approach. Both semi-structured interviews and focus group discussions were conducted. Participants, persons affected and their family members, were selected by purposive sampling. Data were collected between August and November 2017 in Awi zone, Northwest Ethiopia and analysed by three independent researchers using open, inductive coding and content analysis. Results A total of 86 participants were included in this study: 56 participants in the in-depth interviews and 30 participants in the focus group discussions. We found that participation restrictions, reduced productivity and marginalisation were common. In addition, discrimination in the communities occurred often, often extending to family members of persons affected. Divorce and difficulties in finding a spouse were common for persons affected and their family members. Many persons affected reported mental health problems. While most people got social and physical support from their families, there were a few exceptions. In particular, persons with younger children seemed to lack social support. Having to provide for their affected family member sometimes caused stress, school dropouts and an additional workload. Financial problems and loss of livelihood were reported by almost all participants. Conclusion This study revealed that leprosy, lymphatic filariasis and podoconiosis have an effect on several dimensions of family quality of life. Many problems reported related to stigma and poverty. Several studies have shown that leprosy, podoconiosis and lymphatic filariasis impact individual quality of life. In contrast, family quality of life has not received as much attention despite evidence that families are also affected. This is especially relevant given the crucial role of the family in most societies around the world. This study looked at the impact of leprosy, podoconiosis and lymphatic filariasis on family quality of life in Northwest Ethiopia. The study used a cross-sectional design with a qualitative approach. Both semi-structured interviews and focus group discussions were conducted with persons affected and their family members. A total of 86 participants were included in this study: 56 participants in the in-depth interviews and 30 participants in the focus group discussions. This study revealed that leprosy, lymphatic filariasis and podoconiosis have an effect on family quality of life, resulting in: participation restrictions, reduced productivity, marginalisation, discrimination, divorce, difficulties finding a spouse, school dropouts, mental health problems and poverty. Both persons affected and their family members were impacted. Many problems reported related to impairments, stigma and poverty. The results of this study can be used to inform leprosy, lymphatic filariasis and podoconiosis treatment and after care programmes.
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Affiliation(s)
- Anna T. van ‘t Noordende
- Disability Studies in the Netherlands, Almere, The Netherlands
- NLR, Amsterdam, The Netherlands
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | | | - Alice Schippers
- Disability Studies in the Netherlands, Almere, The Netherlands
- Amsterdam University Medical Centre, Location VU Medical Center, Amsterdam, The Netherlands
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15
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Chandler DJ, Grijsen ML, Fuller LC. With Bare Feet in the Soil: Podoconiosis, a Neglected Cause of Tropical Lymphoedema. Dermatology 2020; 237:236-247. [PMID: 32101870 DOI: 10.1159/000506045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/19/2020] [Indexed: 11/19/2022] Open
Abstract
Podoconiosis is a form of lymphoedema that occurs in tropical highland areas in genetically susceptible individuals who are exposed to irritant volcanic soils. The disease is preventable through consistent use of footwear and attention to foot hygiene; however, in endemic areas there is a strong barefoot tradition, and many cannot afford shoes. Patients with podoconiosis face significant physical disability, psychological comorbidity, reduced quality of life and experience frequent episodes of systemic illness due to acute dermatolymphangioadenitis. This review provides an overview of this important and neglected tropical skin disease and summarizes the latest research findings.
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Affiliation(s)
- David J Chandler
- Dermatology Department, Brighton General Hospital, Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom,
| | - Marlous L Grijsen
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
| | - Lucinda C Fuller
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.,International Foundation for Dermatology, London, United Kingdom
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16
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Saenz V, Mazzanti di Ruggiero MDLA. Propuestas bioéticas frente a los problemas sociales y éticos que generan las enfermedades infecciosas desatendidas. PERSONA Y BIOÉTICA 2019. [DOI: 10.5294/pebi.2019.23.1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Este artículo de revisión se centra en el tema de las enfermedades infecciosas desatendidas (EID), grupo de 18 patologías de carácter incapacitante, a veces mortales y frecuentemente deformantes, que prevalecen en poblaciones de Asia, África y en las zonas tropicales de Sur América. Mediante una revisión bibliográfica se plantean los elementos que se relacionan con estas enfermedades, se categorizan y se analizan a la luz de la Declaración Universal sobre Bioética y Derechos Humanos de 2005, en cuanto a igualdad, justicia y equidad, el enfoque de no discriminación y estigmatización, responsabilidad social y salud. A lo largo de la revisión se concluye que la problemática alrededor de las EID es multifactorial y se presentan propuestas, desde una mirada de la bioética centrada en el respeto por la dignidad de la persona y de las poblaciones afectadas, para mitigar y solucionar la atención a partir de estrategias posibles que aborden determinantes sociales. Se propone incluir la bioética en el debate sobre la atención de las EID para analizar los problemas y examinar soluciones por medio de proyectos de investigación transdisciplinaria que impliquen un trabajo colaborativo y formativo entre las comunidades afectadas, entidades gubernamentales y profesionales de la salud y de las ciencias veterinarias.
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17
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Tsegay G, Deribe K, Deyessa N, Addissie A, Davey G, Cooper M, Trueba ML. 'I should not feed such a weak woman'. Intimate partner violence among women living with podoconiosis: A qualitative study in northern Ethiopia. PLoS One 2018; 13:e0207571. [PMID: 30521548 PMCID: PMC6283553 DOI: 10.1371/journal.pone.0207571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/03/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Intimate Partner Violence (IPV) is a serious, preventable public health problem that affects millions of people worldwide. Research indicates that adults suffering from long term, disabling conditions are more likely to be victims of IPV due to the intersection of disease-associated stigma and discrimination. IPV in turn is known to worsen the overall health and wellbeing of those affected by it. Little research however explores the relationship between neglected tropical diseases such as podoconiosis and IPV. This study explores the relationship between IPV and podoconiosis in northern Ethiopia with the aim of identifying new avenues for limiting disability and promoting the wellbeing of people affected by this neglected tropical disease. METHODS The study was conducted in East and West Gojjam zones, located in the Amhara Regional State of Ethiopia. Research participants were first screened using the domestic violence screening tool Hurt-Insult-Threaten-Scream (HITS). Data were collected by native speakers of the local language (Amharic) in the form of semi-structured interviews during January and February 2016. Thematic and content data analysis was carried out, using the Open Code 3.4 qualitative data analysis software for coding. RESULTS A total of 15 women living with podoconiosis and experiencing IPV were interviewed (aged 31 to 75). Women experienced different forms of IPV, including beatings (with or without an object), insults, name calling, undermining, denial of equal rights over common assets, movement monitoring, cheating, abandonment, forced divorce, obstruction of health care access, inhibition of decision-making and sexual coercion. Podoconiosis increases the frequency and severity of IPV and in occasions shapes a change from physical to psychological and financial violence. In turn, frequent episodes of IPV worsen disease outcomes and contribute to disease persistence in the region, in that these impede women's ability to manage the disease and help perpetuate the conditions of poverty that influence disease onset. CONCLUSIONS Women living with podoconiosis are victims of various, overlapping forms of IPV that negatively impact their health and wellbeing. Poverty, scarce IPV prevention services in the area together with a social acceptance of IPV and these women's decreased ability to work due to the debilitating effects of podoconiosis and childcare responsibilities frequently prompt these women to tolerate IPV and remain in abusive relationships. Tackling disease-associated taboo and stigma, developing accessible IPV interventions, working towards greater gender equality at the household and societal levels and developing sustainable strategies for improving the socio-economic assets of women affected by podoconiosis are all necessary to both prevent IPV and to improve disease outcome.
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Affiliation(s)
- Girmay Tsegay
- College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Kebede Deribe
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, United Kingdom
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, United Kingdom
| | - Max Cooper
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, United Kingdom
| | - Mei L. Trueba
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, United Kingdom
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18
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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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Tora A, Mengiste A, Davey G, Semrau M. Community Involvement in the Care of Persons Affected by Podoconiosis-A Lesson for Other Skin NTDs. Trop Med Infect Dis 2018; 3:E87. [PMID: 30274483 PMCID: PMC6161108 DOI: 10.3390/tropicalmed3030087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/08/2018] [Accepted: 08/11/2018] [Indexed: 12/30/2022] Open
Abstract
Podoconiosis is a neglected tropical disease (NTD) characterized by lower-leg swelling (lymphedema), which is caused by long-term exposure to irritant red-clay soils found within tropical volcanic high-altitude environments with heavy rainfall. The condition places a substantial burden on affected people, their families and communities, including disability, economic consequences, social exclusion, and stigma; mental disorders and distress are also common. This paper focuses on community-based care of podoconiosis, and, in particular, the role that community involvement can have in the reduction of stigma against people affected by podoconiosis. We first draw on research conducted in Ethiopia for this, which has included community-based provision of care and treatment, education, and awareness-raising, and socioeconomic rehabilitation to reduce stigma. Since people affected by podoconiosis and other skin NTDs often suffer the double burden of mental-health illness, which is similarly stigmatized, we then point to examples from the mental-health field in low-resource community settings to suggest avenues for stigma reduction and increased patient engagement that may be relevant across a range of skin NTDs, though further research is needed on this.
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Affiliation(s)
- Abebayehu Tora
- Department of Sociology, Wolaita Sodo University, Sodo, Ethiopia.
| | - Asrat Mengiste
- National Podoconiosis Action Network, Addis Ababa, Ethiopia.
| | - Gail Davey
- Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer Campus, University of Sussex, Brighton BN1 9PX, UK.
| | - Maya Semrau
- Department of Global Health and Infection, Brighton and Sussex Medical School, Falmer Campus, University of Sussex, Brighton BN1 9PX, UK.
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Shahvisi A, Meskele E, Davey G. A Human Right to Shoes? Establishing Rights and Duties in the Prevention and Treatment of Podoconiosis. Health Hum Rights 2018; 20:53-65. [PMID: 30008552 PMCID: PMC6039730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Podoconiosis is a debilitating chronic swelling of the foot and lower leg caused by long-term exposure to irritant red volcanic clay soil in the highland regions of Africa, Central America, and India. In this paper, we consider the human rights violations that cause, and are caused by, podoconiosis in Ethiopia. Specifically, we discuss the way in which the right to an adequate basic standard of living is not met in endemic regions, where the following basic necessities are not readily available: appropriate footwear, health education, and affordable, accessible health care. Those living with podoconiosis experience disablement, stigma and discrimination, and mental distress, contributing to greater impoverishment and a reduced quality of life. We suggest that while identifying rights violations is key to characterizing the scale and nature of the problem, identifying duties is critical to eliminating podoconiosis. To this end, we describe the duties of the Ethiopian government, the international community, and those sourcing Ethiopian agricultural products in relation to promoting shoe-wearing, providing adequate health care, and improving health literacy.
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Affiliation(s)
- Arianne Shahvisi
- Lecturer in ethics and medical humanities at Brighton and Sussex Medical School, Brighton, UK
| | - Enguday Meskele
- Lecturer in human rights law at Wolaita Sodo University, Ethiopia
| | - Gail Davey
- Professor of global health epidemiology at Brighton and Sussex Centre for Global Health Research, Brighton, UK
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21
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Tembei AM, Kengne-Ouaffo JA, Ngoh EA, John B, Nji TM, Deribe K, Enyong P, Nkuo-Akenji T, Davey G, Wanji S. A Comparative Analysis of Economic Cost of Podoconiosis and Leprosy on Affected Households in the Northwest Region of Cameroon. Am J Trop Med Hyg 2018; 98:1075-1081. [PMID: 29460727 PMCID: PMC5899508 DOI: 10.4269/ajtmh.17-0931] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/25/2017] [Indexed: 11/07/2022] Open
Abstract
Leprosy and podoconiosis (podo) are neglected tropical diseases that cause severe disfigurement and disability, and may lead to catastrophic health expenditure and hinder economic development of affected persons and households. This study compared economic costs of both diseases on affected households with unaffected neighboring households in the Northwest Region (N.W.R.) of Cameroon. A matched comparative cross-sectional design was used enrolling 170 households (43 podo case households, 41 podo control households, 43 leprosy case households, and 43 leprosy control households) from three health districts in the N.W.R. Direct treatment costs for podo averaged 142 United State dollar (USD), compared with zero for leprosy (P < 0.001). This was also reflected in the proportion of annual household income consumed (0.4 versus 0.0, respectively, P < 0.001). Both diseases caused considerable reductions in working days (leprosy 115 versus podo 135 days. P for comparison < 0.001). The average household income was considerably lower in podo-affected households than unaffected households (410 versus 913 USD, P = 0.01), whereas income of leprosy-affected households was comparable to unaffected households (329 versus 399 USD, P = 0.23). Both leprosy and podo cause financial burdens on affected households, but those on podo-affected families are much greater. These burdens occur through direct treatment costs and reduced ability to work. Improved access to public health interventions for podo including prevention, morbidity management and disability prevention are likely to result in economic returns to affected families. In Cameroon, one approach to this would be through subsidized health insurance for these economically vulnerable households.
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Affiliation(s)
- Ayok M. Tembei
- Epidemiology and Control of Infectious Diseases, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Jonas A. Kengne-Ouaffo
- Epidemiology and Control of Infectious Diseases, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Elvis A. Ngoh
- Epidemiology and Control of Infectious Diseases, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Bonekeh John
- Mbebah Vigilantic Farming and Development Association in Ndop, Ngokutunja Sub-division of the North West Region, Ndop, Cameroon
| | - Theobald M. Nji
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
- Department of Sociology and Anthropology, University of Buea, Buea, Cameroon
| | - Kebede Deribe
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Peter Enyong
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
| | - Theresa Nkuo-Akenji
- Epidemiology and Control of Infectious Diseases, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Gail Davey
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Samuel Wanji
- Epidemiology and Control of Infectious Diseases, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Research Foundation in Tropical Diseases and Environment, Buea, Cameroon
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22
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Molla M, Negussie H, Ngari M, Kivaya E, Njuguna P, Enqueselassie F, Berkley JA, Davey G. Pragmatism in practice: lessons learned during screening and enrollment for a randomised controlled trial in rural northern Ethiopia. BMC Med Res Methodol 2018. [PMID: 29514613 PMCID: PMC5842624 DOI: 10.1186/s12874-018-0486-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background We use the example of the Gojjam Lymphoedema Best Practice Trial (GoLBeT), a pragmatic trial in a remote rural setting in northern Ethiopia, to extract lessons relevant to other investigators balancing the demands of practicality and community acceptability with internal and external validity in clinical trials. Methods We explain in detail the preparation for the trial, its setting in northern Ethiopia, the identification and selection of patients (inclusion and exclusion criterion, identifying and screening of patients at home, enrollment of patients at the health centres and health posts), and randomisation. Results We describe the challenges met, together with strategies employed to overcome them. Conclusions Examples given in the previous section are contextualised and general principles extracted where possible. We conclude that it is possible to conduct a trial that balances approaches that support internal validity (e.g. careful design of proformas, accurate case identification, control over data quality and high retention rates) with those that favour generalisability (e.g. ‘real world’ setting and low rates of exclusion). Strategies, such as Rapid Ethical Assessment, that increase researchers’ understanding of the study setting and inclusion of hard-to-reach participants are likely to have resource and time implications, but are vital in achieving an appropriate balance. Trial registration ISRCTN67805210, registered 24/01/2013.
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Affiliation(s)
- Meseret Molla
- Centre for Environment and Development Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Henok Negussie
- Wellcome Trust Centre for Global Health Research, Brighton & Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - Moses Ngari
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Esther Kivaya
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - James A Berkley
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
| | - Gail Davey
- Wellcome Trust Centre for Global Health Research, Brighton & Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK. .,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
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23
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Murray SM, Robinette KL, Bolton P, Cetinoglu T, Murray LK, Annan J, Bass JK. Stigma Among Survivors of Sexual Violence in Congo: Scale Development and Psychometrics. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:491-514. [PMID: 26460106 PMCID: PMC5578912 DOI: 10.1177/0886260515608805] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Stigma related to sexual violence (SV) is associated with many negative physical and social outcomes. We sought to create a contextually relevant measure of SV-related stigma for women in the Democratic Republic of Congo (DRC) and assess itspsychometrics and validity. Using baseline screening data from two randomized controlled trials of services for female SV survivors in Eastern DRC ( n = 1,184), we conducted exploratory and confirmatory factor analyses to test the measurement model. Cronbach's alphas and Kuder-Richardson 20 (KR-20) statistics were used to evaluate internal consistency. Logistic and linear regressions of the stigma measures with related constructs were used to assess construct validity. Two distinct but related scales were developed based on factor analyses: a four-item scale of discrimination-related stigma (i.e., enacted stigma) and an eight-item scale of combined perceived and internalized stigma (i.e., felt stigma). Both scales showed good internal consistency (KR-20 = .68; α = .86). A higher felt stigma score was associated with significant increases in combined depression and anxiety and trauma symptoms, as well as functional impairment ( p < .001). Having a child as a result of SV was associated with both significantly higher enacted and felt stigma ( p < .001). Neither SV stigma scale was associated with medical care seeking. To address harmful ramifications of stigma among SV survivors, locally relevant quantitative measures are necessary to understand the nature and severity of stigma they experience. Our process of scale creation and evaluation can serve as an example for developing locally relevant SV-related stigma measures.
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Affiliation(s)
| | | | - Paul Bolton
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Laura K Murray
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeannie Annan
- 2 The International Rescue Committee, New York, NY, USA
| | - Judith K Bass
- 1 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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24
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Burn H, Aweke S, Wondie T, Habtamu E, Deribe K, Rajak S, Bremner S, Davey G. Podoconiosis, trachomatous trichiasis and cataract in northern Ethiopia: A comparative cross sectional study. PLoS Negl Trop Dis 2017; 11:e0005388. [PMID: 28187129 PMCID: PMC5322969 DOI: 10.1371/journal.pntd.0005388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 02/23/2017] [Accepted: 02/04/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rural populations in low-income countries commonly suffer from the co-morbidity of neglected tropical diseases (NTDs). Podoconiosis, trachomatous trichiasis (both NTDs) and cataract are common causes of morbidity among subsistence farmers in the highlands of northern Ethiopia. We explored whether podoconiosis was associated with cataract or trachomatous trichiasis (TT) among this population. METHODS A comparative cross-sectional study was conducted in East Gojam region, Amhara, Ethiopia in May 2016. Data were collected from patients previously identified as having podoconiosis and from matched healthy neighbourhood controls. Information on socio-demographic factors, clinical factors and past medical history were collected by an interview-administered questionnaire. Clinical examination involved grading of podoconiosis by examination of both legs, measurement of visual acuity, direct ophthalmoscopy of dilated pupils to grade cataract, and eyelid and corneal examination to grade trachoma. Multiple logistic regression was conducted to estimate independent association and correlates of podoconiosis, TT and cataract. FINDINGS A total of 700 participants were included in this study; 350 podoconiosis patients and 350 healthy neighbourhood controls. The prevalence of TT was higher among podoconiosis patients than controls (65 (18.6%) vs 43 (12.3%)) with an adjusted odds ratio OR 1.57 (95% CI 1.02-2.40), p = 0.04. There was no significant difference in prevalence of cataract between the two populations with an adjusted OR 0.83 (95% CI 0.55-1.25), p = 0.36. Mean best visual acuity was 0.59 (SD 0.06) in podoconiosis cases compared to 0.44 (SD 0.04) in controls, p<0.001. The proportion of patients classified as blind was higher in podoconiosis cases compared with healthy controls; 5.6% vs 2.0%; adjusted OR 2.63 (1.08-6.39), P = 0.03. CONCLUSIONS Individuals with podoconiosis have a higher burden of TT and worse visual acuity than their matched healthy neighbourhood controls. Further research into the environmental and biological reasons for this co-morbidity is required. A shared approach to managing these two NTDs within the same population could be beneficial.
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Affiliation(s)
- Helen Burn
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
| | | | | | - Esmael Habtamu
- The Carter Center, Addis Ababa, Ethiopia
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kebede Deribe
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Saul Rajak
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Sussex Eye Hospital, Brighton, Sussex, United Kingdom
| | - Stephen Bremner
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Gail Davey
- Wellcome Trust Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
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25
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Deribe K, Kebede B, Mengistu B, Negussie H, Sileshi M, Tamiru M, Tomczyk S, Tekola-Ayele F, Davey G, Fentaye A. Podoconiosis in Ethiopia: From Neglect to Priority Public Health Problem. ETHIOPIAN MEDICAL JOURNAL 2017; 55:65-74. [PMID: 28878431 PMCID: PMC5582632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Podoconiosis is a geochemical disease occurring in individuals exposed to red clay soil of volcanic origin. This Neglected Tropical Disease (NTD) is highly prevalent in Ethiopia. According to the nationwide mapping in 2013, the disease is endemic in 345 districts, where an estimated 35 million people live. The government of Ethiopia prioritized podoconiosis as one of eight priority NTDs and included it in the national integrated master plan for NTDs. An integrated lymphoedema management guideline has been developed. Service expansion has continued in the last few years and lymphoedema management services have been expanded to over one hundred endemic districts. The last few years have been critical in generating evidence about the distribution, burden and effective interventions for podoconiosis in Ethiopia. Although the extent of the problem within Ethiopia is considerable, the country is well positioned to now scale-up elimination efforts. Given the extraordinary progress of the past ten years and the current commitment of government, private and third sectors, Ethiopia seems to be on course for the elimination of podoconiosis in our lifetime. We need continued strong partner commitment, evidence-building, and scale-up of activities to accomplish this.
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Affiliation(s)
- Kebede Deribe
- Federal Ministry of Health, Addis Ababa, Ethiopia
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK
- Addis Ababa University, School of Public Health, Addis Ababa, Ethiopia
- RTI International, Addis Ababa, Ethiopia
| | | | | | - Henok Negussie
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK
| | - Mesfin Sileshi
- Federal Ministry of Health, Addis Ababa, Ethiopia
- RTI International, Addis Ababa, Ethiopia
| | | | - Sara Tomczyk
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Fasil Tekola-Ayele
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland, USA
| | - Gail Davey
- Wellcome Trust Brighton & Sussex Centre for Global Health Research, Brighton & Sussex Medical School, Falmer, Brighton, UK
| | - Amha Fentaye
- Federal Ministry of Health, Addis Ababa, Ethiopia
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26
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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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Ayode D, Tora A, Farrell D, Tadele G, Davey G, McBride CM. Dual Perspectives On Stigma: Reports of Experienced and Enacted Stigma by Those Affected and Unaffected by Podoconiosis. J Public Health Res 2016; 5:689. [PMID: 27747202 PMCID: PMC5062755 DOI: 10.4081/jphr.2016.689] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/06/2016] [Indexed: 02/04/2023] Open
Abstract
Background: Disease-related stigma is a public health concern steadily gaining global attention. Evidence consistently shows that an individual’s attribution of disease cause can prompt or justify interpersonal stigma. However, few studies have explored causal beliefs about inherited disease and their influence on stigmatising behaviours in low and middle income countries. Design and methods: The study was conducted in 2013, in six communities in Wolaita zone, Southern Ethiopia. A total of 1800 respondents took part in the study, 600 were affected by an inherited disease and 1200 were unaffected neighbours. Two versions of the interviewer-administered survey were created, with measures assessed in parallel on experienced stigma for the affected and enacted stigma for unaffected respondents. Results: Mean levels of enacted stigma reported by unaffected respondents were slightly lower (2.0, SD=0.7) than experienced stigma reported by affected respondents [2.2 (standard deviation=1.1)]. Beliefs that podoconiosis was hereditary were significantly and positively associated with levels of enacted stigma reported by unaffected respondents and experienced stigma reported by affected respondents (P<0.001). There was no association of reported levels of stigma experienced by affected respondents with levels of enacted stigma reported by the neighbouring unaffected respondents. Males consistently reported significantly lower levels of experienced and enacted stigma than females, P<0.0001. Conclusions: If stigma reduction interventions are to be successful, culturally tailored, gender inclusive and innovative health education programs are required, directed at the general community as well as individuals affected by inherited diseases. Significance for public health Disease-related stigma is a public health concern steadily gaining global attention. In this report, we evaluated dual perspectives of stigma, that is, we compared reports of stigma experienced by families affected by a heritable neglected tropical disease with reports of enacted stigma among neighbouring families unaffected by the disease. We found that unaffected neighbours reported enacting less stigma than affected respondents reported experiencing. Levels of enacted and experienced stigma also were influenced by community members’ perceptions of the causes of disease. Enacted and experienced stigma levels also varied by gender (males reported less of each) across sites. Taken together, these findings highlight the need for stigma reduction strategies to involve both affected and unaffected groups if interventions are to be effective. These efforts also should address community members’ baseline explanations of what causes heritable health conditions while considering gender and community context.
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Affiliation(s)
- Desta Ayode
- College of Social Sciences, Addis Ababa University , Addis Ababa, Ethiopia
| | - Abebayehu Tora
- Department of Sociology, Wolaita Sodo University , Sodo, Ethiopia
| | | | - Getnet Tadele
- College of Social Sciences, Addis Ababa University , Addis Ababa, Ethiopia
| | - Gail Davey
- Brighton and Sussex Medical School , Falmer, Brighton, UK
| | - Colleen M McBride
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University , Atlanta, CA, USA
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Bartlett J, Deribe K, Tamiru A, Amberbir T, Medhin G, Malik M, Hanlon C, Davey G. Depression and disability in people with podoconiosis: a comparative cross-sectional study in rural Northern Ethiopia. Int Health 2016; 8:124-31. [PMID: 26113669 PMCID: PMC4604655 DOI: 10.1093/inthealth/ihv037] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 05/06/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Little is known about depressive symptoms in podoconiosis despite the independent contribution of depression to worse health outcomes and disability in people with other chronic disorders. METHOD Two-hundred and seventy-one individuals with podoconiosis and 268 healthy neighbours (individuals from the nearest household in any direction) were investigated for depressive symptoms using a validated Amharic version of the Patient Health Questionnaire (PHQ-9). The WHO Disability Assessment Schedule II (WHODAS II) tool was used to measure disability. Logistic regression and zero inflated negative binomial regression were used to identify factors associated with elevated depressive symptoms, and disability, respectively. RESULTS Among study participants with podoconiosis, 12.6% (34/269) had high levels of depressive symptoms (scoring 5 or more points on the PHQ-9, on two assessments two weeks apart) compared to 0.7% (2/268) of healthy neighbours (p<0.001). Having podoconiosis and being older were significantly associated with increased odds of a high PHQ-9 score (adjusted odds ratios [AOR] 11.42; 95% CI: 2.44-53.44 and AOR 1.04; 95% CI: 1.00-1.08, respectively). Significant predictors of a higher disability score were having podoconiosis (WHODAS II multiplier value: 1.48; 95% CI: 1.39-1.58) and having a high PHQ-9 score (1.07; 95% CI: 1.06-1.08). CONCLUSION We recommend integrating evidence-based treatments for depression into podoconiosis interventions.
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Affiliation(s)
| | - Kebede Deribe
- Brighton & Sussex Medical School, Brighton, UK School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abreham Tamiru
- International Orthodox Christian Charities, Debre Markos, Ethiopia
| | - Tsige Amberbir
- International Orthodox Christian Charities, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Aklilu Lemma Institute of Pathology, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gail Davey
- Brighton & Sussex Medical School, Brighton, UK
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Experiences of a Community-Based Lymphedema Management Program for Lymphatic Filariasis in Odisha State, India: An Analysis of Focus Group Discussions with Patients, Families, Community Members and Program Volunteers. PLoS Negl Trop Dis 2016; 10:e0004424. [PMID: 26849126 PMCID: PMC4744078 DOI: 10.1371/journal.pntd.0004424] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/11/2016] [Indexed: 12/04/2022] Open
Abstract
Background Globally 68 million people are infected with lymphatic filariasis (LF), 17 million of whom have lymphedema. This study explores the effects of a lymphedema management program in Odisha State, India on morbidity and psychosocial effects associated with lymphedema. Methodology/Principal Findings Focus groups were held with patients (eight groups, separated by gender), their family members (eight groups), community members (four groups) and program volunteers (four groups) who had participated in a lymphedema management program for the past three years. Significant social, physical, and economic difficulties were described by patients and family members, including marriageability, social stigma, and lost workdays. However, the positive impact of the lymphedema management program was also emphasized, and many family and community members indicated that community members were accepting of patients and had some improved understanding of the etiology of the disease. Program volunteers and community members stressed the role that the program had played in educating people, though interestingly, local explanations and treatments appear to coexist with knowledge of biomedical treatments and the mosquito vector. Conclusions/Significance Local and biomedical understandings of disease can co-exist and do not preclude individuals from participating in biomedical interventions, specifically lymphedema management for those with lymphatic filariasis. There is a continued need for gender-specific psychosocial support groups to address issues particular to men and women as well as a continued need for improved economic opportunities for LF-affected patients. There is an urgent need to scale up LF-related morbidity management programs to reduce the suffering of people affected by LF. Around the world 68 million people are infected with lymphatic filariasis (LF), a mosquito-borne disease caused by filarial worms. The parasite can damage patients’ lymphatic systems causing pain, infections and swollen limbs, known as lymphedema or, in more advanced stages, elephantiasis. Lymphedema management programs can help patients to deal with the physical and emotional effects of lymphedema and elephantiasis. We held a total of 24 focus groups to discuss the experiences of people with lymphedema in Odisha State, India who participate in such a program. Discussions were held with patients, family members of patients, community members and program volunteers. Significant social, physical and economic difficulties were described by patients and family members, including marriage-related issues, social stigma, and lost workdays. However, the positive impacts of the lymphedema management program were also emphasized, and many family and community members indicated that community members were accepting of patients and had some improved understanding of the cause of the disease. People were able to hold both a ‘scientific’ and a ‘traditional’ understanding of LF at the same time. The financial hardships that people described highlight the need for improved economic opportunities for lymphedema-affected patients. Support programs based in the community also have clear social and emotional benefits. There is an urgent need to scale up LF management programs to reduce the suffering of people affected by LF.
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Podoconiosis: Endemic Non-filarial Elephantiasis. NEGLECTED TROPICAL DISEASES - SUB-SAHARAN AFRICA 2016. [DOI: 10.1007/978-3-319-25471-5_10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Prieto-Pérez L, Soriano Cea JJ, Górgolas Hernández-Mora M. [Podoconiosis, a society and medical community neglected disease]. Med Clin (Barc) 2015; 145:446-51. [PMID: 25726310 DOI: 10.1016/j.medcli.2014.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 11/30/2014] [Accepted: 12/09/2014] [Indexed: 12/19/2022]
Abstract
Podoconiosis, mossy foot or endemic non-filarial elephantiasis, is a geochemical disease that causes lower limb lymphedema; it is directly related to walking barefoot over soils of volcanic origin, in areas with a high pluviometric annual index. It has a specific geographical distribution, affecting around 5% population in areas where it is endemic. It is debilitating and disfiguring disease, which frequently leads to social margination. Podoconiosis is totally preventable and, once a diagnosis is established, it may improve with simple therapeutic measures.
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Affiliation(s)
- Laura Prieto-Pérez
- División de Enfermedades Infecciosas, Instituto de Investigación Sanitaria Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Madrid, España.
| | | | - Miguel Górgolas Hernández-Mora
- División de Enfermedades Infecciosas, Instituto de Investigación Sanitaria Fundación Jiménez Díaz-Universidad Autónoma de Madrid, Madrid, España
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Kengne-Ouafo JA, Millard JD, Nji TM, Tantoh WF, Nyoh DN, Tendongfor N, Enyong PA, Newport MJ, Davey G, Wanji S. Understanding of research, genetics and genetic research in a rapid ethical assessment in north west Cameroon. Int Health 2015; 8:197-203. [PMID: 25969503 PMCID: PMC4866326 DOI: 10.1093/inthealth/ihv034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 04/13/2015] [Indexed: 02/02/2023] Open
Abstract
Background There is limited assessment of whether research participants in low-income settings are afforded a full understanding of the meaning of medical research. There may also be particular issues with the understanding of genetic research. We used a rapid ethical assessment methodology to explore perceptions surrounding the meaning of research, genetics and genetic research in north west Cameroon. Methods Eleven focus group discussions (including 107 adults) and 72 in-depth interviews were conducted with various stakeholders in two health districts in north west Cameroon between February and April 2012. Results Most participants appreciated the role of research in generating knowledge and identified a difference between research and healthcare but gave varied explanations as to this difference. Most participants' understanding of genetics was limited to concepts of hereditary, with potential benefits limited to the level of the individual or family. Explanations based on supernatural beliefs were identified as a special issue but participants tended not to identify any other special risks with genetic research. Conclusion We demonstrated a variable level of understanding of research, genetics and genetic research, with implications for those carrying out genetic research in this and other low resource settings. Our study highlights the utility of rapid ethical assessment prior to complex or sensitive research.
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Affiliation(s)
- Jonas A Kengne-Ouafo
- Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - James D Millard
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, Brighton BN1 9PX, UK
| | - Theobald M Nji
- Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon Department of Sociology and Anthropology, University of Buea, PO Box 63, Buea, Cameroon
| | - William F Tantoh
- Department of Sociology and Anthropology, University of Buea, PO Box 63, Buea, Cameroon
| | - Doris N Nyoh
- Department of Sociology, University of Douala, Cameroon
| | - Nicholas Tendongfor
- Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - Peter A Enyong
- Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
| | - Melanie J Newport
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, Brighton BN1 9PX, UK
| | - Gail Davey
- Wellcome Trust Centre for Global Health Research, Brighton and Sussex Medical School, Falmer Campus, Brighton BN1 9PX, UK
| | - Samuel Wanji
- Department of Microbiology and Parasitology, University of Buea, PO Box 63, Buea, Cameroon Research Foundation in Tropical Diseases and Environment, PO Box 474, Buea, Cameroon
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Deribe K, Brooker SJ, Pullan RL, Sime H, Gebretsadik A, Assefa A, Kebede A, Hailu A, Rebollo MP, Shafi O, Bockarie MJ, Aseffa A, Reithinger R, Cano J, Enquselassie F, Newport MJ, Davey G. Epidemiology and individual, household and geographical risk factors of podoconiosis in Ethiopia: results from the first nationwide mapping. Am J Trop Med Hyg 2014; 92:148-158. [PMID: 25404069 PMCID: PMC4288951 DOI: 10.4269/ajtmh.14-0446] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Although podoconiosis is one of the major causes of tropical lymphoedema and is endemic in Ethiopia its epidemiology and risk factors are poorly understood. Individual-level data for 129,959 individuals from 1,315 communities in 659 woreda (districts) were collected for a nationwide integrated survey of lymphatic filariasis and podoconiosis. Blood samples were tested for circulating Wuchereria bancrofti antigen using immunochromatographic card tests. A clinical algorithm was used to reach a diagnosis of podoconiosis by excluding other potential causes of lymphoedema of the lower limb. Bayesian multilevel models were used to identify individual and environmental risk factors. Overall, 8,110 of 129,959 (6.2%, 95% confidence interval [CI] 6.1–6.4%) surveyed individuals were identified with lymphoedema of the lower limb, of whom 5,253 (4.0%, 95% CI 3.9–4.1%) were confirmed to be podoconiosis cases. In multivariable analysis, being female, older, unmarried, washing the feet less frequently than daily, and being semiskilled or unemployed were significantly associated with increased risk of podoconiosis. Attending formal education and living in a house with a covered floor were associated with decreased risk of podoconiosis. Podoconiosis exhibits marked geographical variation across Ethiopia, with variation in risk associated with variation in rainfall, enhanced vegetation index, and altitude.
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Affiliation(s)
- Kebede Deribe
- *Address correspondence to Kebede Deribe, Brighton & Sussex Medical School and School of Public Health, Addis Ababa University, P.O. Box 2082/1250, Addis Ababa, Ethiopia. E-mail:
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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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Mousley E, Deribe K, Tamiru A, Tomczyk S, Hanlon C, Davey G. Mental distress and podoconiosis in Northern Ethiopia: a comparative cross-sectional study. Int Health 2014; 7:16-25. [PMID: 25062906 PMCID: PMC4236095 DOI: 10.1093/inthealth/ihu043] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The stigma, deformity and disability related to most neglected tropical diseases may lead to poor mental health. We aimed to assess the comorbidity of podoconiosis and mental distress. Methods A comparative cross-sectional study was conducted in 2012, including 346 people with podoconiosis and 349 healthy neighbourhood controls. Symptoms of mental distress were assessed using the validated Amharic translation of the Kessler-10 scale (K10). A linear regression analysis was conducted to identify factors associated with mental distress. Results The mean K10 score was 15.92 (95% CI: 15.27 to 16.57) in people with podoconiosis and 14.49 (95% CI: 13.85 to 15.12) in controls (average K10 scores 1.43 points higher [95% CI: 0.52 to 2.34]). In multivariate linear regression of K10 scores, the difference remained significant when adjusted for gender, income, alcohol use, age, place of residence and family history of mental illness. In the adjusted model, people with podoconiosis had K10 scores 1.37 points higher than controls (95% CI: 0.64 to 2.18). Other variables were also associated with high K10 scores: women had K10 scores 1.41 points higher than men (95% CI: 0.63 to 2.18). Those with family history of mental illness had K10 scores 3.56 points higher than those without (95% CI: 0.55 to 6.56). Conclusions This study documented a high burden of mental distress among people with podoconiosis compared with healthy controls. Taking this finding in the context of the high stigma and reduced quality of life, we recommend integration of psychosocial care into the current morbidity management of podoconiosis.
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Affiliation(s)
| | - Kebede Deribe
- Brighton & Sussex Medical School, Brighton, UK School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abreham Tamiru
- International Orthodox Christian Charities, Debre Markos, Ethiopia
| | - Sara Tomczyk
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia
| | - Gail Davey
- Brighton & Sussex Medical School, Brighton, UK
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