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ter Ellen F, Tielens K, Fenenga C, Mieras L, Schoenmakers A, Arif MA, Veldhuijzen N, Peters R, Ignotti E, Kasang C, Quao B, Steinmann P, Banstola NL, Oraga J, Budiawan T. Implementation approaches for leprosy prevention with single-dose rifampicin: A support tool for decision making. PLoS Negl Trop Dis 2022; 16:e0010792. [PMID: 36251696 PMCID: PMC9612816 DOI: 10.1371/journal.pntd.0010792] [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: 03/11/2022] [Revised: 10/27/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND In the past 15 years, the decline in annually detected leprosy patients has stagnated. To reduce the transmission of Mycobacterium leprae, the World Health Organization recommends single-dose rifampicin (SDR) as post-exposure prophylaxis (PEP) for contacts of leprosy patients. Various approaches to administer SDR-PEP have been piloted. However, requirements and criteria to select the most suitable approach were missing. The aims of this study were to develop an evidence-informed decision tool to support leprosy programme managers in selecting an SDR-PEP implementation approach, and to assess its user-friendliness among stakeholders without SDR-PEP experience. METHODOLOGY The development process comprised two phases. First, a draft tool was developed based on a literature review and semi-structured interviews with experts from various countries, organisations and institutes. This led to: an overview of existing SDR-PEP approaches and their characteristics; understanding the requirements and best circumstances for these approaches; and, identification of relevant criteria to select an approach. In the second phase the tool's usability and applicability was assessed, through interviews and a focus group discussion with intended, inexperienced users; leprosy programme managers and non-governmental organization (NGO) staff. PRINCIPAL FINDINGS Five SDR-PEP implementation approaches were identified. The levels of endemicity and stigma, and the accessibility of an area were identified as most relevant criteria to select an approach. There was an information gap on cost-effectiveness, while successful implementation depends on availability of resources. Five basic requirements, irrespective of the approach, were identified: stakeholder support; availability of medication; compliant health system; trained health staff; and health education. Two added benefits of the tool were identified: its potential value for advocacy and for training. CONCLUSION An evidence-informed SDR-PEP decision tool to support the selection of implementation approaches for leprosy prevention was developed. While the tool was evaluated by potential users, more research is needed to further improve the tool, especially health-economic studies, to ensure efficient and cost-effective implementation of SDR-PEP.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Benedict Quao
- National Leprosy Control Programme, Ghana Health Service, Accra, Ghana
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Allschwil Switzerland, University of Basel, Basel, Switzerland
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Urgesa K, de Bruijne ND, Bobosha K, Seyoum B, Mihret A, Geda B, Schoenmakers A, Mieras L, van Wijk R, Kasang C, Kaba M, Aseffa A. Prolonged delays in leprosy case detection in a leprosy hot spot setting in Eastern Ethiopia. PLoS Negl Trop Dis 2022; 16:e0010695. [PMID: 36094952 PMCID: PMC9499267 DOI: 10.1371/journal.pntd.0010695] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/22/2022] [Accepted: 07/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Leprosy or Hansen’s disease is known to cause disability and disfigurement. A delay in case detection of leprosy patients can lead to severe outcomes. In Ethiopia, the disability rates caused by leprosy among new cases are relatively high compared to other endemic countries. This suggests the existence of hidden leprosy cases in the community and a delay in timely detection. To reduce disability rates, it is crucial to identify the factors associated with this delay. This study aimed to determine the extent of delay in case detection among leprosy cases in Eastern Ethiopia. Methods This cross-sectional explorative study was conducted in January and February 2019 among 100 leprosy patients diagnosed ≤6 months prior to inclusion. A structured questionnaire was used to collect data, including the initial onset of symptoms, and the reasons for delayed diagnosis. Descriptive statistics, including percentages and medians, were used to describe the case detection delay. Logistic regression analysis was carried out to evaluate the predictors of delay in case detection of >12 months. Findings The median age of patients was 35 years, with a range of 7 to 72 years. The majority were male (80%) and rural residents (90%). The median delay in case detection was 12 months (interquartile range 10–36 months) among the included patients. The mean delay in case detection was 22 months, with a maximum delay of 96 months. The overall prevalence of disability among the study population was 42% (12% grade I and 30% grade II). Fear of stigma (p = 0.018) and experiencing painless symptoms (p = 0.018) were highly associated with a delay in case detection of >12 months. Conclusions Being afraid of stigma and having painless symptoms, which are often misinterpreted as non-alarming at the onset of the disease, were associated with a delay in case detection. This study showed the need to increase knowledge on early symptoms of leprosy among affected communities. Furthermore, it is important to support initiatives that reduce leprosy related stigma and promote health worker training in leprosy control activities. Leprosy, also called Hansen’s disease, is a chronic infectious disease that may result in devastating disabilities. The disability rate among new leprosy patients in Ethiopia is high compared to other countries. A delay in case detection is a major factor contributing to the development of disability. Late diagnosis also fosters ongoing transmission, increasing the incidence of the disease. We aimed to determine the extent of the detection delay and find the reasons for this delay in eastern Ethiopian districts, endemic for leprosy. One hundred leprosy patients who recently started multi-drug therapy were included in the study. The median detection delay was one year among all patients. About half of the patients had sought treatment from health institutions within one year after the onset of their first symptoms. Longer delays among leprosy patients were associated with a fear of stigma and painless symptoms at an early stage of the disease. This indicates that it is vital to improve community knowledge of leprosy symptoms and to take initiatives that reduce stigma. This should improve health-seeking behaviour and may prevent the development of disability as well as halt transmission.
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Affiliation(s)
- Kedir Urgesa
- Haramaya University, College of Health and Medical Sciences, Harar, Ethiopia
| | - Naomi D. de Bruijne
- Athena Institute, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam (VU University), Amsterdam, Netherlands
- NLR, Amsterdam, Netherlands
| | - Kidist Bobosha
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Berhanu Seyoum
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Biftu Geda
- College of Health and Medical Sciences, Department of Nursing, Meda Walebu University, Shashamane, Ethiopia
| | - Anne Schoenmakers
- NLR, Amsterdam, Netherlands
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | | | - Robin van Wijk
- NLR, Amsterdam, Netherlands
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christa Kasang
- Deutsche Lepra- und Tuberkulosehilfe e.V. (DAHW), Wurzburg, Germany
| | - Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Dharmawan Y, Fuady A, Korfage IJ, Richardus JH. Delayed detection of leprosy cases: A systematic review of healthcare-related factors. PLoS Negl Trop Dis 2022; 16:e0010756. [PMID: 36067195 PMCID: PMC9481154 DOI: 10.1371/journal.pntd.0010756] [Citation(s) in RCA: 8] [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: 01/28/2022] [Revised: 09/16/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background In new leprosy cases, grade 2 disability (G2D) is still a public health burden worldwide. It is often associated with the delayed leprosy diagnoses that healthcare systems should play a crucial role in preventing. The aim of this systematic review was to identify healthcare factors related to delays in case detection in leprosy. Methods PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) was used as a guideline in this research. The study protocol was registered in the PROSPERO (International Prospective Register of Systematic Reviews) with reference code CRD42020189274. Data was collected from five electronic databases: Embase, Medline All Ovid, Web of Science, Cochrane CENTRAL, and the WHO Global Health Library. Results After applying the selection criteria for original empirical studies, and after removing duplicates, we included 20 papers from 4313 records. They had been conducted in ten countries and published between January 1, 2000, and January 31, 2021. We identified three categories of healthcare factors related to delayed case. 1) Structural factors, such as i) financial and logistic issues, and geographical circumstances (which we classified as barriers); ii) Health service organization and management including the level of decentralization (classified as facilitators). 2) Health service factors, such as problems or shortages involving referral centers, healthcare personnel, and case-detection methods. 3) Intermediate factors, such as misdiagnosis, higher numbers of consultations before diagnosis, and inappropriate healthcare services visited by people with leprosy. Conclusions Delays in leprosy case detection are due mainly to misdiagnosis. It is crucial to improve the training and capacity of healthcare staff. To avoid misdiagnosis and reduce detection delays, national leprosy control programs should ensure the sustainability of leprosy control within integrated health services. New leprosy patients diagnosed with visible physical deformities represent a significant disease burden that also poses an important public health challenge. The physical deformities often result from long delays in case detection. Greater insight into the healthcare factors that contribute to such delays will support the development of effective prevention programs. We therefore reviewed all studies on the healthcare factors related to case-detection delay that had been published between January 1, 2000, and January 31, 2021. Twenty studies were included in our analysis. We found that misdiagnosis was a core healthcare factor related to delays. Other common factors included inappropriate health services, a high number of consultations before diagnosis; and a lack of referral centers, healthcare personnel, and case-detection methods. Detection delay was further influenced by geographical circumstances, financial and logistic issues, and health-service organization and management including the level of the decentralization of healthcare programs. Because delays in leprosy case detection are due mainly to misdiagnosis, we recommend to improve the training and capacity of healthcare staff. To avoid misdiagnosis and reduce detection delays, national leprosy control programs should ensure the sustainability of leprosy control within integrated health services.
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Affiliation(s)
- Yudhy Dharmawan
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
- * E-mail: ,
| | - Ahmad Fuady
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Primary Health Care Research and Innovation Center, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ida J. Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Akamike IC, Okedo-Alex IN, Uneke CJ, Madubueze UC, Agbo UN, Okeke IM, Ogbonnaya LU. Health workers' knowledge and practice of Isoniazid preventive treatment guidelines in health facilities in Ebonyi State, Nigeria. Malawi Med J 2022; 34:184-191. [PMID: 36406103 PMCID: PMC9641607 DOI: 10.4314/mmj.v34i3.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Isoniazid preventive therapy is recommended as part of a comprehensive HIV and AIDS care strategy. IPT is used as prophylaxis to reduce the incidence of TB in HIV-infected persons. However, its implementation has been very slow and has been influenced by several factors. This study assessed health workers' knowledge and adherence to Isoniazid Preventive Therapy guidelines. Methods This was a cross-sectional study in six health facilities providing HIV care in Ebonyi State using a semi-structured, self-administered questionnaire. Data were collected from 85 health workers working in the HIV clinics. Data were also extracted from 200 patient treatment cards. Data analysis was carried out using SPSS version 20 software. Chi-square statistics and logistic regression were carried out to determine the association between socio-demographic characteristics and knowledge as well as self-reported practice of the guideline. Result Slightly over half of the respondents (58.8%) had good knowledge of the guideline, and the majority (75.3%) self-reported that they practiced the guideline. Only 17% of the treatment cards had isoniazid prescribed and only 11% of these had patient adherence assessed. The most common challenges to implementation of the guideline cited by health workers were unavailability of isoniazid, poor awareness, patient non-adherence, poor resources, high pill burden, and lack of training. Being a doctor and more than 3 years duration of work in the clinic were predictors of good knowledge. There was no predictor of practice. Conclusion There was good knowledge and practice of the guideline from health worker self-reports, however, review of treatment card showed prescription was low. Further studies to explore and understand why there is such low prescription of INH/IPT to HIV patients despite good knowledge of healthcare professionals are recommended.
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Affiliation(s)
- Ifeyinwa Chizoba Akamike
- Department of Community Medicine, Alex Ekwueme Federal University Teaching, Hospital, Abakaliki, Ebonyi State, Nigeria, African Institute for Health Policy and Health Systems, Ebonyi State University, Nigeria
| | - Ijeoma Nkem Okedo-Alex
- Department of Community Medicine, Alex Ekwueme Federal University Teaching, Hospital, Abakaliki, Ebonyi State, Nigeria, African Institute for Health Policy and Health Systems, Ebonyi State University, Nigeria
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Nigeria
| | - Ugochukwu Chinyem Madubueze
- Department of Community Medicine, Alex Ekwueme Federal University Teaching, Hospital, Abakaliki, Ebonyi State, Nigeria, Alex Ekwueme Federal University, Ndufu Alike Ikwo, Ebonyi State, Nigeria
| | - Urudinachi Nnenne Agbo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching, Hospital, Abakaliki, Ebonyi State, Nigeria, African Institute for Health Policy and Health Systems, Ebonyi State University, Nigeria
| | - Ifeyinwa Maureen Okeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching, Hospital, Abakaliki, Ebonyi State, Nigeria, African Institute for Health Policy and Health Systems, Ebonyi State University, Nigeria
| | - Lawrence Ulu Ogbonnaya
- Department of Community Medicine, Alex Ekwueme Federal University Teaching, Hospital, Abakaliki, Ebonyi State, Nigeria, African Institute for Health Policy and Health Systems, Ebonyi State University, Nigeria, Alex Ekwueme Federal University, Ndufu Alike Ikwo, Ebonyi State, Nigeria
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Muula AS. How much has been achieved to prevent and control leprosy in Malawi since 2012? Malawi Med J 2022; 34:151. [PMID: 36406097 PMCID: PMC9641606 DOI: 10.4314/mmj.v34i3.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Gowran RJ, Clifford A, Gallagher A, McKee J, O'Regan B, McKay EA. Wheelchair and seating assistive technology provision: a gateway to freedom. Disabil Rehabil 2020; 44:370-381. [PMID: 32510246 DOI: 10.1080/09638288.2020.1768303] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: The meaning of wheelchair and seating assistive technology and the impact inappropriate provision has on people's lives from a service user's perspective within an Irish context is highlighted. There is a dearth in evidence examining the process of wheelchair and seating provision and the interconnectedness between satisfaction, performance and participation from an equality and human rights perspective. The purpose if the study is to investigate wheelchair service users' perspectives of wheelchair and seating provision in Ireland.Method: This is a mixed-methods study with an exploratory sequential design that includes two phases. During phase one, wheelchair service users were invited to take part in qualitative in-depth semi-structured interviews, which were thematically analysed and formed part of a larger ethnographic study involving multiple stakeholders in sustainable wheelchair and seating provision strategy development. In phase two, an online Survey Monkey questionnaire was distributed to obtain a wider overview of wheelchair service provision from a wheelchair service users perspective. Data obtained from the closed questions and content analysis for open comments was analysed descriptively for this phase.Results: Eight wheelchair service users agreed to participate in the interviews and 273 responded to the online survey. Thematic analysis and questionnaire frequency and content analysis revealed the vital meaning of wheelchair and seating assistive technology provision. However, bottlenecks within the system affect daily living, with qualitative data highlighting the obstruction to experiences of independent living from initial appointment to wheelchair breakdowns during daily life.Conclusion: Appropriate wheelchair and seating assistive technology provision is a basic human right, supported by the essential and embodied nature of the wheelchair as demonstrated through the wheelchair service users' perspective throughout this study. These findings highlight the impact of ad-hoc services on individual freedoms and how the overall pace of the system affects a person's ability to organise their time as an equal member of the community across the lifespan. A national review of wheelchair and seating assistive technology provision services is called for, giving consideration to access to services, assessment and delivery, follow up and management, education and training.IMPLICATIONS FOR REHABILITATIONWheelchair and seating assistive technology provision as a basic human right is misunderstood.Appropriate wheelchair and seating assistive technology provision should be provided to meet this primary need as a pre-requisite for survival.Every aspect of the wheelchair and seating provision process impacts on occupational performance, equality of opportunity and community mobility. Wheelchair and seating assistive technology professionals and providers have a responsibility to review their practice and service provision systems.
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Affiliation(s)
- Rosemary J Gowran
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Health Implementation Science and Technology, University of Limerick, Limerick, Ireland.,School of Health and Sports Science, University of the Sunshine Coast, Maroochydore, Australia.,Assisting Living and Learning (ALL), Institute Maynooth University, Maynooth, Ireland
| | - Amanda Clifford
- School of Allied Health, Faculty of Education and Health Sciences, Health Research Institute, Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Andrea Gallagher
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Jennifer McKee
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Bernadette O'Regan
- Centre for Environmental Research, University of Limerick, Limerick, Ireland
| | - Elizabeth A McKay
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
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Koffi AP, Yao TAK, Barogui YT, Diez G, Djakeaux S, Zahiri MH, Sopoh GE, Santos S, Asiedu KB, Johnson RC, Assé H. Integrated approach in the control and management of skin neglected tropical diseases in three health districts of Côte d'Ivoire. BMC Public Health 2020; 20:517. [PMID: 32303204 PMCID: PMC7164353 DOI: 10.1186/s12889-020-08632-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 04/01/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) comprise 20 communicable diseases that are prevalent in rural poor and remote communities with less access to the health system. For effective and efficient control, the WHO recommends that affected countries implement integrated control interventions that take into account the different co-endemic NTDs in the same community. However, implementing these integrated interventions involving several diseases with different etiologies, requiring different control approaches and driven by different vertical programs, remains a challenge. We report here the results and lessons learned from a pilot test of this integrated approach based on integrated screening of skin diseases in three co-endemic health districts of Côte d'Ivoire, a West African country endemic for Buruli ulcer, leprosy and yaw. METHOD This cross-sectional study took place from April 2016 to March 2017 in 3 districts of Côte d'Ivoire co-endemic for BU, leprosy and yaws. The study was carried out in 6 stages: identification of potentially co-endemic communities; stakeholder training; social mobilization; mobile medical consultations; case detection and management; and a review meeting. RESULTS We included in the study all patients with skin signs and symptoms at the screening stage who voluntarily accepted screening. In total, 2310 persons screened had skin lesions at the screening stage. Among them, 07 cases were diagnosed with Buruli ulcer. There were 30 leprosy cases and 15 yaws detected. Other types of ulcerations and skin conditions have been identified and represent the majority of cases detected. We learned from this pilot experience that integration can be successfully implemented in co-endemic communities in Côte d'Ivoire. Health workers are motivated and available to implement integrated interventions instead of interventions focused on a single disease. However, it is essential to provide capacity building, a minimum of drugs and consumables for the care of the patients identified, as well as follow-up of identified patients, including those with other skin conditions. CONCLUSIONS The results of this study show that the integration of activities can be successfully implemented in co-endemic communities under the condition of staff capacity building and minimal care of identified patients.
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Affiliation(s)
- Aboa Paul Koffi
- Programme National de Lutte contre l’Ulcère de Buruli, Abidjan, Côte d’Ivoire
| | | | - Yves Thierry Barogui
- Centre Inter Facultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d’Abomey Calavi, BP: 2733, Abomey-Calavi, Bénin
| | | | - Simplice Djakeaux
- Programme National d’Elimination de la Lèpre, Abidjan, Côte d’Ivoire
| | | | | | | | | | - Roch Christian Johnson
- Centre Inter Facultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d’Abomey Calavi, BP: 2733, Abomey-Calavi, Bénin
- Fondation Raoul Follereau, Fondation Raoul Follereau, 31 rue de Dantzig, 75015, Paris, France
| | - Henri Assé
- Programme National de Lutte contre l’Ulcère de Buruli, Abidjan, Côte d’Ivoire
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Yotsu RR. Integrated Management of Skin NTDs-Lessons Learned from Existing Practice and Field Research. Trop Med Infect Dis 2018; 3:E120. [PMID: 30441754 PMCID: PMC6306929 DOI: 10.3390/tropicalmed3040120] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/10/2018] [Accepted: 11/11/2018] [Indexed: 12/18/2022] Open
Abstract
Integration of neglected tropical diseases (NTDs) into the public health agenda has been a priority in global health for the last decade. Because a number of these diseases share not only the geographical distribution, but also a common feature which is skin involvement, bringing together a sub-group of 'skin NTDs' is one way forward to promote further integration among NTDs. With these diseases, which include leprosy, Buruli ulcer, yaws, mycetoma, lymphatic filariasis, and leishmaniasis, patients may be left with life-long deformities and disabilities when diagnosis and treatment are delayed. Stigma is another serious consequence of skin NTDs as it places a large barrier on the economic activities and social life of a patient. As a result, this creates a vicious cycle and obstructs a key goal of society, the elimination of poverty. Enhancement in surveillance systems as well as the further development of diagnostic methods, improvement in treatment and management, and identification of preventative measures for skin NTDs are therefore urgently needed. This article summarizes the existing practices and field research on skin NTDs and identifies potential synergies that could be achieved by adopting this integrated approach.
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Affiliation(s)
- Rie R Yotsu
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8102, Japan.
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
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Integrated approach in the control and management of skin neglected tropical diseases in Lalo, Benin. PLoS Negl Trop Dis 2018; 12:e0006584. [PMID: 29939988 PMCID: PMC6034899 DOI: 10.1371/journal.pntd.0006584] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/06/2018] [Accepted: 06/04/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neglected Tropical Diseases (NTDs) are a group of several communicable diseases prevalent in the tropical and subtropical areas. The co-endemicity of these diseases, the similarity of the clinical signs, and need to maximize limited financial and human resources have necessitated implementation of integrated approach. Our study aims to share the lessons of this integrated approach in the fight against Buruli ulcer (BU), leprosy and yaws in a rural district in Benin. METHODS It is a cross-sectional study using a single set of activities data conducted from May 2016 to December 2016. Health workers and community health volunteers involved in this study were trained on integrated approach of the Buruli ulcer, leprosy and yaws. Village chiefs were briefed about the activity. The trained team visited the villages and schools in the district of Lalo in Benin. After the education and awareness raising sessions, all persons with a skin lesion who presented voluntarily to the team were carefully examined in a well-lit area which respected their privacy. Suspected cases were tested as needed. The socio-demographic information and the characteristics of the lesions were collected using a form. A descriptive analysis of the epidemiological, clinical and laboratory variables of the cases was made using Excel 2013 and SPSS version 22.00. PRINCIPAL FINDINGS In the study period, 1106 people were examined. The median (IQR) age of those examined was 11 (8; 27) years. Of 34 (3.1%) suspected BU cases, 15 (1.4%) were confirmed by PCR. Only three cases of leprosy were confirmed. The 185 (16.7%) suspected cases of yaws were all negative with the rapid test. The majority of cases were other skin conditions, including fungal infections, eczema and traumatic lesions. CONCLUSION The integrated approach of skin NTD allows optimal use of resources and surveillance of these diseases. Sustaining this skin NTD integrated control will require the training of peripheral health workers not only on skin NTD but also on basic dermatology.
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Roe C, May LS. A case of leprosy in Malawi. Making the final push towards eradication: a clinical and public health perspective. Infect Dis Poverty 2016; 5:90. [PMID: 27585828 PMCID: PMC5009641 DOI: 10.1186/s40249-016-0176-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 07/20/2016] [Indexed: 11/10/2022] Open
Abstract
Statistically speaking, Malawi has achieved the World Health Organisation's target for the elimination of leprosy (<1 case per 10 000 people), yet the disease is still considered a leading cause of long term physical disability. In this case study the authors discuss the presentation of a 39-year-old gentleman to a district hospital in Malawi with multibacillary, lepromatous leprosy. The condition was initially managed in the community as an 'allergy' which suggests that local barriers currently hinder the detection of leprosy in this developing primary care system. Leprosy is a multi-system disease and this gentleman demonstrated evidence of lepromatous orchitis. Promoting an awareness of these systemic manifestations will increase the the detection of complications and circumvent long term morbidity. Efforts to optimise systems of detection, management and public and professional education are essential to drive eradication in these at-risk populations. At an international level, we must strive to fulfil the objectives outlined by the 'Enhanced Global Strategy for Further Reducing the Disease Burden due to Leprosy for 2011-2015'. At a national level, local research should delineate community factors that impede the eradication of leprosy. Developing new diagnostic and epidemiologic tools, more efficacious chemoprophylactic regimens and vaccination for endemic regions would facilitate these efforts.
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Affiliation(s)
- Cieron Roe
- Brighton and Sussex Medical School, Brighton, UK
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Nenoff P, Krüger C, Mayser P. Kutane Malassezia-Infektionen und Malassezia-assoziierte Dermatosen. Hautarzt 2015; 66:465-84; quiz 485-6. [DOI: 10.1007/s00105-015-3631-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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12
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Purtle J, Roman LA. Health awareness days: sufficient evidence to support the craze? Am J Public Health 2015; 105:1061-5. [PMID: 25879148 DOI: 10.2105/ajph.2015.302621] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Health awareness initiatives are a ubiquitous intervention strategy. Nearly 200 health awareness days, weeks, and months are on the US National Health Observances calendar, and more than 145 awareness day bills have been introduced in Congress since 2005. We contend that health awareness days are not held to appropriate scrutiny given the scale at which they have been embraced and are misaligned with research on the social determinants of health and the tenets of ecological models of health promotion. We examined health awareness days from a critical public health perspective and offer empirically supported recommendations to advance the intervention strategy. If left unchecked, health awareness days may do little more than reinforce ideologies of individual responsibility and the false notion that adverse health outcomes are simply the product of misinformed behaviors.
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Affiliation(s)
- Jonathan Purtle
- Jonathan Purtle is with the Department of Health Management & Policy, Drexel University School of Public Health, Philadelphia, PA. Leah A. Roman is with Roman Public Health Consulting LLC, Philadelphia
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