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Willis M, Fastenau A, Penna S, Klabbers G. Interventions to reduce leprosy related stigma: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003440. [PMID: 39172813 PMCID: PMC11340997 DOI: 10.1371/journal.pgph.0003440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/11/2024] [Indexed: 08/24/2024]
Abstract
Stigmatisation is a major issue faced by those affected by leprosy globally. Reducing stigmatisation encourages care seeking behaviour to occur earlier and can help reduce harm and spread of leprosy. This systematic literature review aimed to summarise what effective stigma reducing interventions exist for leprosy, and as a secondary question explore what evidence exists regarding their cost. A systematic literature review was conducted. Three databases-PubMed, Embase and Web of science-were searched using the search terms "leprosy", "interven*", "reduc*", and "stigma*".Seventeen publications were eligible for inclusion in the review. The current manuscript identified interventions under 6 main categories (i) Information, education, and communication (IEC) (ii) community led projects, (iii) Socioeconomic rehabilitation, (iv) mixed interventions, (v) integration of leprosy within the health system and (vi) Cosmetic or surgical care. Specific evidence regarding cost was only provided by one out of the seventeen papers. Multiple interventions were shown to successfully reduce leprosy related stigma, however, information on their cost is not readily available. The evidence uncovered by this review is restricted to three Asian countries; Nepal, India and Indonesia. To ensure the success of stigma reduction in leprosy interventions worldwide these interventions need to be tried in other leprosy endemic areas to test their effectiveness across contextual and cultural scenarios.
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Affiliation(s)
- Matthew Willis
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Marie Adelaide Leprosy Centre, Karachi, Pakistan
- German Leprosy and Tuberculosis Relief Association (GLRA/DAHW), Wurzburg, Germany
| | - Anil Fastenau
- Marie Adelaide Leprosy Centre, Karachi, Pakistan
- German Leprosy and Tuberculosis Relief Association (GLRA/DAHW), Wurzburg, Germany
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Department of Global Health, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Srilekha Penna
- German Leprosy and Tuberculosis Relief Association (GLRA/DAHW), Wurzburg, Germany
| | - Gonnie Klabbers
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Okyere D, Ocloo EK, Owusu L, Amoako YA, Tuwor RD, Koka E, Novignon J, Asante-Poku A, Siam IM, Afreh EK, Agbanyo A, Akuffo RA, Gyabaah S, Oppong MN, Halliday KE, Simpson H, Timothy J, Marks M, Zuurmond M, Walker SL, Pullan RL, Ahorlu CS, Phillips RO, Yeboah-Manu D, Pitt C, Palmer J. Improving experiences of neglected tropical diseases of the skin: Mixed methods formative research for development of a complex intervention in Atwima Mponua District, Ghana. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002833. [PMID: 38870111 PMCID: PMC11175470 DOI: 10.1371/journal.pgph.0002833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 05/21/2024] [Indexed: 06/15/2024]
Abstract
Integrated approaches to managing co-endemic neglected tropical diseases (NTDs) of the skin within primary healthcare services are complex and require tailoring to local contexts. We describe formative research in Atwima Mponua District in Ghana's Ashanti Region designed to inform the development of a sustainable intervention to improve access to skin NTD care. We employed a convergent, parallel, mixed-methods design, collecting data from February 2021 to February 2022. We quantitatively assessed service readiness using a standardised checklist and reviewed outpatient department registers and condition-specific case records in all government health facilities in the district. Alongside a review of policy documents, we conducted 49 interviews and 7 focus group discussions with purposively selected affected persons, caregivers, community members, health workers, and policy-makers to understand skin NTD care-seeking practices and the policy landscape. Outside the district hospital, skin NTD reporting rates in the surveyed facilities were low; supply chains for skin NTD diagnostics, consumables, and medicines had gaps; and health worker knowledge of skin NTDs was limited. Affected people described fragmented care, provided mostly by hospitals (often outside the district) or traditional healers, resulting in challenges obtaining timely diagnosis and treatment and high care-seeking costs. Affected people experienced stigma, although the extent to which stigma influenced care-seeking behaviour was unclear. National actors were more optimistic than district-level actors about local resource availability for skin NTD care and were sceptical of including traditional healers in interventions. Our findings indicate that improvement of the care cascade for affected individuals to reduce the clinical, economic, and psychosocial impact of skin NTDs is likely to require a complementary set of interventions. These findings have informed the design of a strategy to support high-quality, integrated, decentralised care for skin NTDs in Atwima Mponua, which will be assessed through a multidisciplinary evaluation.
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Affiliation(s)
- Daniel Okyere
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Edmond Kwaku Ocloo
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
- Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana
| | - Lucy Owusu
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Ruth Dede Tuwor
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Eric Koka
- Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana
| | - Jacob Novignon
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- Department of Economics, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Adwoa Asante-Poku
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Ishaque Mintah Siam
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Emmanuel Kyei Afreh
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Abigail Agbanyo
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Richard Adjei Akuffo
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Solomon Gyabaah
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Michael Ntiamoah Oppong
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Katherine E. Halliday
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hope Simpson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joseph Timothy
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Maria Zuurmond
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Stephen L. Walker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel L. Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Catherine Pitt
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Jennifer Palmer
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Sebti M, Schweitzer-Chaput A, Cisternino S, Hinterlang M, Ancedy D, Lam S, Auvity S, Cotteret C, Lortholary O, Schlatter J. Formulation and Stability of a 1% Clarithromycin-Based Topical Skin Cream: A New Option to Treat Buruli Ulcers? Pharmaceuticals (Basel) 2024; 17:691. [PMID: 38931358 PMCID: PMC11206874 DOI: 10.3390/ph17060691] [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: 04/23/2024] [Revised: 05/14/2024] [Accepted: 05/19/2024] [Indexed: 06/28/2024] Open
Abstract
There are more than 170 known species of non-tuberculous mycobacteria, and some are responsible for serious diseases in people infected with them. One of these is Buruli ulcers, a neglected tropical disease endemic in more than 33 countries and caused by Mycobacterium ulcerans, which infects skin tissue. Treatment consists of a long-term regimen combining the use of oral rifampin with another anti-tuberculosis drug (e.g., clarithromycin). Patients in these countries face difficulties in accessing and adhering to this therapy. This study investigates the feasibility of formulating stable, optimized clarithromycin as a topical cutaneous cream. The cream was formulated, and its stability was evaluated under different storage temperature conditions and using a stability indicator method. The results showed that the clarithromycin cream was stable for at least 60 days, even at extreme temperatures (40 °C). In conclusion, the data presented here demonstrate the stability of a new form of topical cutaneous clarithromycin, which may offer a new approach to the treatment of Buruli ulcers and clarithromycin-sensitive infections.
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Affiliation(s)
- Maria Sebti
- Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), 149 Rue de Sèvres, F-75015 Paris, France; (M.S.); (A.S.-C.); (M.H.); (D.A.); (S.L.); (S.A.); (C.C.); (J.S.)
| | - Arnaud Schweitzer-Chaput
- Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), 149 Rue de Sèvres, F-75015 Paris, France; (M.S.); (A.S.-C.); (M.H.); (D.A.); (S.L.); (S.A.); (C.C.); (J.S.)
| | - Salvatore Cisternino
- Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), 149 Rue de Sèvres, F-75015 Paris, France; (M.S.); (A.S.-C.); (M.H.); (D.A.); (S.L.); (S.A.); (C.C.); (J.S.)
- Faculté de Pharmacie, Université Paris Cité, Inserm UMRS 1144, 4, Avenue de l’Observatoire, F-75006 Paris, France
| | - Mélanie Hinterlang
- Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), 149 Rue de Sèvres, F-75015 Paris, France; (M.S.); (A.S.-C.); (M.H.); (D.A.); (S.L.); (S.A.); (C.C.); (J.S.)
| | - Dimitri Ancedy
- Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), 149 Rue de Sèvres, F-75015 Paris, France; (M.S.); (A.S.-C.); (M.H.); (D.A.); (S.L.); (S.A.); (C.C.); (J.S.)
| | - Sandrine Lam
- Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), 149 Rue de Sèvres, F-75015 Paris, France; (M.S.); (A.S.-C.); (M.H.); (D.A.); (S.L.); (S.A.); (C.C.); (J.S.)
| | - Sylvain Auvity
- Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), 149 Rue de Sèvres, F-75015 Paris, France; (M.S.); (A.S.-C.); (M.H.); (D.A.); (S.L.); (S.A.); (C.C.); (J.S.)
- Faculté de Pharmacie, Université Paris Cité, Inserm UMRS 1144, 4, Avenue de l’Observatoire, F-75006 Paris, France
| | - Camille Cotteret
- Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), 149 Rue de Sèvres, F-75015 Paris, France; (M.S.); (A.S.-C.); (M.H.); (D.A.); (S.L.); (S.A.); (C.C.); (J.S.)
| | - Olivier Lortholary
- Service des Maladies Infectieuses et Tropicales, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), F-75015 Paris, France;
- Institut Pasteur, Molecular Mycology Unit, National Reference Centre for Invasive Mycoses and Antifungals, CNRS UMR 2000, F-75015 Paris, France
- Institut Imagine, Hôpital Universitaire Necker—Enfants Malades, F-75105 Paris, France
| | - Joël Schlatter
- Service Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris (APHP), 149 Rue de Sèvres, F-75015 Paris, France; (M.S.); (A.S.-C.); (M.H.); (D.A.); (S.L.); (S.A.); (C.C.); (J.S.)
- Service Pharmacie, Hôpital Paul Doumer, Assistance Publique des Hôpitaux de Paris (APHP), 1 Rue de l’Hôpital, F-60140 Labruyère, France
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Tuwor RD, Mtuy TB, Amoako YA, Owusu L, Oppong MN, Agbanyo A, Agbavor B, Marks M, Walker SL, Yeboah-Manu D, Pullan RL, Dapaah JM, Phillips RO, Palmer J. Stigma experiences, effects and coping among individuals affected by Buruli ulcer and yaws in Ghana. PLoS Negl Trop Dis 2024; 18:e0012093. [PMID: 38683858 PMCID: PMC11081504 DOI: 10.1371/journal.pntd.0012093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 05/09/2024] [Accepted: 03/22/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Stigma related to skin neglected tropical diseases like Buruli ulcer (BU) and yaws has remained underexplored and existing studies are limited to individual diseases despite the WHO call for integration in disease management. Within two districts in central Ghana, we explored stigma associated with BU and yaws to understand overlaps and disease-specific nuances to help guide integrated interventions. METHODOLOGY/PRINCIPAL FINDINGS In-depth interviews were conducted with 31 current or formerly affected individuals to assess the experiences, effects and coping strategies adopted to manage disease related stigma. Data were analysed along broad themes based on the sociological construct of macro and micro interaction and Goffman's treatise on stigma. Disapproving community labels fueled by misconceptions were noted among BU participants which contributed to macro stigma experiences, including exclusion, discrimination and avoidance. In contrast, a high level of social acceptance was reported among yaws participants although some micro-level stigma (anticipated, felt and self-stigma) were noted by individuals with both diseases. While younger participants experienced name-calling and use of derogatory words to address affected body parts, older participants and caregivers discussed the pain of public staring. Stigma experiences had negative consequences on psychosocial well-being, schooling, and social relations, particularly for BU affected people. Problem-focused strategies including confrontation, selective disclosure and concealment as well as emotion-focused strategies (religious coping and self-isolation) were noted. CONCLUSIONS AND SIGNIFICANCE The types and levels of stigma varied for BU and yaws. Stigma experiences also differed for adults and children in this setting and these differences should be accounted for in integrated interventions for these skin NTDs. School health programs need to prioritize educating school teachers about skin NTDs and the negative impact of stigma on the wellbeing of children.
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Affiliation(s)
- Ruth Dede Tuwor
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Tara B. Mtuy
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lucy Owusu
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Ntiamoah Oppong
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abigail Agbanyo
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bernadette Agbavor
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Marks
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephen L. Walker
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Rachel L. Pullan
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jonathan Mensah Dapaah
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Odame Phillips
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jennifer Palmer
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Phillips RO, Owusu L, Koka E, Ocloo EK, Simpson H, Agbanyo A, Okyere D, Tuwor RD, Fokuoh-Boadu A, Akuffo RA, Novignon J, Oppong MN, Mosweu I, Asante-Poku A, Cobbinah J, Mtuy TB, Palmer J, Ahorlu C, Amoako YA, Walker SL, Yeboah-Manu D, Marks M, Pitt C, Pullan R. Development of an integrated and decentralised skin health strategy to improve experiences of skin neglected tropical diseases and other skin conditions in Atwima Mponua District, Ghana. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002809. [PMID: 38241242 PMCID: PMC10798462 DOI: 10.1371/journal.pgph.0002809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024]
Abstract
Integrated strategies are recommended to tackle neglected tropical diseases of the skin (skin NTDs), which pose a substantial health and economic burden in many countries, including Ghana. We describe the development of an integrated and decentralised skin health strategy designed to improve experiences of skin NTDs in Atwima Mponua district in Ashanti Region. A multidisciplinary research team led an iterative process to develop an overall strategy and specific interventions, based on a theory of change informed by formative research conducted in Atwima Mponua district. The process involved preparatory work, four co-development workshops (August 2021 to November 2022), collaborative working groups to operationalise intervention components, and obtaining ethical approval. Stakeholders including affected individuals, caregivers, other community members and actors from different levels of the health system participated in co-development activities. We consulted these stakeholders at each stage of the research process, including discussion of study findings, development of our theory of change, identifying implementable solutions to identified challenges, and protocol development. Participants determined that the intervention should broadly address wounds and other skin conditions, rather than only skin NTDs, and should avoid reliance on non-governmental organisations and research teams to ensure sustainable implementation by district health teams and transferability elsewhere. The overall strategy was designed to focus on a decentralised model of care for skin conditions, while including other interventions to support a self-care delivery pathway, community engagement, and referral. Our theory of change describes the pathways through which these interventions are expected to achieve the strategy's aim, the assumptions, and problems addressed. This complex intervention strategy has been designed to respond to the local context, while maximising transferability to ensure wider relevance. Implementation is expected to begin in 2023.
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Affiliation(s)
- Richard Odame Phillips
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Lucy Owusu
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Eric Koka
- Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana
| | - Edmond Kwaku Ocloo
- Department of Sociology and Anthropology, University of Cape Coast, Cape Coast, Ghana
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Hope Simpson
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Abigail Agbanyo
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Daniel Okyere
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ruth Dede Tuwor
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Adelaide Fokuoh-Boadu
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Richard Adjei Akuffo
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Jacob Novignon
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Ntiamoah Oppong
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Iris Mosweu
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Adwoa Asante-Poku
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Jojo Cobbinah
- Atwima Mponua District Health Directorate, Nhinahin, Ghana
| | - Tara B. Mtuy
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
| | - Jennifer Palmer
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
| | - Collins Ahorlu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Yaw Ampem Amoako
- Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
- School of Medicine and Dentistry, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
| | - Stephen L. Walker
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Michael Marks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, University College London Hospital, London, United Kingdom
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Catherine Pitt
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel Pullan
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Godwin-Akpan TG, Chowdhury S, Rogers EJ, Kollie KK, Zaizay FZ, Wickenden A, Zawolo GVK, Parker CBMC, Dean L. The development, implementation, and evaluation of an optimal model for the case detection, referral, and case management of Neglected Tropical Diseases. PLoS One 2023; 18:e0283856. [PMID: 37163515 PMCID: PMC10171595 DOI: 10.1371/journal.pone.0283856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 03/19/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND People affected by Neglected Tropical Diseases (NTDs), specifically leprosy, Buruli ulcer (BU), yaws, and lymphatic filariasis, experience significant delays in accessing health services, often leading to catastrophic physical, psychosocial, and economic consequences. Global health actors have recognized that Sustainable Development Goal 3:3 is only achievable through an integrated inter and intra-sectoral response. This study evaluated existing case detection and referral approaches in Liberia, utilizing the findings to develop and test an Optimal Model for integrated community-based case detection, referral, and confirmation. We evaluate the efficacy of implementing the Optimal Model in improving the early diagnosis of NTDs, thus minimizing access delays and reducing disease burden. METHODS We used a participatory action research approach to develop, implement, and evaluate an Optimal Model for the case detection, referral, and management of case management NTDs in Liberia. We utilized qualitative and quantitative methods throughout the cycle and implemented the model for 12 months. RESULTS During the implementation of our optimal model, the annual number of cases detected increased compared to the previous year. Cases were detected at an earlier stage of disease progression, however; gendered dynamics in communities shape the case identification process for some individuals. Qualitative data showed increased knowledge of the transmission, signs, symptoms, and management options among community health workers (CHW). CONCLUSION The results provide evidence of the benefits of an integrated approach and the programmatic challenges to improve access to health services for persons affected by NTDs. The effectiveness of an integrated approach depends on a high level of collaboration, joint planning, and implementation embedded within existing health systems infrastructure.
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Affiliation(s)
| | - Shahreen Chowdhury
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Emerson J Rogers
- Neglected Tropical Disease Program, Ministry of Health, Oldest Congo Town, Monrovia, Liberia
| | - Karsor K Kollie
- Neglected Tropical Disease Program, Ministry of Health, Oldest Congo Town, Monrovia, Liberia
| | - Fasseneh Zeela Zaizay
- Neglected Tropical Disease Program, Ministry of Health, Oldest Congo Town, Monrovia, Liberia
| | - Anna Wickenden
- American Leprosy Mission, Greenville, South Carolina, United States of America
| | - Georgina V K Zawolo
- University of Liberia-Atlantic Centre for Research and Evaluation, Capitol Hill, Monrovia, Liberia
| | - Colleen B M C Parker
- Research Unit, Ministry of Health, Liberia, Oldest Congo Town, Monrovia, Liberia
| | - Laura Dean
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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7
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Barriers and Enablers to Health-Seeking for People Affected by Severe Stigmatising Skin Diseases (SSSDs): A Scoping Review. SOCIAL SCIENCES 2022. [DOI: 10.3390/socsci11080332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
People affected by severe stigmatising skin diseases (SSSDs) often live in the poorest communities, within the poorest countries, and experience a range of barriers to seeking timely, quality care. This scoping review analyses the available literature on health-seeking for patients affected by SSSDs, to identify enablers and barriers to health-seeking. We searched MEDLINE complete, CINAHL, Global Health databases for suitable articles published between 2010 and 2020. Search strings were compiled for health-seeking, SSSDs and lower middle-income countries (LMIC). Our search returned 1004 studies from across three databases. Of these, 136 potentially relevant studies were identified and full texts were reviewed for eligibility against the inclusion criteria, leading to the inclusion of 55 studies. Thematic narrative analysis was used, with results framed around the Levesque framework to analyse barriers and enablers to health-seeking along the continuum of the patient pathway. This scoping review has revealed barriers across the patient pathway, from both supply and demand aspects of health services. Spiritual beliefs emerged strongly relating to care-seeking and underlying stigma. Curative care was a focus for the majority of studies, but few papers emphasised holistic care (such as physical rehabilitation and psychosocial support). From our analysis, greater community engagement is needed to reduce barriers along the patient-care pathway.
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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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Asiedu K, Marks M, Hay R. Podoconiosis, skin-NTDs and global health. Trans R Soc Trop Med Hyg 2021; 114:887-888. [PMID: 33169171 DOI: 10.1093/trstmh/traa069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/23/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organisation, Geneva, Switzerland
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Roderick Hay
- Kings College London and the International Foundation for Dermatology, London, United Kingdom
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Semrau M, Ali O, Deribe K, Mengiste A, Tesfaye A, Kinfe M, Bremner SA, Hounsome N, Kelly-Hope LA, MacGregor H, Taddese HB, Banteyerga H, HaileMariam D, Negussu N, Fekadu A, Davey G. EnDPoINT: protocol for an implementation research study to integrate a holistic package of physical health, mental health and psychosocial care for podoconiosis, lymphatic filariasis and leprosy into routine health services in Ethiopia. BMJ Open 2020; 10:e037675. [PMID: 33060082 PMCID: PMC7566734 DOI: 10.1136/bmjopen-2020-037675] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Neglected tropical diseases (NTDs) causing lower limb lymphoedema such as podoconiosis, lymphatic filariasis (LF) and leprosy are common in Ethiopia. Routine health services for morbidity management and disability prevention (MMDP) of lymphoedema caused by these conditions are still lacking, even though it imposes a huge burden on affected individuals and their communities in terms of physical and mental health, and psychosocial and economic outcomes. This calls for an integrated, holistic approach to MMDP across these three diseases. METHODS AND ANALYSIS The 'Excellence in Disability Prevention Integrated across NTDs' (EnDPoINT) implementation research study aims to assess the integration and scale-up of a holistic package of care-including physical health, mental health and psychosocial care-into routine health services for people with lymphoedema caused by podoconiosis, LF and leprosy in selected districts in Awi zone in the North-West of Ethiopia. The study is being carried out over three phases using a wide range of mixed methodologies. Phase 1 involves the development of a comprehensive holistic care package and strategies for its integration into the routine health services across the three diseases, and to examine the factors that influence integration and the roles of key health system actors. Phase 2 involves a pilot study conducted in one subdistrict in Awi zone, to establish the care package's adoption, feasibility, acceptability, fidelity, potential effectiveness, its readiness for scale-up, costs of the interventions and the suitability of the training and training materials. Phase 3 involves scale-up of the care package in three whole districts, as well as its evaluation in regard to coverage, implementation, clinical (physical health, mental health and psychosocial) and economic outcomes. ETHICS AND DISSEMINATION Ethics approval for the study has been obtained in the UK and Ethiopia. The results will be disseminated through publications in scientific journals, conference presentations, policy briefs and workshops.
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Affiliation(s)
- Maya Semrau
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | - Oumer Ali
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Kebede Deribe
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
- School of Public Health, College of Health Sciences, 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
| | - Abraham Tesfaye
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Mersha Kinfe
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Stephen A Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Natalia Hounsome
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
| | - Louise A Kelly-Hope
- Centre for Neglected Tropical Diseases, Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hayley MacGregor
- Health and Development Cluster, Institute of Development Studies, University of Sussex, Brighton, UK
| | - Henock B Taddese
- Faculty of Medicine, School of Public Health, Imperial College London, London, UK
| | - Hailom Banteyerga
- College of Humanities, Language Studies, Journalism and Communication, Addis Ababa University, Addis Ababa, Ethiopia
| | - Damen HaileMariam
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nebiyu Negussu
- Neglected Tropical Diseases, Disease Prevention and Control Directorate, Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia
| | - Gail Davey
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, UK
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