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Murphy-Okpala N, Dahiru T, Eze C, Nwafor C, Ekeke N, Abdullahi S, Iyama FS, Meka A, Njoku M, Ezeakile O, Ukwaja KN, Anyaike C, Sesere O, Chukwu J. Investigation of community knowledge, attitudes and stigma towards leprosy in Nigeria: a mixed-methods study. Trans R Soc Trop Med Hyg 2024:trae050. [PMID: 39126677 DOI: 10.1093/trstmh/trae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/15/2024] [Accepted: 07/16/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Little is known about community knowledge and stigma towards leprosy in endemic settings. The aim of this study was to evaluate community knowledge, attitudes and stigma towards leprosy in Nigeria. METHODS This was a mixed-methods study consisting of a quantitative cross-sectional survey of community members and qualitative focus group discussions with community members and people affected by leprosy as well as key informant interviews with healthcare workers and community leaders. RESULTS Of the 811 survey participants, 401 (49.4%) had a poor knowledge of leprosy that was driven by cultural beliefs, fear of its contagiousness and poor knowledge of its means of transmission. The participants reported high stigma levels with a mean score of 18.96±7.73 on the Explanatory Model Interview Catalogue Community Stigma Scale and 9.39±7.03 on the Social Distance Scale. Stigma levels were influenced by age, residence, education and knowledge of leprosy. Qualitative data suggested that community members were scared of leprosy infectiousness, and local illness concepts and misconceptions informed attitudes and behaviour towards leprosy in the community. CONCLUSION Community members have a poor knowledge of, and high stigma levels towards leprosy. Culture-specific health education and behavioural change interventions are needed to address the identified gaps.
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Affiliation(s)
| | - Tahir Dahiru
- Tahir Dahiru, Medical Department, Leprosy and Tuberculosis Relief Initiative, Jos 930252 Plateau State, Nigeria
| | - Chinwe Eze
- Medical Department, RedAid Nigeria, Enugu 400001 Enugu State, Nigeria
| | - Charles Nwafor
- Medical Department, RedAid Nigeria, Enugu 400001 Enugu State, Nigeria
| | - Ngozi Ekeke
- Medical Department, RedAid Nigeria, Enugu 400001 Enugu State, Nigeria
| | - Suleiman Abdullahi
- Tahir Dahiru, Medical Department, Leprosy and Tuberculosis Relief Initiative, Jos 930252 Plateau State, Nigeria
| | - Francis S Iyama
- Medical Department, RedAid Nigeria, Enugu 400001 Enugu State, Nigeria
| | - Anthony Meka
- Medical Department, RedAid Nigeria, Enugu 400001 Enugu State, Nigeria
| | - Martin Njoku
- Medical Department, RedAid Nigeria, Enugu 400001 Enugu State, Nigeria
| | | | - Kingsley N Ukwaja
- Department of Medicine, College of Health Sciences, Ebonyi State University, Abakaliki 480214 Ebonyi State, Nigeria
- Department of Medical Physiology, College of Health Sciences, David Umahi Federal University of Health Sciences, Uburu 491101 Ebonyi State, Nigeria
| | - Chukwuma Anyaike
- National Tuberculosis and Leprosy Control Programme, Federal Ministry of Health, Abuja 900211, Nigeria
| | - Omayeli Sesere
- National Tuberculosis and Leprosy Control Programme, Federal Ministry of Health, Abuja 900211, Nigeria
| | - Joseph Chukwu
- Medical Department, RedAid Nigeria, Enugu 400001 Enugu State, Nigeria
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Pratibha, Kavita, Mehta H, Narang T, Singh S. Task sharing for the management of leprosy by nurses in a tertiary healthcare setting of Northern India. Trans R Soc Trop Med Hyg 2024; 118:376-383. [PMID: 38240067 DOI: 10.1093/trstmh/trad101] [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: 07/31/2023] [Revised: 10/19/2023] [Accepted: 01/01/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND This study aimed to assess the effectiveness of nurse-led interventions in managing leprosy due to a shortage of dermatologists and other healthcare professionals. METHODS A total of 100 leprosy patients were divided into experimental (n=50) and control groups (n=50). The intervention included face-to-face counseling by a trained nurse, motivational videos and exercise demonstrations. The control group received standard care. The primary outcome of interest was treatment adherence (Adherence to Refills and Medications Scale); other assessed outcomes included changes in perceived stigma (Stigma Assessment and Reduction of Impact scale), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder seven-item) and quality of life (WHO QOL-BREF Scale) from baseline to week 8. RESULTS The intervention group had better treatment adherence (p<0.001). At baseline, moderately severe and severe depression prevalence was 18% and 28%, respectively, and anxiety was 25%, with no intergroup differences. Anxiety significantly decreased in the intervention group (p<0.001), but depression remained similar (p=0.291). Perceived stigma improved notably, especially in disclosure of concern (p<0.001), internal stigma (p<0.001) and anticipated stigma (p<0.001). Quality of life scores improved in the intervention group vs controls. CONCLUSION Nurse-led interventions effectively enhanced quality of life and treatment adherence and reduced anxiety, depression and perceived stigma among leprosy patients. The study recommends strengthening the capacity of nurses for active involvement in leprosy care.
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Affiliation(s)
- Pratibha
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Kavita
- National Institute of Nursing Education, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh 160012, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh 160012, India
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Jockers D, Bakoubayi AW, Bärnighausen K, Bando PP, Pechar S, Maina TW, Wachinger J, Vetter M, Djakpa Y, Saka B, Gnossike P, Schröder NM, Liu S, Gadah DAY, Kasang C, Bärnighausen T. Effectiveness of Sensitization Campaigns in Reducing Leprosy-Related Stigma in Rural Togo: Protocol for a Mixed Methods Cluster Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e52106. [PMID: 38635983 PMCID: PMC11066741 DOI: 10.2196/52106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND In the global strategy to eliminate leprosy, there remains a need for early case detection to successfully interrupt transmissions. Poor knowledge about leprosy and leprosy-related stigma are key drivers of delayed diagnosis and treatment. Sensitization campaigns to inform and increase awareness among the general population are an integral part of many national neglected tropical disease programs. Despite their importance, the effectiveness of such campaigns has not been rigorously studied in the West African context. A multilingual rural setting with low health literacy in this region presents challenges to the potential impact of sensitization campaigns. OBJECTIVE The primary objective of this study is to assess the causal effect of common practice community sensitization campaigns on leprosy-related knowledge and stigma at the community level and among community health volunteers. Additionally, we will test the potential of novel educational audio tools in the 15 most prominent local languages to overcome literacy and language barriers and amplify sensitization campaigns. METHODS We will conduct a cluster randomized controlled trial using a sequential mixed methods approach in 60 rural communities across all regions of Togo, West Africa. The study features 2 intervention arms and 1 control arm, with intervention and control assignments made at the community level through randomization. Communities in intervention arm 1 will receive a sensitization campaign in line with the current Togolese national neglected tropical disease program. Communities in intervention arm 2 will receive the same sensitization campaign along with educational audio tools distributed to community households. The control arm will receive no intervention before data collection. Quantitative outcome measures on knowledge and stigma will be collected from a random sample of 1200 individuals. Knowledge will be assessed using the 9-item standardized Knowledge, Attitudes, and Practices Questionnaire. Stigma will be measured using the 7-item Social Distance Scale and the 15-item Explanatory Model Interview Catalogue Community Stigma Scale. We will estimate intention-to-treat effects at the individual level, comparing the outcomes of the intervention and control arms. In an accompanying qualitative component, we will conduct in-depth interviews with community members, community health volunteers, and health care workers in both treatment arms and the control arm to explore intervention and stigma-related experiences. RESULTS This paper describes and discusses the protocol for a mixed methods cluster randomized controlled trial. Data collection is planned to be completed in June 2024, with ongoing data analysis. The first results are expected to be submitted for publication by the end of 2024. CONCLUSIONS This trial will be among the first to test the causal effectiveness of community-based sensitization campaigns and audio tools to increase knowledge and reduce leprosy-related stigma. As such, the results will inform health policy makers, decision-makers, and public health practitioners designing sensitization campaigns in rural multilingual settings. TRIAL REGISTRATION German Clinical Trials Register DRKS00029355; https://drks.de/search/en/trial/DRKS00029355. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52106.
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Affiliation(s)
- Dominik Jockers
- Heidelberg Insititute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | | | - Kate Bärnighausen
- Heidelberg Insititute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | | | - Stefanie Pechar
- Public Health and Prevention, Technical University of Munich, Munich, Germany
| | - Teresia Wamuyu Maina
- Heidelberg Insititute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Jonas Wachinger
- Heidelberg Insititute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Mark Vetter
- Geovisualization, Technical University of Applied Sciences Würzburg-Schweinfurt, Würzburg, Germany
| | - Yawovi Djakpa
- German Leprosy and Tuberculosis Relief Association, Lomé, Togo
| | - Bayaki Saka
- Department of Dermatology, Tsévié Hospital, University of Lomé, Lomé, Togo
| | - Piham Gnossike
- National Programme for Neglected Tropical Diseases, Lomé, Togo
| | - Nora Maike Schröder
- Heidelberg Insititute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Shuyan Liu
- Department of Psychiatry and Psychotherapy (Campus Charité Mitte), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Christa Kasang
- German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | - Till Bärnighausen
- Heidelberg Insititute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
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Tora A, Bremner S, Ali O, Kinfe M, Mengiste A, Anagnostopoulou V, Fekadu A, Davey G, Semrau M. The role of a community conversation intervention in reducing stigma related to lower limb lymphoedema in Northern Ethiopia. BMC Health Serv Res 2024; 24:353. [PMID: 38504232 PMCID: PMC10949692 DOI: 10.1186/s12913-024-10864-w] [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: 10/19/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Stigma related to lower-limb lymphoedema poses a major psychosocial burden to affected persons and acts as a barrier to them accessing morbidity management and disability prevention (MMDP) services. Community Conversation (CC), which actively engages community members and disseminates health information amongst them, is believed to break the vicious cycle of stigma by enhancing disease-related health literacy at the community level. METHODS A quasi-experimental study was conducted in Northern Ethiopia to assess the role of the CC intervention in reducing stigma. In two control districts, a comprehensive and holistic MMDP care package was implemented that included physical health, mental health and psychosocial interventions, whilst in the intervention district the CC intervention was added to the MMDP care package. A total of 289 persons affected by lymphoedema and 1659 community members without lymphoedema were included in the study. RESULTS Over the course of the intervention, in all sites, community members' knowledge about the causes of lymphoedema increased, and perceived social distance and stigmatizing attitudes towards people with lymphoedema decreased in the community, whilst experienced and internalized stigma decreased amongst affected persons. There were no significant changes for perceived social support. However, the changes were greater in the control sites overall, i.e. those districts in which the holistic care package was implemented without CC. CONCLUSION The findings suggest that the CC intervention provides no additional stigma reduction when used alongside a holistic MMDP care package. Provision of comprehensive and holistic MMDP services may be adequate and appropriate to tackle stigma related to lower-limb lymphoedema in a resource-constrained setting like Ethiopia.
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Affiliation(s)
- Abebayehu Tora
- Department of Sociology, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Stephen Bremner
- Centre for Global Health Research, Brighton and Sussex Medical School (BSMS), Brighton, UK
| | - Oumer Ali
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Mersha Kinfe
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Asrat Mengiste
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Vasso Anagnostopoulou
- Centre for Global Health Research, Brighton and Sussex Medical School (BSMS), Brighton, UK
| | - Abebaw Fekadu
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Health Research, Brighton and Sussex Medical School (BSMS), Brighton, UK
| | - Gail Davey
- Centre for Global Health Research, Brighton and Sussex Medical School (BSMS), Brighton, UK
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maya Semrau
- Centre for Global Health Research, Brighton and Sussex Medical School (BSMS), Brighton, UK
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Obindo T, Eaton J, Tsaku P, Nwefoh E, Ode P, Baird T, Sunday P, Afolaranmi T. Integrated services for neglected tropical diseases and mental health: pilot study assessing acceptability, feasibility and attitudes in Benue State, Nigeria. Int Health 2023; 15:iii37-iii46. [PMID: 38118157 PMCID: PMC10732684 DOI: 10.1093/inthealth/ihad073] [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: 06/08/2022] [Revised: 01/30/2023] [Accepted: 08/06/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND The World Health Organization recommends person-centred and integrated care for mental health of people with Neglected Tropical Diseases. This study assesses the feasibility and acceptability of mental health care for people with NTDs, which integrated mental health care into primary health care services, in central Nigeria. METHODS People affected by NTDs were screened for depression and anxiety, and those identified referred to the integrated service. Following their use of the service, Focus Group Discussions were held with service users and carers, and Key Informant Interviews with health service providers. Service providers were also interviewed on attitudes, before and after training with the WHO mhGAP Intervention Guide. RESULTS In general service users reported satisfaction with the services, which they found to be dignified and accessible. They expressed concern about affordability, and waiting times. Providers also felt the service was acceptable. System gaps were identified, for example in health information systems and supervision. Poor political will threatened sustainability. CAMI scores did not change with mhGAP training. CONCLUSION Locally designed services that support mental health of people with NTDs can be integrated into primary care. Weak basic infrastructure and lack of investment are barriers to sustainability and potential effectiveness. CONTEXTE L'Organisation mondiale de la santé recommande des soins centrés sur la personne et intégrés pour la santé mentale des personnes atteintes de maladies tropicales négligées. Cette étude évalue la faisabilité et l'acceptabilité des soins de santé mentale pour les personnes atteintes de MTN, qui ont intégré les soins de santé mentale dans les services de soins de santé primaires, dans le centre du Nigeria. Cette étude évalue la faisabilité et l'acceptabilité des soins de santé mentale pour les personnes atteintes de MTN, qui intègrent les soins de santé mentale dans les services de soins de santé primaires, au centre du Nigeria. MÉTHODES UTILISÉES Les personnes atteintes de MTN ont fait l'objet d'un dépistage de la dépression et de l'anxiété, et celles qui ont été identifiées ont été orientées vers le service intégré. Après leur utilisation du service, des discussions de groupe ont été organisées avec les utilisateurs du service et les soignants, et des entretiens avec des informateurs clés avec des prestataires de services de santé. Les prestataires de services ont également été interrogés sur leurs attitudes, avant et après la formation au guide d'intervention mhGAP de l'OMS. RÉSULTATS En général, les utilisateurs des services se sont déclarés satisfaits des services, qu'ils ont trouvés dignes et accessibles. Ils ont exprimé des inquiétudes quant à l'accessibilité financière et aux temps d'attente. Les prestataires ont également estimé que le service était acceptable. Des lacunes ont été identifiées dans le système, par exemple dans les systèmes d'information sanitaire et la supervision. Le manque de volonté politique a menacé la viabilité des services. Les scores CAMI restent inchangés suite à la formation au mhGAP. CONCLUSION Des services de santé mentale conçus localement pour venir en aide aux personnes atteintes de MTN peuvent être intégrés aux soins primaires. La qualité de l'infrastructure de base et le manque d'investissement sont les obstacles principaux à la durabilité et à l'efficacité potentielle de ces interventions. ANTECEDENTES La Organización Mundial de la Salud recomienda una atención centrada en la persona e integrada para la salud mental de las personas con Enfermedades Tropicales Desatendidas. Este estudio evalúa la viabilidad y aceptabilidad de la atención a la salud mental de las personas con ETD, que integra la atención a la salud mental en los servicios de atención primaria, en Nigeria central. MÉTODOS Las personas afectadas por ETD fueron examinadas para detectar depresión y ansiedad, y las identificadas fueron derivadas al servicio integrado. Tras su utilización del servicio, se celebraron debates de grupos focales con los usuarios y cuidadores del servicio, y entrevistas a informantes clave con los proveedores de servicios sanitarios. También se entrevistó a los proveedores de servicios sobre sus actitudes, antes y después de la formación con la Guía de Intervención mhGAP de la OMS. RESULTADOS En general, los usuarios se mostraron satisfechos con los servicios, que consideraron dignos y accesibles. Expresaron su preocupación por la asequibilidad y los tiempos de espera. Los proveedores también consideraron que el servicio era aceptable. Se detectaron deficiencias en el sistema, por ejemplo en los sistemas de información sanitaria y la supervisión. La escasa voluntad política amenazaba la sostenibilidad. Las puntuaciones CAMI no cambiaron con la formación mhGAP. CONCLUSIÓN Los servicios diseñados localmente para apoyar la salud mental de las personas con ETD pueden integrarse en la atención primaria. La debilidad de la infraestructura básica y la falta de inversión son obstáculos para la sostenibilidad y la eficacia potencial.
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Affiliation(s)
- Taiwo Obindo
- Department of Psychiatry, University of Jos, Plateau State, Nigeria
| | - Julian Eaton
- CBM Global and Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Paul Tsaku
- The Leprosy Mission Nigeria, Fort Royal Homes Estate, 12 King's Drive, Lugbe, Abuja, Nigeria
| | - Emeka Nwefoh
- CBM Global Country Office, 8 Huambo Crescent, Wuse 7, Abuja, Nigeria
| | - Philip Ode
- CBM Global Country Office, 8 Huambo Crescent, Wuse 7, Abuja, Nigeria
| | | | - Pius Sunday
- The Leprosy Mission Nigeria, Fort Royal Homes Estate, 12 King's Drive, Lugbe, Abuja, Nigeria
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Davis A, Stringer KL, Drainoni ML, Oser CB, Knudsen HK, Aldrich A, Surratt HL, Walker DM, Gilbert L, Downey DL, Gardner SD, Tan S, Lines LM, Vandergrift N, Mack N, Holloway J, Lunze K, McAlearney AS, Huerta TR, Goddard-Eckrich DA, El-Bassel N. Community-level determinants of stakeholder perceptions of community stigma toward people with opioid use disorders, harm reduction services and treatment in the HEALing Communities Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104241. [PMID: 37890391 PMCID: PMC10841835 DOI: 10.1016/j.drugpo.2023.104241] [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: 07/17/2023] [Revised: 09/16/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Community stigma toward people with opioid use disorder (OUD) can impede access to harm reduction services and treatment with medications for opioid use disorder (MOUD). Such community OUD stigma is partially rooted in community-level social and economic conditions, yet there remains a paucity of large-scale quantitative data examining community-level factors associated with OUD stigma. We examined whether rurality, social inequity, and racialized segregation across communities from four states in the HEALing Communities Study (HCS) were associated with 1) greater perceived community stigma toward people treated for OUD, 2) greater perceived intervention stigma toward MOUD, and 3) greater perceived intervention stigma toward naloxone by community stakeholders in the HCS. METHODS From November 2019-January 2020, a cross-sectional survey about community OUD stigma was administered to 801 members of opioid overdose prevention coalitions across 66 communities in four states prior to the start of HCS intervention activities. Bivariate analyses assessed pairwise associations between community rural/urban status and each of the three stigma variables, using linear mixed effect modeling to account for response clustering within communities, state, and respondent sociodemographic characteristics. We conducted similar bivariate analyses to assess pairwise associations between racialized segregation and social inequity. RESULTS On average, the perceived community OUD stigma scale score of stakeholders from rural communities was 4% higher (β=1.57, SE=0.7, p≤0.05), stigma toward MOUD was 6% higher (β=0.28, SE=0.1, p≤0.05), and stigma toward naloxone was 10% higher (β=0.46, SE=0.1, p≤0.01) than among stakeholders from urban communities. No significant differences in the three stigma variables were found among communities based on racialized segregation or social inequity. CONCLUSION Perceived community stigma toward people treated for OUD, MOUD, and naloxone was higher among stakeholders in rural communities than in urban communities. Findings suggest that interventions and policies to reduce community-level stigma, particularly in rural areas, are warranted.
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Affiliation(s)
- Alissa Davis
- Columbia University School of Social Work, New York, NY, United States.
| | - Kristi Lynn Stringer
- Department of Health and Human Performance, Community and Public Health, Middle Tennessee State University, Murfreesboro, TN, United States
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, MA, United States; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, United States
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, KY, United States
| | - Hannah K Knudsen
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Alison Aldrich
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Hilary L Surratt
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Daniel M Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Louisa Gilbert
- Columbia University School of Social Work, New York, NY, United States
| | - Dget L Downey
- Columbia University School of Social Work, New York, NY, United States
| | - Sam D Gardner
- Columbia University School of Social Work, New York, NY, United States
| | - Sylvia Tan
- RTI International, Research Triangle Park, NC, United States
| | - Lisa M Lines
- RTI International, Research Triangle Park, NC, United States
| | | | - Nicole Mack
- RTI International, Research Triangle Park, NC, United States
| | - JaNae Holloway
- RTI International, Research Triangle Park, NC, United States
| | - Karsten Lunze
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, MA, United States
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | | | - Nabila El-Bassel
- Columbia University School of Social Work, New York, NY, United States
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Dharmawan Y, Korfage IJ, Abqari U, Widjanarko B, Richardus JH. Measuring leprosy case detection delay and associated factors in Indonesia: a community-based study. BMC Infect Dis 2023; 23:555. [PMID: 37626291 PMCID: PMC10464084 DOI: 10.1186/s12879-023-08552-x] [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: 05/20/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Leprosy is a public health burden in Indonesia with a high number of new cases every year and a high proportion of disability among new cases. Case detection delay (CDD) can contribute to ongoing transmission and increased disability chances among leprosy patients. This study aimed to establish the CDD of leprosy and the factors associated with detection delay in Indonesia. METHOD Community-based study with a cross-sectional design. Data were collected through interviews about sociodemographic and behavioral factors, anticipated stigma, and duration of CDD. Leprosy classification and case detection methods were obtained from health service records. A random sample was taken of 126 leprosy patients registered between 1st October 2020 and 31st March 2022 in the Tegal regency in the Central Java Province. Data were analysed by descriptive and analytical statistics using multiple linear regression. RESULTS The mean CDD, patient delay, and health system delay were 13.0 months, 9.7 months, and 3.2 months, respectively. Factors associated with longer CDD are younger age (below 35 years), male, found through passive case detection, and not having a family member with leprosy. Factors associated with longer patient delay were being younger (below 35 years), being male, not having a family member with leprosy, and anticipated stigma of leprosy. It was not possible to reliably identify factors associated with health system delay. CONCLUSION CDD in leprosy should be reduced in Indonesia. The Indonesian National Leprosy Control Program (NLCP) is advised to adopt an integrated intervention programme combining active case detection with targeted health education to reduce CDD and thereby preventing disabilities in people affected by leprosy.
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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.
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ulfah Abqari
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- NLR Indonesia, Jakarta, Indonesia
| | - Bagoes Widjanarko
- Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Yotsu RR, Fuller LC, Murdoch ME, van Brakel WH, Revankar C, Barogui MYT, Postigo JAR, Dagne DA, Asiedu K, Hay RJ. A global call for action to tackle skin-related neglected tropical diseases (skin NTDs) through integration: An ambitious step change. PLoS Negl Trop Dis 2023; 17:e0011357. [PMID: 37319139 PMCID: PMC10270348 DOI: 10.1371/journal.pntd.0011357] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
On 8 June 2022, the World Health Organization (WHO) released pivotal guidance, "Ending the neglect to attain the Sustainable Development Goals: A strategic framework for integrated control and management of skin-related neglected tropical diseases." Skin-related neglected tropical diseases, or skin NTDs, comprise a group of NTDs that produce signs and symptoms on the skin and include at least 9 diseases or disease groups. Moving away from disease-specific approaches, it is anticipated that synergies will be identified and integrated building on this shared feature, where possible, to achieve a greater health impact. This paper intends to draw attention to the prospects created by this scheme. The framework is a key basis for a proposal produced by WHO dedicated to skin NTD integration and describes the practical opportunities for this evolving strategy. It underlines the wider health benefits that will follow, thus working towards Universal Health Coverage and skin health for all.
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Affiliation(s)
- Rie R. Yotsu
- Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - L. Claire Fuller
- International Foundation for Dermatology, London, United Kingdom
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Michele E. Murdoch
- Department of Dermatology, West Herts Teaching Hospitals NHS Trust, Watford General Hospital, Watford, United Kingdom
| | | | - Chandrakant Revankar
- Elimination of NTDs (Independent), North Brunswick, New Jersey, United States of America
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Beitollahi M, Forouzi MA, Tirgari B, Jahani Y. Fatigue, stigma, and mood in patients with multiple sclerosis: effectiveness of guided imagery. BMC Neurol 2022; 22:152. [PMID: 35459106 PMCID: PMC9024285 DOI: 10.1186/s12883-022-02677-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background and objectives The present study aimed to assess the effectiveness of guided imagery on fatigue, stigma, and mood in patients with multiple sclerosis. Methods This clinical trial is a double-blind study that was conducted on 60 patients with multiple sclerosis referred to the largest center for special diseases in the southeast of Iran in 2020. The convenience sampling method was used to select the participants who were later divided into two groups of intervention (n = 30) and control (n = 30) using block randomization method. The intervention group listened to the guided imagery audio file at home for 25 min. The control group did not receive any intervention. Data were collected by demographic information questionnaires, Fatigue Severity Scale (FSS), Reece Stigma Scale for Multiple Sclerosis (RSS-MS), and the Profile of Mood States (POMS) before and one month after the intervention. Results According to the results, there was no significant difference between the two groups before the intervention in terms of the score of fatigue (P < 0.0 = 67), stigma (P < 0.64), and mood (P < 0.17). However, after the intervention, a significant differences was observed in this regard (P < 0.0001). In the intervention group, the mean score of fatigue decreased from 59.72 ± 18.32 to 35.8 ± 16.15, and the mean score of stigma decreased from 17.31 ± 15.62 to 5.09 ± 8.06, showing a significant reduction in the levels of fatigue (P < 0.0001) and stigma (P < 0.0001) compared to before intervention. Also, the mean score of mood decreased from 36.90 ± 12.21 to 28.55 ± 11.87, indicating an improvement in the mood of samples in the intervention group (P < 0.0001). Conclusions The results indicated that guided imagery, as a cost-effective method, can decrease the fatigue and stigma, and enhance the mood of patients with MS. Therefore, nursing staff can use this method to improve MS patients’ mood and decrease their fatigue and stigma.
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Affiliation(s)
- Mina Beitollahi
- Department of Medical Surgical Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Batool Tirgari
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.
| | - Yunes Jahani
- Modelling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Timothy JWS, Pullan RL, Yotsu RR. Methods and Approaches for Buruli Ulcer Surveillance in Africa: Lessons Learnt and Future Directions. Methods Mol Biol 2022; 2387:87-102. [PMID: 34643905 DOI: 10.1007/978-1-0716-1779-3_10] [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] [Indexed: 06/13/2023]
Abstract
Over 95% of the global burden of Buruli ulcer disease (BU) caused by Mycobacterium ulcerans occurs in equatorial Africa. National and sub-national programs have implemented various approaches to improve detection and reporting of incident cases over recent decades. Regional incidence rates are currently in decline; however, surveillance targets outlined in 2012 by WHO have been missed and detection bias may contribute to these trends. In light of the new 2030 NTD roadmap and disease-specific targets, BU programs are required to strengthen case detection and begin a transition towards integration with other skin-NTDs. This transition comes with new opportunities to enhance existing BU surveillance systems and develop novel approaches for implementation and evaluation.In this review, we present a breakdown and assessment of the methods and approaches that have been the pillars of BU surveillance systems in Africa: (1) Passive case detection, (2) Data systems, (3) Clinical training, (4) Active case finding, (5) Burden estimation, and (6) Laboratory confirmation pathways. We discuss successes, challenges, and relevant case studies before highlighting opportunities for future development and evaluation including novel data collection tools, risk-based surveillance, and integrated skin-NTD surveillance. We draw on both experience and available literature to critically evaluate methods of BU surveillance in Africa and highlight new approaches to help achieve 2030 roadmap targets.
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Affiliation(s)
- Joseph W S Timothy
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel L Pullan
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Rie R Yotsu
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan.
- Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, USA.
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Sommer R, Weinberger NA, Von Spreckelsen R, Mrowietz U, Schielein MC, Luck-Sikorski C, Augustin M. A Structured Intervention for Medical Students Significantly Improves Awareness for Stigmatisation in Visible Chronic Skin Diseases: A Randomised Controlled Trial. Acta Derm Venereol 2021; 102:adv00641. [PMID: 34904689 PMCID: PMC9631292 DOI: 10.2340/actadv.v101.894] [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] [Indexed: 11/26/2022] Open
Abstract
People with visible skin diseases often experience stigmatisation. The aim of this study was to develop and evaluate a new intervention for medical students to counter the stigmatisation of people with skin diseases. The intervention was evaluated using a randomised controlled design. Effectiveness was assessed at 3 time points. Data from 127 participants were analysed. Regarding the outcome “social distance”, a significant difference between the measurement points was observed for the intervention group (χ2(2) = 54.32, p < 0.001), which also showed a significant effect on agreement with negative stereotypes (F(1.67, 118.67) = 23.83, p < 0.001, partial η2 = 0.25). Regarding the outcome “agreement with disease-related misconceptions”, a significant difference between the measurement time points was observed for the intervention group (χ2(2) = 46.33, p < 0.001); similar results were found for the outcome “stigmatising behaviour” (F(1.86, 131.89) = 6.16, p = 0.003, partial η2 = 0.08). The results should encourage medical faculties to invest in such courses in order to prevent stigmatisation of people with skin diseases.
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Affiliation(s)
- Rachel Sommer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, DE-20246 Hamburg, Germany.
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Dharmawan Y, Fuady A, Korfage I, Richardus JH. Individual and community factors determining delayed leprosy case detection: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009651. [PMID: 34383768 PMCID: PMC8360380 DOI: 10.1371/journal.pntd.0009651] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022] Open
Abstract
Background The number of new leprosy cases is declining globally, but the disability caused by leprosy remains an important disease burden. The chance of disability is increased by delayed case detection. This review focusses on the individual and community determinants of delayed leprosy case detection. Methods This study was conducted according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The study protocol is registered in PROSPERO (code: CRD42020189274). To identify determinants of delayed detection, data was collected from five electronic databases: Embase.com, Medline All Ovid, Web of Science, Cochrane CENTRAL, and the WHO Global Health Library. Results We included 27 papers from 4315 records assessed. They originated in twelve countries, had been published between January 1, 2000, and January 31, 2021, and described the factors related to delayed leprosy case detection, the duration of the delayed case, and the percentage of Grade 2 Disability (G2D). The median delay in detection ranged from 12 to 36 months, the mean delay ranged from 11.5 to 64.1 months, and the percentage of G2D ranged from 5.6 to 43.2%. Health-service-seeking behavior was the most common factor associated with delayed detection. The most common individual factors were older age, being male, having a lower disease-symptom perception, having multibacillary leprosy, and lack of knowledge. The most common socioeconomic factors were living in a rural area, performing agricultural labor, and being unemployed. Stigma was the most common social and community factor. Conclusions Delayed leprosy case detection is clearly correlated with increased disability and should therefore be a priority of leprosy programs. Interventions should focus on determinants of delayed case detection such as health-service-seeking behavior, and should consider relevant individual, socioeconomic, and community factors, including stigmatization. Further study is required of the health service-related factors contributing to delay. Leprosy remains an important public health problem with many new leprosy patients diagnosed with visible physical deformities, indicating a long delay in the detection of cases. For effective prevention programs, it is important to know the factors at the level of the individual and the community that contribute to the delay. We reviewed all published studies that reported individual and community factors related to delayed case detection in leprosy and included 27 studies in our analysis, published between January 1, 2000, and January 31, 2021. Health-service-seeking behavior was the most common factor associated with delay in case detection. The most common individual factors were older age, being male, having a lower disease-symptom perception, having multibacillary leprosy, and lack of knowledge about leprosy. The most common socioeconomic factors were living in a rural area, performing agricultural labor, and being unemployed. Stigma was the most common social and community factor associated with detection delay. The presence of physical disability in newly diagnosed leprosy patients is clearly related to the delay in detecting these patients. Leprosy control interventions should take factors related to detection delay into account more comprehensively. Also, there is a need to study health service-related factors that contribute to detection delay of leprosy patients.
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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: , (YD)
| | - 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
| | - Ida 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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Weinberger NA, Mrowietz S, Luck-Sikorski C, von Spreckelsen R, John SM, Sommer R, Augustin M, Mrowietz U. Effectiveness of a structured short intervention against stigmatisation in chronic visible skin diseases: Results of a controlled trial in future educators. Health Expect 2021; 24:1790-1800. [PMID: 34318568 PMCID: PMC8483191 DOI: 10.1111/hex.13319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/06/2021] [Accepted: 07/01/2021] [Indexed: 12/03/2022] Open
Abstract
Background Chronic visible skin diseases are highly prevalent, and patients affected frequently report feeling stigmatised. Interventions to reduce stigmatisation are rare. Objectives This study aimed to evaluate the effectiveness of a structured short intervention in reducing stigmatising attitudes towards psoriasis in future educators. Methods The intervention consisted of four components: (1) self‐reflection, (2) education on skin diseases, (3) contact between participants and a person with psoriasis and (4) practising of knowledge via case studies. A quasi‐experimental, pre–post study design was chosen with a nonrandomized contemporaneous control group that attended regular lessons. The main outcomes were participants' desire for social distance, stereotype endorsement, illness‐related misconceptions and intended behaviour. Intervention effects were analysed using mixed repeated‐measures analysis of variance, with Bonferroni post‐hoc tests for pairwise comparisons. Results The sample consisted of 221 students attending vocational training as educators (n = 118 intervention group, n = 103 control group). While no effect of the intervention was found in social distance, small to large effect sizes were observed for intended behaviour (r = .14), illness‐related misconceptions (r = .28) and stereotype endorsement (r = .42). The intervention group reported significantly higher satisfaction with the seminar compared to the control group. Conclusions Overall, the short intervention was effective at reducing stigmatising attitudes in future educators. In perspective, revised versions could help in reducing stigmatisation in various demographics and promote patient empowerment by acknowledging and including them as experts on their own behalf. Patient or Public Contribution Patient advocate groups were consulted and involved in the superordinate destigmatization research programme and intervention.
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Affiliation(s)
- Natascha-Alexandra Weinberger
- Research Group: Chronic Diseases and Psychological Health (COPE), University of Applied Health Sciences SRH Gera, Gera, Germany
| | - Sonja Mrowietz
- Vocational College for Social Pedagogy, RBZ Koenigsweg, Kiel, Germany
| | - Claudia Luck-Sikorski
- Research Group: Chronic Diseases and Psychological Health (COPE), University of Applied Health Sciences SRH Gera, Gera, Germany
| | - Regina von Spreckelsen
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sven M John
- Department of Dermatology, Environmental Medicine, Health Theory, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrueck, Osnabrueck, Germany
| | - Rachel Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ulrich Mrowietz
- Psoriasis-Center at the Department of Dermatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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van Netten WJ, van Dorst M, Waltz M, Pandey B, Aley D, Choudhary R, van Brakel W. Mental wellbeing among people affected by leprosy in the Terai region, Nepal. LEPROSY REV 2021. [DOI: 10.47276/lr.92.1.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Van't Noordende AT, Lisam S, Ruthindartri P, Sadiq A, Singh V, Arifin M, van Brakel WH, Korfage IJ. Leprosy perceptions and knowledge in endemic districts in India and Indonesia: Differences and commonalities. PLoS Negl Trop Dis 2021; 15:e0009031. [PMID: 33476343 PMCID: PMC7853455 DOI: 10.1371/journal.pntd.0009031] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 02/02/2021] [Accepted: 12/02/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Understanding how knowledge, attitudes and practices regarding leprosy differ in endemic countries can help us develop targeted educational and behavioural change interventions. This study aimed to examine the differences and commonalities in and determinants of knowledge, attitudes, practices and fears regarding leprosy in endemic districts in India and Indonesia. PRINCIPLE FINDINGS A cross-sectional mixed-methods design was used. Persons affected by leprosy, their close contacts, community members and health workers were included. Through interview-administered questionnaires we assessed knowledge, attitudes, practices and fears with the KAP measure, EMIC-CSS and SDS. In addition, semi-structured interviews and focus group discussions were conducted. The quantitative data were analysed using stepwise multivariate regression. Determinants of knowledge and stigma that were examined included age, gender, participant type, education, occupation, knowing someone affected by leprosy and district. The qualitative data were analysed using open, inductive coding and content analysis. We administered questionnaires to 2344 participants (46% from India, 54% from Indonesia) as an interview. In addition, 110 participants were interviewed in-depth and 60 participants were included in focus group discussions. Knowledge levels were low in both countries: 88% of the participants in India and 90% of the participants in Indonesia had inadequate knowledge of leprosy. In both countries, cause, mode of transmission, early symptoms and contagiousness of leprosy was least known, and treatment and treatability of leprosy was best known. In both countries, health workers had the highest leprosy knowledge levels and community members the highest stigma levels (a mean score of up to 17.4 on the EMIC-CSS and 9.1 on the SDS). Data from the interviews indicated that people were afraid of being infected by leprosy. Local beliefs and misconceptions differed, for instance that leprosy is in the family for seven generations (Indonesia) or that leprosy is a result of karma (India). The determinants of leprosy knowledge and stigma explained 10-29% of the variability in level of knowledge and 3-10% of the variability in level of stigma. CONCLUSION Our findings show the importance of investigating the perceptions regarding leprosy prior to educational interventions in communities: even though knowledge levels were similar, local beliefs and misconceptions differed per setting. The potential determinants we included in our study explained very little of the variability in level of knowledge and stigma and should be explored further. Detailed knowledge of local knowledge gaps, beliefs and fears can help tailor health education to local circumstances.
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Affiliation(s)
| | | | | | | | | | | | | | - Ida J Korfage
- Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Govindasamy K, Jacob I, Solomon RM, Darlong J. Burden of depression and anxiety among leprosy affected and associated factors-A cross sectional study from India. PLoS Negl Trop Dis 2021; 15:e0009030. [PMID: 33481790 PMCID: PMC7857628 DOI: 10.1371/journal.pntd.0009030] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 02/03/2021] [Accepted: 12/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leprosy is a Neglected Tropical Diseases (NTDs) known to cause stigma and discrimination in low-and middle-income countries. It often results in visible impairments, thus pre-disposing to poor mental health. Aim of the study was to estimate the prevalence of depression and anxiety among people affected by Leprosy and to determine the associated factors. METHODOLOGY/PRINCIPAL FINDINGS A multi-centric, cross-sectional study was carried out in four leprosy endemic states of India-Chhattisgarh, Maharashtra, West Bengal and Tamil Nadu in randomly selected blocks (a sub-unit of district), from one district in each state. From selected blocks those registered for leprosy treatment at public health or referral centres, people above the age of 18 years were interviewed with PHQ-9 and GAD-7 questionnaires for Depression and Anxiety, respectively. Disease profile like leprosy classification, deformity grade, number and site of the patches and socio-economic status were collected along with individual data. Of the total 220 respondents, prevalence of depression and anxiety symptoms was, 33% (73) and 19% (42), respectively. Presence of disability (47%) and Female gender (46%) were significantly associated with depression. Presence of disability (32%), Lower income group (27%) and low education (22%) were significantly associated with symptoms of anxiety. As the severity of disability increased, risk of developing depression and anxiety increased. CONCLUSION The study indicates that more than 30% of people affected by leprosy have mental health problems, which emphasizes the importance of mental health care services in leprosy. Women, those who had lower level of education, those belonging to lower socio-economic status and those with any level of disability due to leprosy are at risk of developing depression and/or anxiety. The study concludes more attention to be paid to the categories identified to be at risk.
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Affiliation(s)
| | - Immanuel Jacob
- Counselling department, TLM Community Hospital, Vadathorasalur, Tamil Nadu, India
| | | | - Joydeepa Darlong
- Research Domain, The Leprosy Mission Trust India, New Delhi, India
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Mieras L, Singh M, Manglani P, Arif M, Banstola N, Pandey B, Budiawan T, Utami R, Wibowo T, Iswandi A, Peters R, van Brakel W. A single dose of rifampicin to prevent leprosy; quantitative analysis of impact on perception, attitudes and behaviour of persons affected, contacts and community members towards leprosy in India, Nepal and Indonesia. LEPROSY REV 2020. [DOI: 10.47276/lr.91.4.314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Martos-Casado G, Gil-González D, Vives-Cases C. Gender perspective in leprosy programs: A critical literature review. LEPROSY REV 2020. [DOI: 10.47276/lr.91.4.300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sianturi EI, Latifah E, Probandari A, Effendy C, Taxis K. Daily struggle to take antiretrovirals: a qualitative study in Papuans living with HIV and their healthcare providers. BMJ Open 2020; 10:e036832. [PMID: 32988944 PMCID: PMC7523200 DOI: 10.1136/bmjopen-2020-036832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The aim of the study was to explore the experiences of Papuans living with HIV to take antiretroviral therapy (ART) from the patient and the healthcare providers (HCPs) perspective. DESIGN This was a qualitative study covering all five tribes located in Papua Provinces one of two Indonesian provinces on Papua Island. Semistructured interviews were conducted with Papuans living with HIV and their HCPs. Interviews were transcribed verbatim and coded to find themes. RESULTS Overall, we conducted interviews with 13 Papuans living with HIV (mean age: 33 years, 61% female) and 14 HCPs (mean age: 42 years, 64% female) within five customary areas. HCPs included three physicians, nine nurses, two others. Two main themes were identified: (1) personal factors and (2) healthcare environment-related factors. Personal factors were beliefs and knowledge of ART, stigma from family, community and HCPs as well as practical problems such as transportation because of long distance. Within the theme of healthcare environment, the competences and attitudes of HCPs were particularly relevant. The findings are important in refining HIV treatment strategies implemented in Papua, especially when extending HIV care provided by community centres. CONCLUSIONS Despite free access to ART, Papuans living with HIV struggle to remain on treatment. Considering local culture and religion in strategies to reduce stigma should be a priority.
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Affiliation(s)
- Elfride Irawati Sianturi
- Groningen Research Institute of Pharmacy Unit PharmacoTherapy, -Epidemiology & -Economics (PTEE), Groningen University, Faculty of Mathematics and Natural Sciences, Groningen, The Netherlands
- Department of Pharmacy,Faculty of Mathematics and Natural Sciences, University Cenderawasih, Jayapura, Indonesia
| | - Elmiawati Latifah
- Department of Pharmacy, Faculty of Health Science, Universitas Muhammadiyah Magelang, Magelang, Indonesia
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Jawa Tengah, Indonesia
| | - Christantie Effendy
- School of Nursing, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Katja Taxis
- Groningen Research Institute of Pharmacy Unit PharmacoTherapy, -Epidemiology & -Economics (PTEE), Groningen University, Faculty of Mathematics and Natural Sciences, Groningen, The Netherlands
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Kuper H. Neglected tropical diseases and disability-what is the link? Trans R Soc Trop Med Hyg 2020; 113:839-844. [PMID: 30892653 PMCID: PMC6903791 DOI: 10.1093/trstmh/trz001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/13/2018] [Accepted: 01/17/2019] [Indexed: 01/05/2023] Open
Abstract
Neglected tropical diseases (NTDs) are a diverse group of infectious conditions that vary in their epidemiology, impact and control. They are among the most common conditions globally, affecting approximately one billion people. Many NTDs have long-term consequences, such as visual and physical impairments. As a result, people with NTDs may have difficulties in carrying out activities or participating in society—in other words, NTDs can cause disabilities. Additionally, NTDs are often strongly linked to stigma and can have mental health consequences. It is therefore important to incorporate rehabilitation within NTD programmes. Rehabilitation can be conceptualized narrowly in terms of the provision of clinical services (e.g. physiotherapy and assistive devices) or, more broadly, including efforts to improve employment, overcome stigma and enhance social participation of people with disabilities. Approximately 15% of the global population has a disability, and this large group must be considered when designing NTD programmes. Improving the inclusion of people with disabilities may require adaptations to NTD programmes, such as making them physically accessible or training staff about disability awareness. Without incorporating disability within NTD programmes, the quality of life of people with NTDs will suffer and global targets for elimination and management of NTDs will not be met.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
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Budiawan T, Ferdiana A, Daendel S, Widayati R, de Hart J, Soesman M, Mieras L. “We are not afraid anymore…” Capturing the most significant change of the Leprosy Friendly Village approach in North Sulawesi, Indonesia. LEPROSY REV 2020. [DOI: 10.47276/lr.91.2.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Smythe T, Adelson JD, Polack S. Systematic review of interventions for reducing stigma experienced by children with disabilities and their families in low‐ and middle‐income countries: state of the evidence. Trop Med Int Health 2020; 25:508-524. [DOI: 10.1111/tmi.13388] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Tracey Smythe
- London School of Hygiene & Tropical Medicine London UK
| | - Jaimie D Adelson
- Institute for Health Metrics and Evaluation University of Washington Seattle WA USA
| | - Sarah Polack
- London School of Hygiene & Tropical Medicine London UK
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Prochazka M, Timothy J, Pullan R, Kollie K, Rogers E, Wright A, Palmer J. "Buruli ulcer and leprosy, they are intertwined": Patient experiences of integrated case management of skin neglected tropical diseases in Liberia. PLoS Negl Trop Dis 2020; 14:e0008030. [PMID: 32023242 PMCID: PMC7001903 DOI: 10.1371/journal.pntd.0008030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/06/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Skin neglected tropical diseases (NTDs) such as Buruli ulcer (BU) and leprosy produce significant stigma and disability. Shared clinical presentations and needs for care present opportunities for integrated case management in co-endemic areas. As global policies are translated into local integrated services, there remains a need to monitor what new configurations of care emerge and how individuals experience them. METHODS To explore patient experiences of integrated case management for skin NTDs, in 2018, we conducted a field-based qualitative case series in a leprosy rehabilitation centre in Ganta, Liberia where BU services were recently introduced. Twenty patients with BU (n = 10) and leprosy (n = 10) participated in in-depth interviews that incorporated photography methods. We contextualised our findings with field observations and unstructured interviews with health workers. FINDINGS The integration of care for BU and leprosy prompted new conceptualisations of these diseases and experiences of NTD stigma. Some patients felt anxiety about using services because they feared being infected with the other disease. Other patients viewed the two diseases as 'intertwined': related manifestations of the same condition. Configurations of inter-disease stigma due to fear of transmission were buffered by joint health education sessions which also appeared to facilitate social support between patients in the facility. For both diseases, medication and wound care were viewed as the cornerstones of care and appreciated as interventions that led to rehabilitation of the whole patient group through shared experiences of healing, avoidance of physical deformities and stigma reduction. Patient accounts of intense pain during wound care for BU and inability of staff to manage severe complications, however, exposed some shortcomings of medical care for the newly integrated service, as did patient fears of long-lasting disability due to lack of physiotherapy services. SIGNIFICANCE Under integrated care policies, the possibility of new discourses about skin NTD identities emerging along with new configurations of stigma may have unanticipated consequences for patients' experiences of case management. The social experience of integrated medication and wound dressing has the potential to link patients within a single, supportive patient community. Control programmes with resource constraints should anticipate potential challenges of integrating care, including the need to ameliorate lasting disability and provide adequate clinical management of severe BU cases.
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Affiliation(s)
- Mateo Prochazka
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joseph Timothy
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel Pullan
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Karsor Kollie
- Liberia Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Emerson Rogers
- Liberia Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Abednego Wright
- Liberia Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Jennifer Palmer
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Jung SH, Han HW, Koh H, Yu SY, Nawa N, Morita A, Ong KIC, Jimba M, Oh J. Patients help other patients: Qualitative study on a longstanding community cooperative to tackle leprosy in India. PLoS Negl Trop Dis 2020; 14:e0008016. [PMID: 31929530 PMCID: PMC6980679 DOI: 10.1371/journal.pntd.0008016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/24/2020] [Accepted: 12/27/2019] [Indexed: 11/26/2022] Open
Abstract
Background Although leprosy is portrayed as a disappearing disease, leprosy affected persons in India are still suffering massively. Even further, nearly 60% of the world’s newly detected cases are appearing from India alone. The problem has exacerbated due to the drastic decrease of global funding after India’s official declaration of ‘elimination’, which did not foster the actual pain of patients beyond prevalence. Leprosy patients have hardships in their lives due to disabilities, stigma and poverty; thus, they require sustained, continuous care even after release from treatment. Yet, current interventions mostly have a vertical, short-term approach, not showing much progress in lightening the burden of leprosy. In contrast, Little Flower Hospital Community (LFHC) in India has been remarkably providing holistic care for thousands of leprosy patients for 35 years. However, there has not been any research conducted to uncover the underlying factors of this longstanding leprosy control model. Therefore, this research explores the in-depth contextual attributes of this hospital community that has been able to successfully provide sustainable care for a long time even without excessive external funds. Methods and findings This qualitative research used a grounded theory approach, involving 28 in-depth interviews of 11 patients, 13 workers, and 4 board members from the hospital. The interview data were inductively analyzed to examine the contextual factors of the hospital’s sustainability. Open coding, axial coding and selective coding were conducted, and Glaser’s Six C’s model was used to create a theoretical model of the sustainability of LFHC. The fundamental cause of the sustainability was the leprosy patients’ strong craving for life with dignity, despite the isolation from the society. The desire resulted in a bottom-up formation of a ‘consumer-provider cooperative’, where patients mutually support each other with basic treatment learned from experience. The profits earned from the patients’ occupational efforts such as dairy farming, cover the costs needed to manage the hospital community, which contributes to economical sustainability. Social sustainability was established through the holistic care including psychosocial, educational, medical, and residential support. The wholesome care socially rehabilitated the patients to be included in the society with satisfaction, social justice and social cohesion. The main limitation of this study is that this study cannot be generalized due to the nature of Grounded Theory based study. Conclusions This study investigated the determinants that made LFHC sustainable, and the findings suggested the importance of forming a cooperative community and implementing social rehabilitation for sustainable leprosy control. More exploration on transferring this model to other leprosy colonies will have great impact in maintaining sustainable care for leprosy patients. Furthermore, this research may highlight the importance of sustainable development in policies targeting neglected tropical diseases beyond leprosy as well. A typical day for a leprosy patient starts like this. One wakes up and discovers that the ulcer on his left foot has worsened over a few days. Strong odor coming from the wound is disturbing and skin continues to deteriorate but he can’t visit the clinic because it is too far from home and also because he does not have enough money. He leaves the house to beg for money on the streets. As usual, people try to avoid being close to him and stares at him with fear. A typical day for a leprosy patient from Little Flower Hospital Community (LFHC) goes like this. One wakes up from the housing provided by LFHC and discovers that the ulcer on her left foot has worsened over a few days. She visits the hospital nearby and gets her wound checked up by the nurse. She leaves the hospital to work at the dairy farm, which is a job provided by the LFHC. The money that she earns is used to support her and the hospital both. As usual, people in the community greet her with a smile. LFHC created a vast difference in the life of the patient, meeting one’s holistic needs. This research explores how LFHC was able to provide appropriate care for leprosy patients and sustain itself for 35 years. The possibilities of implementing the sustainable model of LFHC to marginalized people in the rest of the world are noteworthy.
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Affiliation(s)
- Seong Hye Jung
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hee Won Han
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeonseok Koh
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Soo-Young Yu
- Department of Nursing, Seoul National University College of Nursing, Seoul, South Korea
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Nobutoshi Nawa
- Institute of Education, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayako Morita
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ken Ing Cherng Ong
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Juhwan Oh
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail:
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Hartog K, Hubbard CD, Krouwer AF, Thornicroft G, Kohrt BA, Jordans MJD. Stigma reduction interventions for children and adolescents in low- and middle-income countries: Systematic review of intervention strategies. Soc Sci Med 2019; 246:112749. [PMID: 31978636 DOI: 10.1016/j.socscimed.2019.112749] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 11/18/2022]
Abstract
Stigmatisation and discrimination are common worldwide, and have profound negative impacts on health and quality of life. Research, albeit limited, has focused predominantly on adults. There is a paucity of literature about stigma reduction strategies concerning children and adolescents, with evidence especially sparse for low- and middle-income countries (LMIC). This systematic review synthesised child-focused stigma reduction strategies in LMIC, and compared these to adult-focused interventions. Relevant publications were systematically searched in July and August 2018 in the following databases; Cochrane, Embase, Global Health, HMIC, Medline, PsycINFO, PubMed and WorldWideScience.org, and through Google Custom Search. Included studies and identified reviews were cross-referenced. Three categories of search terms were used: (i) stigma, (ii) intervention, and (iii) LMIC settings. Data on study design, participants and intervention details including strategies and implementation factors were extracted. Within 61 unique publications describing 79 interventions, utilising 14 unique stigma reduction strategies, 14 papers discussed 21 interventions and 10 unique strategies involving children. Most studies targeted HIV/AIDS (50% for children, 38% for adults) or mental illness (14% vs 34%) stigma. Community education (47%), individual empowerment (15%) and social contact (12%) were most employed in child-focused interventions. Most interventions were implemented at one socio-ecological level; child-focused interventions mostly employed community-level strategies (88%). Intervention duration was mostly short; between half a day and a week. Printed or movie-based material was key to deliver child-focused interventions (37%), while professionals most commonly implemented adult-focused interventions (53%). Ten unique, child-focused strategies were all evaluated positively, using a diverse set of scales. Children and adolescents are under-represented in stigma reduction in LMIC. More stigma reduction interventions in LMIC, addressing a wider variety of stigmas, with children as direct and indirect target group, are needed. This systematic review is registered under International Prospective Register of Systematic Reviews PROSPERO, reference number #CRD42018094700.
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Affiliation(s)
- Kim Hartog
- War Child Holland, Research and Development, Helmholzstraat 61-G, 1098, LE, Amsterdam, the Netherlands; Amsterdam Institute for Social Science Research, University of Amsterdam, Postbus 15718, 1001, NE, Amsterdam, the Netherlands.
| | - Carly D Hubbard
- London School of Hygiene and Tropical Medicine, Keppel St., Bloomsbury, London, WC1E, 7HT, United Kingdom.
| | - Angelica F Krouwer
- War Child Holland, Research and Development, Helmholzstraat 61-G, 1098, LE, Amsterdam, the Netherlands.
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute for Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB, United Kingdom.
| | - Brandon A Kohrt
- Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington University, 2120 L Street, NW, Suite 600, Washington, DC, 20037, USA.
| | - Mark J D Jordans
- War Child Holland, Research and Development, Helmholzstraat 61-G, 1098, LE, Amsterdam, the Netherlands; Amsterdam Institute for Social Science Research, University of Amsterdam, Postbus 15718, 1001, NE, Amsterdam, the Netherlands.
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Martos-Casado G, Vives-Cases C, Gil-González D. Scoping review: Community-based programmes with people affected by leprosy. Trop Med Int Health 2019; 25:144-158. [PMID: 31713954 DOI: 10.1111/tmi.13345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyse community intervention programmes for people affected by leprosy in 'global priority countries'. METHODS Scoping review of articles in the databases PubMed, Scopus, SciELO, Lilacs and Web of Knowledge that made reference to community intervention programmes aimed at people affected by leprosy in global priority countries and which presented an evaluation of results. Analytical variables analysed were methodological characteristics of the study, type of intervention classified according to the Community-Based Rehabilitation Matrix, indicators and results of the evaluation, and the degree of participation of the community, which was graphically represented as a spidergram. RESULTS Thirty articles met the inclusion criteria. They were mostly related to the health component of the RBC matrix and aimed at the adult population. All evaluated the indicators used positively. The degree of participation generally ranged between mobilisation and collaboration. CONCLUSION Community intervention programmes for people affected by leprosy have a positive effect on health. There are attempts to include affected people and the community in implementing these programmes, but it is not possible to establish a direct relationship with effects of their participation on health due to the study designs used. Future research using more robust methods that include leprosy patients are necessary to evaluate the effectiveness of community participation.
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Affiliation(s)
- Gema Martos-Casado
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Health Sciences School, University of Alicante, Alicante, Spain
| | - Carmen Vives-Cases
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Health Sciences School, University of Alicante, Alicante, Spain.,CIBER of Epidemiology and Public Health, Barcelona, Spain
| | - Diana Gil-González
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Health Sciences School, University of Alicante, Alicante, Spain.,CIBER of Epidemiology and Public Health, Barcelona, Spain
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Pires M, Wright B, Kaye PM, da Conceição V, Churchill RC. The impact of leishmaniasis on mental health and psychosocial well-being: A systematic review. PLoS One 2019; 14:e0223313. [PMID: 31622369 PMCID: PMC6797112 DOI: 10.1371/journal.pone.0223313] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 09/18/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Leishmaniasis is a neglected tropical parasitic disease endemic in South Asia, East Africa, Latin America and the Middle East. It is associated with low socioeconomic status (SES) and responsible for considerable mortality and morbidity. Reports suggest that patients with leishmaniasis may have a higher risk of mental illness (MI), psychosocial morbidity (PM) and reduced quality of life (QoL), but this is not well characterised. The aim of this study was to conduct a systematic review to assess the reported impact of leishmaniasis on mental health and psychosocial wellbeing. METHODS A systematic review of the literature was carried out. Pre-specified criteria were applied to identify publications including observational quantitative studies or systematic reviews. Two reviewers screened all of the titles, abstracts and full-studies and a third reviewer was consulted for disagreements. Data was extracted from papers meeting the criteria and quality appraisal of the methods was performed using the Newcastle-Ottawa Scale or the Risk of Bias in Systematic Review tool. RESULTS A total of 14 studies were identified from 12,517 records. Nine cross-sectional, three case-control, one cohort study and one systematic review were included. Eleven assessed MI outcomes and were measured with tools specifically designed for this; nine measured PM and 12 measured QoL using validated measurement tools. Quality appraisal of the studies showed that six were of good quality. Cutaneous leishmaniasis and post kala-azar dermal leishmaniasis showed evidence of associated MI and PM including depression, anxiety and stigma, while all forms of disease showed decreased QoL. The findings were used to inform a proposed model and conceptual framework to show the possible links between leishmaniasis and mental health outcomes. CONCLUSION There is evidence that leishmaniasis has an impact on MI, PM or QoL of patients and their families and this occurs in all the main subtypes of the disease. There are however large gaps in the evidence. Further research is required to understand the full extent of this problem and its mechanistic basis.
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Affiliation(s)
- Malini Pires
- Mental Health Research Group, Hull York Medical School and Dept. of Health Sciences, University of York, England, United Kingdom
| | - Barry Wright
- Mental Health Research Group, Hull York Medical School and Dept. of Health Sciences, University of York, England, United Kingdom
| | - Paul M. Kaye
- Centre for Reviews and Dissemination, University of York, England, United Kingdom
- Centre for Immunology and Infection, Hull York Medical School and Dept. of Biology, University of York, England, United Kingdom
| | | | - Rachel C. Churchill
- Centre for Reviews and Dissemination, University of York, England, United Kingdom
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Topp J, Andrees V, Weinberger NA, Schäfer I, Sommer R, Mrowietz U, Luck-Sikorski C, Augustin M. Strategies to reduce stigma related to visible chronic skin diseases: a systematic review. J Eur Acad Dermatol Venereol 2019; 33:2029-2038. [PMID: 31177601 DOI: 10.1111/jdv.15734] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/27/2019] [Indexed: 12/14/2022]
Abstract
Many patients with a visible chronic skin disease experience discrimination and stigmatization. This results in psychosocial impairments in addition to the burden of disease and emphasizes the urgency to implement effective stigma-reduction strategies. To synthesize what is known globally about effective interventions to reduce stigma associated with visible chronic skin diseases, a systematic review was conducted. Four electronic databases were searched until May 2018. Studies evaluating interventions to reduce stigmatization in patients with visible chronic skin diseases and applying at least one stigma-related outcome measure were included. Data were extracted on study design, country, study population, outcome measures and main findings. Results were subsequently synthesized in a narrative review. Critical Appraisal Skills Programme tools were used to assess study quality. Nineteen studies were included in the review. Study design was very heterogeneous and study quality rather poor. Thirteen studies addresses patients with leprosy in low- and middle-income countries, and one study each targeted patients with onychomycosis, leg ulcer, facial disfigurement, atopic dermatitis, vitiligo and alopecia. Evaluated interventions were mainly multi-faceted incorporating more than one type of intervention. While 10 studies focused on the reduction in self-stigma and 4 on the reduction in public stigma, another 5 studies aimed at reducing both. The present review revealed a lack of high-quality studies on effective approaches to reduce stigmatization of patients with visible chronic skin diseases. Development and evaluation of intervention formats to adequately address stigma is essential to promote patients' health and well-being.
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Affiliation(s)
- J Topp
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - V Andrees
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - I Schäfer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - R Sommer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - U Mrowietz
- Psoriasis-Center, Department of Dermatology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - M Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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van Brakel WH, Cataldo J, Grover S, Kohrt BA, Nyblade L, Stockton M, Wouters E, Yang LH. Out of the silos: identifying cross-cutting features of health-related stigma to advance measurement and intervention. BMC Med 2019; 17:13. [PMID: 30764817 PMCID: PMC6376667 DOI: 10.1186/s12916-018-1245-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many health conditions perceived to be contagious, dangerous or incurable, or resulting in clearly visible signs, share a common attribute - an association with stigma and discrimination. While the etiology of stigma may differ between conditions and, sometimes, cultural settings, the manifestations and psychosocial consequences of stigma and discrimination are remarkably similar. However, the vast majority of studies measuring stigma or addressing stigma through interventions employ a disease-specific approach. MAIN BODY The current paper opposes this siloed approach and advocates a generic concept of 'health-related stigma' in both stigma measurement and stigma interventions. Employing a conceptual model adapted from Weiss, the current paper demonstrates the commonalities among several major stigmatized conditions by examining how several stigma measurement instruments, such as the Social Distance Scale, Explanatory Model Interview Catalogue, Internalized Stigma of Mental Illness, and Berger stigma scale, and stigma reduction interventions, such as information-based approaches, contact with affected persons, (peer) counselling, and skills building and empowerment, were used successfully across a variety of conditions to measure or address stigma. The results demonstrate that 'health-related stigma' is a viable concept with clearly identifiable characteristics that are similar across a variety of stigmatized health conditions in very diverse cultures. CONCLUSION A more generic approach to the study of health-related stigma opens up important practical opportunities - cross-cutting measurement and intervention tools are resource saving and easier to use for personnel working with multiple conditions, allow for comparison between conditions, and recognize the intersectionality of many types of stigma. Further research is needed to build additional evidence demonstrating the advantages and effectiveness of cross-condition approaches to stigma measurement and interventions.
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Affiliation(s)
| | - Janine Cataldo
- Department of Physiological Nursing, Center for Tobacco Control Research and Education, University of California San Francisco, 2 Koret Way, San Francisco, CA, 94143-0610, USA
| | | | - Brandon A Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | | | - Melissa Stockton
- Epidemiology Department, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Edwin Wouters
- Centre for Longitudinal & Life Course Studies, University of Antwerp, Antwerp, Belgium.,Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Lawrence H Yang
- College of Global Public Health, New York University, New York, NY, USA.,Mailman School of Public Health, Columbia University, New York, NY, USA
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Kemp CG, Jarrett BA, Kwon CS, Song L, Jetté N, Sapag JC, Bass J, Murray L, Rao D, Baral S. Implementation science and stigma reduction interventions in low- and middle-income countries: a systematic review. BMC Med 2019; 17:6. [PMID: 30764820 PMCID: PMC6376798 DOI: 10.1186/s12916-018-1237-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions to alleviate stigma are demonstrating effectiveness across a range of conditions, though few move beyond the pilot phase, especially in low- and middle-income countries (LMICs). Implementation science offers tools to study complex interventions, understand barriers to implementation, and generate evidence of affordability, scalability, and sustainability. Such evidence could be used to convince policy-makers and donors to invest in implementation. However, the utility of implementation research depends on its rigor and replicability. Our objectives were to systematically review implementation studies of health-related stigma reduction interventions in LMICs and critically assess the reporting of implementation outcomes and intervention descriptions. METHODS PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of stigma reduction interventions in LMICs reporting at least one implementation outcome. Study- and intervention-level characteristics were abstracted. The quality of reporting of implementation outcomes was assessed using a five-item rubric, and the comprehensiveness of intervention description and specification was assessed using the 12-item Template for Intervention Description and Replication (TIDieR). RESULTS A total of 35 eligible studies published between 2003 and 2017 were identified; of these, 20 (57%) used qualitative methods, 32 (91%) were type 1 hybrid effectiveness-implementation studies, and 29 (83%) were evaluations of once-off or pilot implementations. No studies adopted a formal theoretical framework for implementation research. Acceptability (20, 57%) and feasibility (14, 40%) were the most frequently reported implementation outcomes. The quality of reporting of implementation outcomes was low. The 35 studies evaluated 29 different interventions, of which 18 (62%) were implemented across sub-Saharan Africa, 20 (69%) focused on stigma related to HIV/AIDS, and 28 (97%) used information or education to reduce stigma. Intervention specification and description was uneven. CONCLUSION Implementation science could support the dissemination of stigma reduction interventions in LMICs, though usage to date has been limited. Theoretical frameworks and validated measures have not been used, key implementation outcomes like cost and sustainability have rarely been assessed, and intervention processes have not been presented in detail. Adapted frameworks, new measures, and increased LMIC-based implementation research capacity could promote the rigor of future stigma implementation research, helping the field deliver on the promise of stigma reduction interventions worldwide.
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Affiliation(s)
| | - Brooke A. Jarrett
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD USA
| | - Churl-Su Kwon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, NY USA
| | - Lanxin Song
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD USA
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, NY USA
| | - Jaime C. Sapag
- Departments of Public Health and Family Medicine, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Office of Transformative Global Health, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Judith Bass
- Department of Mental Health, Johns Hopkins University, Baltimore, MD USA
| | - Laura Murray
- Department of Mental Health, Johns Hopkins University, Baltimore, MD USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD USA
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Stangl AL, Earnshaw VA, Logie CH, van Brakel W, C. Simbayi L, Barré I, Dovidio JF. The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med 2019; 17:31. [PMID: 30764826 PMCID: PMC6376797 DOI: 10.1186/s12916-019-1271-3] [Citation(s) in RCA: 583] [Impact Index Per Article: 116.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 01/23/2019] [Indexed: 12/18/2022] Open
Abstract
Stigma is a well-documented barrier to health seeking behavior, engagement in care and adherence to treatment across a range of health conditions globally. In order to halt the stigmatization process and mitigate the harmful consequences of health-related stigma (i.e. stigma associated with health conditions), it is critical to have an explicit theoretical framework to guide intervention development, measurement, research, and policy. Existing stigma frameworks typically focus on one health condition in isolation and often concentrate on the psychological pathways occurring among individuals. This tendency has encouraged a siloed approach to research on health-related stigmas, focusing on individuals, impeding both comparisons across stigmatized conditions and research on innovations to reduce health-related stigma and improve health outcomes. We propose the Health Stigma and Discrimination Framework, which is a global, crosscutting framework based on theory, research, and practice, and demonstrate its application to a range of health conditions, including leprosy, epilepsy, mental health, cancer, HIV, and obesity/overweight. We also discuss how stigma related to race, gender, sexual orientation, class, and occupation intersects with health-related stigmas, and examine how the framework can be used to enhance research, programming, and policy efforts. Research and interventions inspired by a common framework will enable the field to identify similarities and differences in stigma processes across diseases and will amplify our collective ability to respond effectively and at-scale to a major driver of poor health outcomes globally.
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Affiliation(s)
- Anne L. Stangl
- International Center for Research on Women, 1120 20th St. NW, Suite 500N, Washington, DC, 20036 USA
| | - Valerie A. Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE USA
| | - Carmen H. Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto and Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario Canada
| | | | - Leickness C. Simbayi
- Human Sciences Research Council & Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Iman Barré
- International Center for Research on Women, 1120 20th St. NW, Suite 500N, Washington, DC, 20036 USA
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Assessing the Impact of the Twin Track Socio-Economic Intervention on Reducing Leprosy-Related Stigma in Cirebon District, Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030349. [PMID: 30691157 PMCID: PMC6388109 DOI: 10.3390/ijerph16030349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/14/2018] [Accepted: 01/11/2019] [Indexed: 12/22/2022]
Abstract
The consequences of leprosy go beyond the physical, social and psychological, as leprosy can drive persons affected and their families into poverty, stigmatization and disability. This paper describes the impact of a socio-economic development (SED) intervention that uses a twin-track approach (two micro-credit models) to reduce leprosy-related stigma in Cirebon District, Indonesia. A randomized-controlled mixed-methods study design was used to test the effectiveness of the SED intervention. Three scales were used to measure stigma and participation restrictions among 30 SED clients and 57 controls, 20 in-depth interviews with SED clients and seven Focus Group Discussions (FGDs) with key persons were held and 65 profiles of the clients were written up and analysed. The qualitative data shows the socio-economic status of 44 out of 65 SED clients (67%) improved. The median family income increased by 25%, more clients reported higher self-esteem, better interaction with neighbours and less stigma than before, although disclosure concerns remained an issue. The scales indicate a positive effect of the intervention on reducing stigma (e.g., Stigma Assessment and Reduction of Impact (SARI) stigma scale mean difference total score of pre and post assessment for SED clients versus the control group was 8.5 versus 5.6). A twin track socio-economic intervention, if embedded and integrated, can increase participation, and be constructive in reducing leprosy-related stigma.
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Pelters B. On mountains and prophets: targeting majorities to support minorities by using norm-critics in health education. Int J Qual Stud Health Well-being 2019; 13:1522203. [PMID: 30289027 PMCID: PMC6179063 DOI: 10.1080/17482631.2018.1522203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This debate article advocates for norm-critics instead of empowering coping and pedagogy of tolerance as an educational approach to mitigate stigmatization as well as blame and guilt for health-deviant minorities within the field of health disparities. Norm-critics is a way of making members of the (presumably healthy) normative majority uncover and question their health-related norms and raise awareness for the processes by which members of that majority re/construct images of stereotypic figures (such as “the fatso” or “the couch-potato”) with certain personal character traits which are to be condemned and, in doing so, limit the acting space of those identified as examples of those figures. The approach, its theoretical background, arguments promoting norm-critics, and some suggestions for its practical application are presented. It is concluded that norm-critics render a valuable and much needed addition to the health intervention repertoire.
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Affiliation(s)
- Britta Pelters
- a School of Health and Welfare , Halmstad University , Halmstad , Sweden
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Marahatta SB, Amatya R, Adhikari S, Giri D, Lama S, Kaehler N, Rijal KR, Marahatta S, Adhikari B. Perceived stigma of leprosy among community members and health care providers in Lalitpur district of Nepal: A qualitative study. PLoS One 2018; 13:e0209676. [PMID: 30589875 PMCID: PMC6307718 DOI: 10.1371/journal.pone.0209676] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/07/2018] [Indexed: 02/06/2023] Open
Abstract
Background Leprosy remains a major stigmatizing condition. Stigma is a dynamic process resulting from the interaction between physical attributes caused by leprosy and the existing stereotypes in a community. Leprosy has pervasive impacts on all areas of life including psychosocial burden to an individual, social interaction, marriage, and employment. These impacts vary and are largely dependent on a particular culture and community. The main objective of this study was to explore the perceived stigma of leprosy amongst community members and health care providers in Lalitpur district of Nepal. Methods A total of six focused group discussions (FGDs) with 43 participants from a community living close to Anandaban Leprosy Hospital and ten semi structured interviews (SSIs) with health care providers were conducted between October and December 2016. An interview guide was used for the FGDs and SSIs. All qualitative data were transcribed and translated into English and were thematically analyzed using Atlas.ti software. Results Visible deformities due to leprosy was one of the major contributing factors for stigma. Stigma was further exacerbated by an attitude to conceal the disease due to perceived fear of potential discrimination. While over the years, stigma was felt to be decreasing, various aspects of life were still affected by leprosy stigma including marriage, employment and social interaction. This was largely attributed to leprosy and its consequences, specifically the disability and deformity caused by leprosy. Conclusion Leprosy was still perceived to be feared and concealed because of potential discrimination, even within the community that was close to a long established leprosy hospital. Various aspects such as marriage, employment and social interaction were still affected by the stigma which was strongly associated with visible deformities. In addition to ongoing rehabilitation and stigma reduction programs, integrating strategies such as community engagement wherein community and leprosy affected person jointly take a role in stigma reduction programs can be helpful.
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Affiliation(s)
| | - Rakchya Amatya
- Manmohan Memorial Institute of Health Sciences, Swayambhu, Kathmandu, Nepal
| | - Srijana Adhikari
- Manmohan Memorial Institute of Health Sciences, Swayambhu, Kathmandu, Nepal
| | - Deena Giri
- Manmohan Memorial Institute of Health Sciences, Swayambhu, Kathmandu, Nepal
| | - Sarina Lama
- Manmohan Memorial Institute of Health Sciences, Swayambhu, Kathmandu, Nepal
| | - Nils Kaehler
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- * E-mail:
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Neglected Tropical Diseases and Mental Health: Progress, Partnerships, and Integration. Trends Parasitol 2018; 35:23-31. [PMID: 30578149 DOI: 10.1016/j.pt.2018.11.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 02/01/2023]
Abstract
Neglected tropical diseases (NTDs) are increasingly recognised as major drivers of psychosocial morbidity in affected individuals and their caregivers. Nevertheless, there has remained a lack of prioritisation at the policy level of some of the most stigmatising and chronic NTDs, with subsequent under-representation within NTD programmes. In response, the Neglected Tropical Disease/Non-Governmental Organization/Network (NNN) has established a Mental Wellbeing and Stigma Task Group (MWS) to address these issues through a comprehensive research agenda. In our article, we highlight the progress in understanding the scope of the mental health impact of NTDs and the innovative practice emerging in this area. Finally, we examine opportunities for integration of mental and physical health for individuals with NTDs.
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Daftary A, Mitchell EMH, Reid MJA, Fekadu E, Goosby E. To End TB, First-Ever High-Level Meeting on Tuberculosis Must Address Stigma. Am J Trop Med Hyg 2018; 99:1114-1116. [PMID: 30226149 PMCID: PMC6221214 DOI: 10.4269/ajtmh.18-0591] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/07/2018] [Indexed: 12/30/2022] Open
Abstract
World leaders gather to consolidate their commitment to ending tuberculosis (TB). Vital to the success of renewed efforts is an overdue recognition of the pervasive and pernicious influence of TB stigma. TB stigma is sustained in structures, policies, traditions, and norms. Innovative modifications to infection control, drug dispensing, and surveillance practices are required to increase demand for TB screening and effective therapeutic alliances among those diagnosed. The authors argue that reducing TB stigma requires a scientific and inclusive process, with prominent roles for TB survivors and a willingness to integrate and learn from other stigmatized conditions.
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Affiliation(s)
- Amrita Daftary
- Department of Epidemiology and Biostatistics, McGill International TB Centre, McGill University, Montreal, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA)-Medical Research Council TB-HIV Pathogenesis and Treatment Unit, Durban, South Africa
| | - Ellen M. H. Mitchell
- International Institute for Social Studies, Erasmus University, Rotterdam, Netherlands
| | - Michael J. A. Reid
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, California
| | | | - Eric Goosby
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, California
- United Nations Special Envoy for Tuberculosis, San Francisco, California
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Srinivas G, Kumar S, Mohanraj R, Sekkizhar G, Muthuvel T, Lal V, Koemm B, Kasang C. Development and validation of a scale to assess attitudes of health care providers towards persons affected by leprosy in southern India. PLoS Negl Trop Dis 2018; 12:e0006808. [PMID: 30252851 PMCID: PMC6177202 DOI: 10.1371/journal.pntd.0006808] [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: 03/27/2018] [Revised: 10/09/2018] [Accepted: 09/03/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Assessment of attitudes of health care professionals is important as negative attitude could constitute a major deterrent to care-seeking by persons affected by neglected tropical diseases (NTDs) such as leprosy. Leprosy continues to pose a major disease burden in India with an annual new case detection rate of 10.17 per 100,000 population. This paper reports on the development and validation of a culturally appropriate scale to measure attitude of health care providers (HCPs) towards persons affected by leprosy in Tamil Nadu, India. METHODOLOGY/PRINCIPAL FINDINGS The Affective, Behavioural and Cognitive (ABC) model of attitudes guided the development of the scale. Steps in scale development included qualitative interviews and focus group discussions with medical officers and paramedical staff selected from high prevalence districts in Tamil Nadu, India which informed the development of the draft scale. Reviews of existing attitude questionnaires in related areas further contributed to scale development and together helped to generate a large pool of items which was then subjected to Thurston's scaling method for selection of items from this pool. Face and content validity were obtained, following which internal consistency and test, re-test reliability were assessed. Scaling exercise resulted in 11 items being discarded from an initial pool of 38, owing to the poor agreement among experts regarding relevance. Face and content validity were good with experts endorsing relevance and applicability of items. The intra-class correlation coefficient (ICC) for test re-test reliability of the 27 item scale was 0.6 (95% CI: 0.20-0.78) indicating marginal intra-class correlation. The overall Cronbach's alpha was 0.85 while the alphas for each of the affective and behavioural components was good at 0.78 and 0.69 respectively indicating a good degree of consistency and homogeneity between items but the alpha for the cognitive component was low at 0.53. CONCLUSIONS The ABC model of attitudes guided the development of the scale, ensured a mix of 27 items tapping into the three domains of Affect, Behaviour and Cognition which best explained the attitude construct. With good validity and alphas for each of the affective, behavioural components and overall alpha estimates, this scale can be a valuable tool to provide accurate estimates of the true attitudes held by HCPs. This, in turn, would be useful to obtain insights for appropriate intervention programmes that would help change negative attitudes of HCPs towards persons affected by leprosy. With some adaptations, the scales can be validated for other NTDs as well.
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Affiliation(s)
- Govindarajulu Srinivas
- Department of Epidemiology, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, India
- * E-mail:
| | | | | | | | | | - Vivek Lal
- German Leprosy and TB Relief Association, Kolkata, India
| | - Burkard Koemm
- Deutsche Lepra- und Tuberkulosehilfe e.V., Wuerzburg (DAHW), Germany
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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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Morgado FFDR, Silveira EMKXD, Sales AM, Nascimento LPRD, Sarno EN, Nery JADC, Oliveira AJ, Illarramendi X. Cross-cultural adaptation of the EMIC Stigma Scale for people with leprosy in Brazil. Rev Saude Publica 2017; 51:80. [PMID: 28876410 PMCID: PMC5574468 DOI: 10.11606/s1518-8787.2017051000167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/13/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Describe the process of cross-cultural adaptation of the “Explanatory Model Interview Catalog – Stigma Scale” for people affected by leprosy in Brazil. METHODS After being authorized by the author of the scale to use it in the national context, we initiated the five steps process of cross-cultural adaptation: (1) translation, (2) synthesis meeting, (3) back-translation, (4) committee of experts and (5) pre-test. The internal consistency of the scale was evaluated using Cronbach’s alpha coefficient. RESULTS The 15 items of the scale’s original version were translated into Brazilian Portuguese. The adapted scale showed evidence of a good understanding of its content, attested both by experts and members of the target population. Its internal consistency was 0.64. CONCLUSIONS The adapted instrument shows satisfactory internal consistency. It may be useful in future studies that intend to provide broad situational analysis that supports solid public health programs with a focus on effective stigma reduction. In a later study, the construct’s validity, criterion, and reproducibility will be evaluated.
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Affiliation(s)
- Fabiane Frota da Rocha Morgado
- Instituto de Educação. Departamento de Educação Física e Desportos. Universidade Federal Rural do Rio de Janeiro. Seropédica, RJ, Brasil
| | | | - Anna Maria Sales
- Ambulatório Souza Araújo. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | | | - Euzenir Nunes Sarno
- Laboratório de Hanseníase. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | | | - Aldair J Oliveira
- Instituto de Educação. Departamento de Educação Física e Desportos. Universidade Federal Rural do Rio de Janeiro. Seropédica, RJ, Brasil
| | - Ximena Illarramendi
- Laboratório de Hanseníase. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.,Centro de Desenvolvimento Tecnológico em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
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Ramos ACV, Yamamura M, Arroyo LH, Popolin MP, Chiaravalloti Neto F, Palha PF, Uchoa SADC, Pieri FM, Pinto IC, Fiorati RC, de Queiroz AAR, Belchior ADS, dos Santos DT, Garcia MCDC, Crispim JDA, Alves LS, Berra TZ, Arcêncio RA. Spatial clustering and local risk of leprosy in São Paulo, Brazil. PLoS Negl Trop Dis 2017; 11:e0005381. [PMID: 28241038 PMCID: PMC5344525 DOI: 10.1371/journal.pntd.0005381] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/09/2017] [Accepted: 02/02/2017] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Although the detection rate is decreasing, the proportion of new cases with WHO grade 2 disability (G2D) is increasing, creating concern among policy makers and the Brazilian government. This study aimed to identify spatial clustering of leprosy and classify high-risk areas in a major leprosy cluster using the SatScan method. METHODS Data were obtained including all leprosy cases diagnosed between January 2006 and December 2013. In addition to the clinical variable, information was also gathered regarding the G2D of the patient at diagnosis and after treatment. The Scan Spatial statistic test, developed by Kulldorff e Nagarwalla, was used to identify spatial clustering and to measure the local risk (Relative Risk-RR) of leprosy. Maps considering these risks and their confidence intervals were constructed. RESULTS A total of 434 cases were identified, including 188 (43.31%) borderline leprosy and 101 (23.28%) lepromatous leprosy cases. There was a predominance of males, with ages ranging from 15 to 59 years, and 51 patients (11.75%) presented G2D. Two significant spatial clusters and three significant spatial-temporal clusters were also observed. The main spatial cluster (p = 0.000) contained 90 census tracts, a population of approximately 58,438 inhabitants, detection rate of 22.6 cases per 100,000 people and RR of approximately 3.41 (95%CI = 2.721-4.267). Regarding the spatial-temporal clusters, two clusters were observed, with RR ranging between 24.35 (95%CI = 11.133-52.984) and 15.24 (95%CI = 10.114-22.919). CONCLUSION These findings could contribute to improvements in policies and programming, aiming for the eradication of leprosy in Brazil. The Spatial Scan statistic test was found to be an interesting resource for health managers and healthcare professionals to map the vulnerability of areas in terms of leprosy transmission risk and areas of underreporting.
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Affiliation(s)
- Antônio Carlos Vieira Ramos
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Mellina Yamamura
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Luiz Henrique Arroyo
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Marcela Paschoal Popolin
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Francisco Chiaravalloti Neto
- Department of Epidemiology, School of Public Health of the University of São Paulo, São Paulo, São Paulo, Brazil
| | - Pedro Fredemir Palha
- Maternal-Infant Nursing and Public Health Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | | | | | - Ione Carvalho Pinto
- Maternal-Infant Nursing and Public Health Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Regina Célia Fiorati
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana Angélica Rêgo de Queiroz
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Aylana de Souza Belchior
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Danielle Talita dos Santos
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Maria Concebida da Cunha Garcia
- Graduate Program Interunit Doctoral Program in Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Juliane de Almeida Crispim
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Luana Seles Alves
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Thaís Zamboni Berra
- Graduate Program in Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Ricardo Alexandre Arcêncio
- Maternal-Infant Nursing and Public Health Department, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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The Impact of a Rights-Based Counselling Intervention to Reduce Stigma in People Affected by Leprosy in Indonesia. PLoS Negl Trop Dis 2016; 10:e0005088. [PMID: 27959932 PMCID: PMC5154499 DOI: 10.1371/journal.pntd.0005088] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 09/30/2016] [Indexed: 11/18/2022] Open
Abstract
Background This paper assesses the impact of a counselling intervention on reducing leprosy-related stigma in Cirebon District, Indonesia. The unique features of this intervention are its rights-based approach, the underlying Cognitive Behavioural Therapy (CBT) model, the three types of counselling and the lay and peer counsellors who were involved. Methodology/principal findings Mixed methods (e.g. three scales, interviews, focus group discussions and reflection notes) were used to assess the impact of the intervention, which ran over a two-year period. There was a control area with no interventions. The study participants were people affected by leprosy and other key persons (e.g. family members). The sample size differs per method, for example, data regarding 67 counselling clients and 57 controls from a cohort, and notes from 207 counselling clients were examined. The notes showed that most clients faced stigma on a daily basis, whether internalized, anticipated and/or enacted. A significant reduction was found between the before and after total scores of the SARI Stigma Scale (p-value < 0.001), Participation Scale Short (p-value < 0.001) and WHO Quality of Life score (p-value < 0.001) among the counselling clients. While there is also an effect in the control group, it is much larger in the intervention group. Qualitative data indicates that knowledge and rights trigger change. Clients took steps to improve their life such as re-connecting with neighbours, helping in household activities and applying for jobs. Challenges include the wish to conceal their condition. Conclusion/significance The findings show that the counselling intervention was effective in reducing stigma, promoting the rights of people with leprosy and facilitating their social participation. More research is needed on how to create a more sustainable intervention, preferably structurally embedded in the health or social services. Can building knowledge, increasing the awareness of rights and developing confidence through counselling empower people affected by leprosy and reduce the stigma that surrounds them? In this paper the authors describe the impact of a counselling module designed to address the widespread issue of stigma in Cirebon District, Indonesia. The module ran for a two-year period and has some unique features. For example, it integrates three different types of counselling: individual, family and group. During the counselling, medical information about leprosy was provided and awareness of rights (e.g. right to healthcare, right to education) was raised. The counselling was offered by lay and peer counsellors, the latter having been affected by leprosy, to a total 260 people. This study showed that counselling can be effective in reducing stigma. The authors recommend its application on a larger scale.
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Psychological and Psychosocial Consequences of Zoonotic Cutaneous Leishmaniasis among Women in Tunisia: Preliminary Findings from an Exploratory Study. PLoS Negl Trop Dis 2016; 10:e0005090. [PMID: 27788184 PMCID: PMC5082956 DOI: 10.1371/journal.pntd.0005090] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 10/03/2016] [Indexed: 11/23/2022] Open
Abstract
Background The incidence of zoonotic cutaneous leishmaniasis (ZCL) makes it the most widespread parasitic disease in Tunisia and the Arab world. Yet, few studies have addressed its psychological and psychosocial effects. The purpose of this study was to examine the psychosocial impact of ZCL scars among Tunisian women. Methods We conducted an exploratory study, we administered Revised Illness Perception Questionnaire (IPQ-R), World Health Organization Quality Of Life-26 (WHOQOL-26) and Psoriasis Life Stress Inventory (PLSI) to a group of girls and women with ZCL scar in the region of Sidi Bouzid. This group was randomly selected from volunteers who came to primary health care facilities to seek for treatment for any pathology. Results Descriptive statistics showed that the collected scores from the three scales exhibit heterogeneous distributions: IPQ-R (M = 63.6, SD = 15.6), PSLI (M = 9.5, SD = 6.7), WHOQOL-Physical (M = 63, SD = 12.9), WHOQOL-Psychological (M = 52.6, SD = 11.1), WHOQOL-Social (M = 61.8, SD = 17.5), and WHOQOL-Environmental (M = 47.8, SD = 13.3). The correlation analyses performed on Inter and intra-subscales showed that the emotional representations associated with ZCL were correlated with the loss of self-esteem and feelings of inferiority (r = 0.77, p<0.05). In addition, high education level and the knowledge about ZCL are positively correlated with cognitive and emotional representation in the IPQ-R (r = 0.33, p<0.05). "Rejection experiences" and the "anticipation and avoidance of stress" were respectively negatively correlated with age (r = -0.33, p<0.05 and r = -0.31, p<0.05). Correlations between the scores on IPQ-R domains and PLSI factors were significant. The results showed that anticipation of rejection and avoidance of stress are strongly correlated with a negative perception of ZCL. Quality of life scores were not correlated with either age, education level, time of illness, or the number of facial or body scars. However, the correlations between quality of life scores and the multiple IPQ-R domains were all insignificant. Finally, there was a negative correlation between the scores on the perceived quality of social life and the knowledge about ZCL (r = -0.34, p<0.05). Conclusions This makes it vital to strengthen preventive health education. Conducting studies on ways to establish a holistic support system for managing ZCL, a system that covers the psychological challenges and the barriers it causes to women’s social and professional integration, is a vital first step. Zoonotic cutaneous leishmaniasis (ZCL) is the most common form of leishmaniasis in Tunisia. The disease is not severe and heal spontaneously with a definitive scar causing a social impact mainly when the lesion occurs in the face. Yet, few studies have addressed these psychological and psychosocial effects. To examine these issues among Tunisian women suffering from ZCL, we administered Revised Illness Perception Questionnaire (IPQ-R), World Health Organization Quality Of Life-26 (WHOQOL-26) and Psoriasis Life Stress Inventory (PLSI) to a group of girls and women with ZCL scars in the region of Sidi Bouzid. This study demonstrated the wide range of psychological effects (anxiety, psychological distress, lack of self-confidence and self-esteem, frustration, etc…) and psychosocial impacts (stigma, rejection, discrimination in the social and professional setting, etc…) of ZCL permanent scars; mainly when it is located in the face; among women and girls. This study suggests the need of social and psychological support and professional integration for women and girls in rural remote areas first and second conducts studies on ways to establish control measures for ZCL, mainly in vulnerable exposed population.
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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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