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Hailemichael Y, Novignon J, Owusu L, Okyere D, Mtuy T, Alemu AY, Ocloo EK, Koka E, Palmer J, Walker SL, Gadisa E, Kaba M, Pitt C. The role of economic factors in shaping and constituting the household burden of neglected tropical diseases of the skin: Qualitative findings from Ghana and Ethiopia. Soc Sci Med 2024; 356:117094. [PMID: 39032192 DOI: 10.1016/j.socscimed.2024.117094] [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: 11/30/2023] [Revised: 04/09/2024] [Accepted: 07/03/2024] [Indexed: 07/22/2024]
Abstract
Tracers of health system equity, neglected tropical diseases (NTDs) disproportionately affect marginalized populations. NTDs that manifest on the skin - "skin NTDs" - are associated with scarring, disfigurement, physical disability, social exclusion, psychological distress, and economic hardship. To support development and evaluation of appropriate intervention strategies, we aimed to improve understanding of the role of economic factors in shaping and constituting the burden that skin NTDs place on households. We collected data in 2021 in two predominantly rural districts: Atwima Mponua in Ghana (where Buruli ulcer, yaws, and leprosy are endemic) and Kalu in Ethiopia (where cutaneous leishmaniasis and leprosy are endemic). We conducted interviews (n = 50) and focus group discussions (n = 14) that explored economic themes with affected individuals, caregivers, and community members and analysed the data thematically using a pre-defined framework. We found remarkable commonalities across countries and diseases. We developed a conceptual framework which illustrates skin NTDs' negative economic impact, including financial costs of care-seeking and reductions in work and schooling; categorises coping strategies by their degree of risk-pooling; and clarifies the mechanisms through which skin NTDs disproportionately affect the poorest. Despite health insurance schemes in both countries, wide-ranging, often harmful coping strategies were reported. Traditional healers were often described as more accessible, affordable and offering more flexible payment terms than formal health services, except for Ethiopia's well-established leprosy programme. Our findings are important in informing strategies to mitigate the skin NTD burden and identifying key drivers of household costs to measure in future evaluations. To reduce skin NTDs' impact on households' physical, mental, and economic wellbeing, intervention strategies should address economic constraints to prompt and effective care-seeking. While financial support and incentives for referrals and promotion of insurance enrolment may mitigate some constraints, structural interventions that decentralise care may offer more equitable and sustainable access to skin NTD care.
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Affiliation(s)
| | - Jacob Novignon
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Economics, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana.
| | - Lucy Owusu
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Daniel Okyere
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Tara Mtuy
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Abebaw Yeshambel Alemu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia; Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Edmond Kwaku Ocloo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana; Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana
| | - Eric Koka
- Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana
| | - Jennifer Palmer
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Stephen L Walker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Mirgissa Kaba
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Catherine Pitt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Mendoza Martínez MG, Guadarrama Orozco J, Peláez Ballestas I. Pilgrimage in pediatric palliative care: The journey of caregivers. Soc Sci Med 2024; 343:116508. [PMID: 38242031 DOI: 10.1016/j.socscimed.2023.116508] [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: 08/03/2023] [Revised: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 01/21/2024]
Abstract
Admission of terminally ill patients into pediatric palliative care remains a challenge in Mexico and Latin America, despite the multiple benefits of early transfer. In this context the trajectories in search of health care of patients and caregivers have not been documented. Therefore, the objective of this study was to describe and analyze the experiences of primary caregivers and family members of pediatric patients in the palliative care unit of a Children's Hospital in Mexico, between October 19, 2019, and January 19, 2022. We used the framework of health pilgrimage, which comprises the transformative search of healing for patients, focusing on health barriers and the necessary displacement in search of care. With information obtained through interviews, we reconstructed the pilgrimages in search of health care navigating the Mexican healthcare system. Furthermore, we describe the experience of the primary caregiver accompanying the sick child during their journey to palliative care. We recount the adverse factors associated with this pilgrimage, such as the emotional and socioeconomic impact on primary and secondary caregivers.
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Affiliation(s)
| | - Jessica Guadarrama Orozco
- Department of Palliative Care and Quality of Life. Hospital Infantil de México "Federico Gomez", Mexico City, Mexico.
| | - Ingris Peláez Ballestas
- Rheumatology Department. Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico.
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Nogueira de Brito R, Tanner S, Runk JV, Hoyos J. Looking through the lens of social science approaches: A scoping review of leishmaniases and Chagas disease research. Acta Trop 2024; 249:107059. [PMID: 37918504 DOI: 10.1016/j.actatropica.2023.107059] [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: 08/24/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/04/2023]
Abstract
Scholars have called for increased attention to sociocultural, economic, historical, and political processes shaping Neglected Tropical Diseases (NTDs) ecology. We conducted a scoping review to identify major research themes and the knowledge gaps in social science literature in leishmaniases or Chagas disease (CD). Following the scoping review protocol, we first determined the focus of the review to be centered on identifying research that approaches leishmaniases and CD from social science perspective and was indexed by large, biomedically focused databases. We then searched PubMed and Web of Science using "Leishmaniasis" and "Chagas disease" with "social science" or "anthropology" as search terms. We analyzed 199 articles (123 on leishmaniases and 76 on CD), categorizing them into three main research themes. Sociocultural dimensions of the diseases (leishmaniases=60.2 %; CD=68.4 %) primarily focused on individuals' knowledge, practices, and behaviors, barriers to accessing healthcare (especially in endemic regions), psychosocial effects, stigma, and traditional treatments. Research focused on socioeconomic dimensions of the diseases (leishmaniases=29.3 %; CD=19.7 %) included topics like household characteristics, social capital, and infrastructure access. A final theme, the historical and political contexts of the diseases (Leishmaniases=10.5 %; CD=11.9 %) was less common than other themes. Here, studies consider civil war and the (re)emergence of leishmaniasis, as well as the significance of CD discovery for scientific and public health in Brazil, which is the most common country for research on both leishmaniases and CD that draws on social science approaches. Future directions for research include focusing on how social institutions and economic factors shape diseases education, control measures, healthcare access, and quality of life of people affected by NTDs. Greater attention to social sciences can help mitigate and undo the ways that structural biases have infiltrated biomedicine.
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Affiliation(s)
- Raíssa Nogueira de Brito
- Department of Anthropology, University of Georgia, Athens, GA 30602, United States; Center for the Ecology of Infectious Diseases, University of Georgia, Athens, GA 30602, United States.
| | - Susan Tanner
- Department of Anthropology, University of Georgia, Athens, GA 30602, United States
| | - Julie Velásquez Runk
- Environment and Sustainability Studies Program, Wake Forest University, Winston Salem, NC 27109, United States; Smithsonian Tropical Research Institute, Balboa, Ciudad de Panamá 0843-03092, Republic of Panama
| | - Juliana Hoyos
- Odum School of Ecology, University of Georgia, Athens, GA 30602, United States
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Lyra MR, Oliveira LFA, Schubach AO, Sampaio RNR, Rodrigues BC, Hueb M, Cota G, Silva RE, Francesconi F, Pompilio MA, França AO, Amato VS, Souza RM, Oliveira RVC, Valete CM, Pimentel MIF. A Randomized, Controlled, Noninferiority, Multicenter Trial of Systemic vs Intralesional Treatment With Meglumine Antimoniate for Cutaneous Leishmaniasis in Brazil. Clin Infect Dis 2023; 77:574-582. [PMID: 37100061 DOI: 10.1093/cid/ciad253] [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: 06/29/2022] [Revised: 01/30/2023] [Accepted: 04/24/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Meglumine antimoniate (MA) remains the main treatment for cutaneous leishmaniasis (CL). Uncontrolled studies suggest that intralesional MA (IL-MA) may be noninferior and safer than systemic MA (S-MA). METHODS Multicenter, randomized, controlled, open-label, phase 3 clinical trial to evaluate the efficacy and toxicity of IL-MA in 3 infiltrations at 14-day intervals compared with S-MA (10-20 mg Sb5+/kg/day, 20 days) for CL, with noninferiority margin of 20%. Primary and secondary outcomes were definitive cure at day 180 and epithelialization rate at day 90 of treatment, respectively. A 2-year follow-up was performed to assess relapses and emergence of mucosal lesions. Adverse events (AEs) were monitored according to the Division of AIDS AE grading system. RESULTS We evaluated 135 patients. The cure rates (95% confidence interval) for IL-MA and S-MA treatment were, respectively, 82.8% (70.5-91.4) and 67.8% (53.3-78.3) per protocol (PP) and 70.6% (58.3-81.0) and 59.7% (47.0-71.5) per intention to treat (ITT). The epithelialization rates of the IL-MA and S-MA treatment were, respectively, 79.3% (66.6-88 + 8) and 71.2% (57.9-82.2) PP and 69.1% (55.2-78.5) and 64.2% (50.0-74.2) ITT. AEs in the IL-MA and S-MA groups were, respectively, clinical, 45.6% and 80.6%; laboratory, 26.5% and 73.1%; and electrocardiogram, 8.8% and 25.4%. Ten participants in the S-MA group and 1 in the IL-MA group were discontinued due to severe or persistent AEs. CONCLUSIONS IL-MA provides a similar cure rate and results in less toxicity compared with S-MA and may be used as first-line therapy for CL patients. CLINICAL TRIALS REGISTRATION REBEC: RBR-6mk5n4.
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Affiliation(s)
- Marcelo R Lyra
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Liliane F A Oliveira
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Armando O Schubach
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Raimunda N R Sampaio
- Dermatology Service of Internal Medicine, Faculty of Medicine of the University of Brasília, Brasília, DF, Brazil
| | - Bruna C Rodrigues
- Dermatology Service of Internal Medicine, Faculty of Medicine of the University of Brasília, Brasília, DF, Brazil
| | - Marcia Hueb
- Internal Medicine Department, Julio Muller University Hospital, Federal University of Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Gláucia Cota
- Clinical Research and Public Policies in Infectious Diseases, René Rachou Institute, Fiocruz Minas, Belo Horizonte, MG, Brazil
| | - Rosiana E Silva
- Clinical Research and Public Policies in Infectious Diseases, René Rachou Institute, Fiocruz Minas, Belo Horizonte, MG, Brazil
| | - Fabio Francesconi
- Dermatology Department, Heitor Vieira Dourado Tropical Medicine Foundation, Manaus, AM, Brazil
- Dermatology Department, Federal University of Amazonas, Manaus, AM, Brazil
| | - Maurício A Pompilio
- Faculty of Medicine of the Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Adriana O França
- Faculty of Medicine of the Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Valdir S Amato
- Laboratory of Parasitology, Institute of Tropical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Regina M Souza
- Laboratory of Parasitology, Institute of Tropical Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Raquel V C Oliveira
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cláudia M Valete
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Department of Otorhinolaryngology and Ophthalmology, Faculty of Medicine of Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria I F Pimentel
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Wenning B, Price H, Nuwangi H, Reda KT, Walters B, Ehsanullah R, Viana G, Andras A, Dikomitis L. Exploring the cultural effects of gender on perceptions of cutaneous leishmaniasis: a systematic literature review. Glob Health Res Policy 2022; 7:34. [PMID: 36163191 PMCID: PMC9511709 DOI: 10.1186/s41256-022-00266-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/12/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND More than one million people each year become infected by parasites that cause the disease cutaneous leishmaniasis (CL). This disease manifests as one or more skin lesions or ulcers that are slow to heal with variable response rates to drug treatments. Thus far, little attention has been paid to how the cultural effects of gender shape perceptions and experiences of CL. This review aims to bring together and analyse existing studies which use qualitative data to explore these differences. These studies offered insights into our specific research questions. METHODS We conducted a systematic review of the literature pertaining to either CL or muco-cutaneous leishmaniasis (MCL) through EBSCO, EMBASE, Medline, Scopus and Web of Science databases. To meet inclusion criteria, articles had to be either qualitative or mixed-method with a qualitative component. They also had to include a reflection on how the gender of participants impacted the findings and addressed the lived experiences of CL. We did not exclude articles based on the language they were published in or in which country the study took place. RESULTS From a total of 1589 potential articles, we found that thirteen met the inclusion criteria. These articles were published in English, Spanish or Portuguese and reported on studies carried out in various countries in Africa, Asia and South America. After using the principles of a meta-ethnography to analyse these studies, we generated several key themes. We found that health-seeking behaviours, treatment choices, stigma and the impact of scarring are shaped by gender in a variety of contexts. CONCLUSIONS Gender impacts on an individual's experience of CL. In particular, women are more constricted in their health-seeking behaviours and experience more stigma both from the active lesions and from scarring than men. In many contexts, however, men are more at risk of becoming infected by the parasite that causes CL and may turn to more harmful or aggressive self-treatments. We recommend that future research on CL should consider the impact of gender as this can create very different experiences for individuals.
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Affiliation(s)
- Brianne Wenning
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, CT2 7FS, UK
| | - Helen Price
- School of Life Sciences, Keele University, Newcastle-under-Lyme, UK
| | - Hasara Nuwangi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | | | - Ben Walters
- Royal Stoke University Hospital, Stoke-on-Trent, UK
| | | | - Greice Viana
- State University of Rio de Janeiro (UERJ) and Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Alina Andras
- School of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Lisa Dikomitis
- Kent and Medway Medical School, University of Kent and Canterbury Christ Church University, Canterbury, CT2 7FS, UK.
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Bautista-Gomez MM, Doerfler J, Del Mar Castro M. Barriers to cutaneous leishmaniasis care faced by indigenous communities of rural areas in Colombia: a qualitative study. BMC Infect Dis 2022; 22:302. [PMID: 35351012 PMCID: PMC8962053 DOI: 10.1186/s12879-022-07204-w] [Citation(s) in RCA: 5] [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: 07/12/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neglected tropical diseases (NTDs) such as cutaneous leishmaniasis (CL) are often associated with rural territories and vulnerable communities with limited access to health care services. The objective of this study is to identify the potential determinants of CL care management in the indigenous communities in the rural area of the municipality of Pueblo Rico, through a people-centered approach. METHODS To achieve this goal, qualitative ethnographic methods were used, and a coding framework was developed using procedures in accordance with grounded theory. RESULTS Three dimensions that affect access to health care for CL in this population were identified: (1) contextual barriers related to geographic, economic and socio-cultural aspects; (2) health service barriers, with factors related to administration, insufficient health infrastructure and coverage, and (3) CL treatment, which covers perceptions of the treatment and issues related to the implementation of national CL treatment guidelines. This study identified barriers resulting from structural problems at the national level. Moreover, some requirements of the national guidelines for CL management in Colombia impose barriers to diagnosis and treatment. We furthermore identified cultural barriers that influence the perceptions and behavior of the community and health workers. CONCLUSIONS While the determinants to CL management are multidimensional, the most important barrier is the inaccessibility to CL treatment to the most vulnerable populations and its inadequacy for the socio-territorial setting, as it is not designed around the people, their needs and their context.
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Affiliation(s)
- Martha Milena Bautista-Gomez
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Calle 18 122-135, Campus de la Universidad Icesi (Edificio O-CIDEIM), 760031, Cali, Colombia.
- Universidad Icesi, Calle 18 122-135, Cali, Colombia.
| | - Juliane Doerfler
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Calle 18 122-135, Campus de la Universidad Icesi (Edificio O-CIDEIM), 760031, Cali, Colombia
| | - Maria Del Mar Castro
- Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Calle 18 122-135, Campus de la Universidad Icesi (Edificio O-CIDEIM), 760031, Cali, Colombia
- Universidad Icesi, Calle 18 122-135, Cali, Colombia
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Peralta MF, Usseglio NA, Bracamonte ME, Guzmán ML, Olivera ME, Marco JD, Barroso PA, Carrer DC. Efficacy of topical Miltefosine formulations in an experimental model of cutaneous leishmaniasis. Drug Deliv Transl Res 2022; 12:180-196. [PMID: 33502733 DOI: 10.1007/s13346-021-00896-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
Cutaneous leishmaniasis (CL) is a neglected tropical disease endemic in ~ 90 countries, with an increasing incidence. Presently available pharmacotherapy implies the systemic administration of moderately/very toxic drugs. Miltefosine (Milt) is the only FDA-approved drug to treat CL via the oral route (Impavido®). It produces side effects; in particular, teratogenic effects are of concern. A topical treatment would have the great advantage of minimising the systemic circulation of the drug, preventing side effects. We prepared dispersions containing Milt and liposomes of different compositions to enhance/modulate trans-epidermal penetration and evaluated in vitro and in vivo efficacy and toxicity, in vitro release rate of the drug and particles size stability with time. Treatments were topically administered to BALB/c mice infected with Leishmania (Leishmania) amazonensis. The dispersions containing 0.5% Milt eliminated 99% of the parasites and cured the lesions with a complete re-epithelisation, no visible scar and re-growth of hair. Fluid liposomes decreased the time to heal the lesion and the time needed to eliminate viable amastigotes from the lesion site. Relapse of the infection was not found 1 month after treatment in any case. Ultraflexible liposomes on the other hand had no significant in vitro effect but decreased in vivo efficacy. A topical Milt formulation including fluid liposomes seems a promising treatment against CL.
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Affiliation(s)
- Ma Florencia Peralta
- Instituto de Investigación Médica Mercedes y Martín Ferreyra, INIMEC- CONICET- UNC, 5016, Córdoba, Argentina
| | - Nadina A Usseglio
- Instituto de Investigación Médica Mercedes y Martín Ferreyra, INIMEC- CONICET- UNC, 5016, Córdoba, Argentina
- Departamento de Ciencias Farmacéuticas, UNITEFA - CONICET - Universidad Nacional de Córdoba, 5016, Córdoba, Argentina
| | - Ma Estefanía Bracamonte
- Instituto de Patología Experimental - CONICET - , Universidad Nacional de Salta, 4400, Salta, Argentina
| | - Ma Laura Guzmán
- Departamento de Ciencias Farmacéuticas, UNITEFA - CONICET - Universidad Nacional de Córdoba, 5016, Córdoba, Argentina
| | - Ma Eugenia Olivera
- Departamento de Ciencias Farmacéuticas, UNITEFA - CONICET - Universidad Nacional de Córdoba, 5016, Córdoba, Argentina
| | - J Diego Marco
- Instituto de Patología Experimental - CONICET - , Universidad Nacional de Salta, 4400, Salta, Argentina
| | - Paola A Barroso
- Instituto de Patología Experimental - CONICET - , Universidad Nacional de Salta, 4400, Salta, Argentina
| | - Dolores C Carrer
- Instituto de Investigación Médica Mercedes y Martín Ferreyra, INIMEC- CONICET- UNC, 5016, Córdoba, Argentina.
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Alidosti M, Heidari Z, Shahnazi H, Zamani-Alavijeh F. Behaviors and Perceptions Related to Cutaneous Leishmaniasis in Endemic Areas of the World: A Review. Acta Trop 2021; 223:106090. [PMID: 34389332 DOI: 10.1016/j.actatropica.2021.106090] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/18/2021] [Accepted: 08/01/2021] [Indexed: 12/13/2022]
Abstract
The investigation of perceptions and behaviors associated with cutaneous leishmaniasis (CL) in different societies has indicated that mere attention to biological and medical aspects is not enough to prevent and control diseases and it is necessary to know the disease-associated behaviors and beliefs. The present study aimed to answer a question: what are the behaviors and perceptions associated with cutaneous leishmaniasis in endemic regions of the world?. This study is a review of the articles published on CL from January 2010 to January 2021, on the International databases Science Direct, Scopus and PubMed. We utilized the terms cutaneous leishmaniasis, in combination with some keywords, including belief, perceptions, knowledge, attitude, practices, prevention, and behavior. Non-original studies, including editorials, reviews, prefaces, brief communications, and letters to the editor, CL epidemiological articles, pre-published articles that has not been peer reviewed, and articles that not provide complete findings on CL-related perceptions and behaviors were excluded from the present paper. After screening, 25 articles from 17 regions of the world were included in the study. The results depicted a novel classification of behaviors and perceptions related to CL prevention and control. Two positive and negative categories of perceptions and behaviors were discovered. Positive perceptions and behaviors were classified into five categories, including: 1- good awareness, 2- perceived susceptibility, 3- perceived severity, 4- perceived response efficiency, and 5- appropriate behaviors. Furthermore, negative perceptions and behaviors were classified into four categories: 1- poor awareness 2- misconceptions (A. About the disease vector B.about the cause of the disease, C. about the consequences of the disease and the treatment process), 3- perceived barriers (A. in prevention, B. in medical treatment), and 4- misbehaviors (A. negligence, B. local and traditional behavioral patterns). In most endemic parts of the world, misconceptions are probably the leading cause of several misbehaviors in dealing with CL. It seems that providing educational programs to strengthen positive beliefs and correct negative beliefs are rooted in the studies in different countries and could be useful for improving the relevant behaviors and ultimately, taking a step towards the prevention and control of CL.
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Affiliation(s)
- Masoumeh Alidosti
- Student Research Committee, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Shahnazi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Dinkel KA, Costa ME, Kraft TS, Stieglitz J, Cummings DK, Gurven M, Kaplan H, Trumble BC. Relationship of sanitation, water boiling, and mosquito nets to health biomarkers in a rural subsistence population. Am J Hum Biol 2020; 32:e23356. [PMID: 31821682 PMCID: PMC8018599 DOI: 10.1002/ajhb.23356] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Throughout human evolutionary history, parasites and pathogens were a major cause of mortality-modern urban life with public health infrastructure has changed disease exposure. We examine associations between boiling water, using latrines, mosquito net usage, and biomarkers among the Tsimane, a nonindustrial subsistence population with little public health infrastructure. METHODS We conducted cross sectional surveys on water, latrines, and bed nets among 507 heads of households (aged 18-92 years, median age 41 years). Regression models estimated associations between behaviors and health biomarkers (ie, white blood cell count [WBC], hemoglobin, eosinophil count, and erythrocyte sedimentation rate) adjusting for age, sex, body mass index, wealth, schooling, and distance to the nearby market town. RESULTS Latrine use is associated with 6.5% lower WBC count (β = -679.6, P = .031, SE = 314.1), 17.4% lower eosinophil counts (β = -244.7, P = .023, SE = 107.2), and reduced odds of eosinophilia (adjusted OR = 0.40, P < .019, 95% CI = 0.18-0.86). Boiling water and mosquito net use are not significantly associated with any biomarkers measured. CONCLUSIONS In a subsistence population currently undergoing epidemiological transition, we find that latrine use was associated with several objective measures of health. This suggests that relatively low cost and low maintenance public health interventions may wish to focus on latrine use, as there is unmet need and potential health benefits for those who use latrines. Additionally, while the cost is higher, public health organizations aimed at improving sanitation may be able to use minimally invasive field-collected biomarkers as a diagnostic to objectively test the efficacy of interventions with greater specificity than anthropometric measurements.
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Affiliation(s)
- Katelyn A. Dinkel
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona
| | - Megan E. Costa
- Sanford School of Family Dynamics, Arizona State University, Tempe, Arizona
| | - Thomas S. Kraft
- Department of Anthropology, University of California Santa Barbara, California, Santa Barbara
| | | | - Daniel K. Cummings
- Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Chapman University, Orange, California
| | - Michael Gurven
- Department of Anthropology, University of California Santa Barbara, California, Santa Barbara
| | - Hillard Kaplan
- Department of Health Economics and Anthropology, Economic Science Institute, Argyros School of Business and Economics, Chapman University, Orange, California
| | - Benjamin C. Trumble
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona,Center for Evolution and Medicine, Arizona State University, Tempe, Arizona
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"Cheaper and better": Societal cost savings and budget impact of changing from systemic to intralesional pentavalent antimonials as the first-line treatment for cutaneous leishmaniasis in Bolivia. PLoS Negl Trop Dis 2019; 13:e0007788. [PMID: 31693661 PMCID: PMC6834242 DOI: 10.1371/journal.pntd.0007788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 09/16/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction Cutaneous leishmaniasis (CL), endemic in Bolivia, mostly affects poor people in rainforest areas. The current first-line treatment consists of systemic pentavalent antimonials (SPA) for 20 days and is paid for by the Ministry of Health (MoH). Long periods of drug shortages and a lack of safe conditions to deliver treatment are challenges to implementation. Intralesional pentavalent antimonials (ILPA) are an alternative to SPA. This study aims to compare the cost of ILPA and SPA, and to estimate the health and economic impacts of changing the first-line treatment for CL in a Bolivian endemic area. Methods The cost-per-patient treated was estimated for SPA and ILPA from the perspectives of the MoH and society. The quantity and unit costs of medications, staff time, transportation and loss of production were obtained through a health facility survey (N = 12), official documents and key informants. A one-way sensitivity analysis was conducted on key parameters to evaluate the robustness of the results. The annual number of patients treated and the budget impact of switching to ILPA as the first-line treatment were estimated under different scenarios of increasing treatment utilization. Costs were reported in 2017 international dollars (1 INT$ = 3.10 BOB). Results Treating CL using ILPA was associated with a cost-saving of $248 per-patient-treated from the MoH perspective, and $688 per-patient-treated from the societal perspective. Switching first-line treatment to ILPA while maintaining the current budget would allow two-and-a-half times the current number of patients to be treated. ILPA remained cost-saving compared to SPA in the sensitivity analysis. Conclusions The results of this study support a shift to ILPA as the first-line treatment for CL in Bolivia and possibly in other South American countries. Cutaneous leishmaniasis is a neglected tropical disease which causes chronic skin ulcers and disproportionally affects the poorest of the poor. The current first-line treatment, based on systemic pentavalent antimonials, is quite toxic for patients but also expensive for governments and patients. Given limited budgets, national decision-makers need to know not only the efficacy of alternative treatments, but also how to maximise the population health impact of available resources. To strengthen the evidence base for the scale-up of effective NTD interventions in the era of universal health coverage, we conducted cost-effectiveness analyses and estimations of population-level impact of the implementation of intralesional pentavalent antimonials as first-line treatment for cutaneous leishmaniasis using realistic scenarios. Our results demonstrate that changing first-line treatment would have considerable economic advantages for patients due to the shorter treatment duration (savings in terms of food, accommodation, transport, productivity loss); and for the national control program due to the reduced use of drugs and staff time. In addition, this change would offer better value for money given that two-and-a-half times the current number of patients could be treated with the current expenditure level if intralesional pentavalent antimonials were offered to eligible patients.
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