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Barbosa Ladino MC, Jiménez Betancourth C, Vásquez Acevedo L, Haag M, Zirkel J, Schwienhorst-Stich EM, Navarro M, Kasang C, Gágyor I, Parisi S. Body map stories from Colombia: experiences of people affected by leprosy and the influence of peers during diagnosis and treatment. Int J Equity Health 2024; 23:98. [PMID: 38741119 DOI: 10.1186/s12939-024-02152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 03/15/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Almost one third of people affected by leprosy in Colombia suffer from disability, which often results from delayed diagnosis and treatment. We aimed to explore the experience of people affected by leprosy during the process of diagnosis and treatment and if and how this experience was influenced by peers. METHODS A qualitative study using body map stories was conducted from October 2019 to February 2020 in Colombia. Adult people affected by leprosy were recruited through patient associations in different cities. We conducted three sessions with an average duration of 2-3 h per participant, during which the participants created a painted map of their body and chose symbols to represent their experience, while being engaged in an informal interview. The sessions were audio recorded, transcribed verbatim and analyzed thematically by an interdisciplinary team, consisting of physicians, social workers and a person affected by leprosy. RESULTS The 17 study participants (11 female) were aged 20 to 70 years. Leprosy-related manifestations ranged from no to advanced disability. Some participants were active members of associations for people affected by leprosy. Three main themes were identified during analysis: (1) A long pathway to diagnosis, (2) Therapy as a double-edged sword and (3) The influence of other people affected by leprosy. The participants described an often years-long process until being diagnosed, which was marked by insecurities, repeated misdiagnosis, and worsening mental and physical health. Delayed diagnosis was related to late health care seeking, but also to inadequate health communication, lack of leprosy-related knowledge and negligence among health care workers. A high desire to cure motivated the participants to take their medication rigorously, despite the high treatment burden. Support from peers, either within the own social environment or provided from associations, contributed to a faster diagnosis and increased therapy adherence. Peers helped to recognize the symptoms, urged patients to seek care, recommended physicians with leprosy-related knowledge and provided a realistic example of both disease severity and curability. CONCLUSION People affected by leprosy experience a significant burden during the process of diagnosis and treatment. Involving well-trained peers could foster early diagnosis, treatment compliance and prevention of disability.
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Affiliation(s)
- Martha Cecilia Barbosa Ladino
- DAHW Latin America, GLRA German Leprosy and Tuberculosis Relief Association, Bogotá, Colombia
- FELEHANSEN National federation of people affected by Hansen`s disease in Colombia, Bogotá, Colombia
| | - Camila Jiménez Betancourth
- DAHW Latin America, GLRA German Leprosy and Tuberculosis Relief Association, Bogotá, Colombia
- FELEHANSEN National federation of people affected by Hansen`s disease in Colombia, Bogotá, Colombia
| | - Lucrecia Vásquez Acevedo
- FELEHANSEN National federation of people affected by Hansen`s disease in Colombia, Bogotá, Colombia
| | - Melanie Haag
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Janina Zirkel
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
- Internal Medicine, Unit of Infectious Disease, University Hospital Würzburg, Würzburg, Germany
| | | | - Miriam Navarro
- Epidemiology Unit, Public Health Centre of Elche - FISABIO, Alicante, Spain
- Department of Public Health, Science History and Gynaecology, Universidad Miguel Hernández, Alicante, Spain
| | - Christa Kasang
- DAHW HQ, GLRA German Leprosy and Tuberculosis Relief Association, Würzburg, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Sandra Parisi
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany.
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Meraz Soto JM, Alvarado Motte RA, Ramírez Carrillo P, Meraz Soto AA, Bayón Villaseñor V, Cheirif Wolosky O. Crusted Hyperkeratotic Scabies: A Case Report. Cureus 2023; 15:e34520. [PMID: 36879685 PMCID: PMC9984309 DOI: 10.7759/cureus.34520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Crusted scabies is a rare form of classic scabies characterized by severe symptoms, mainly observed in immunosuppressed patients. This disease has been associated with a variety of health problems, such as delayed diagnosis, infection risk, and high mortality, mainly from sepsis. We report the case of a patient with hyperkeratotic scabies in the context of immunosuppression associated with malnutrition and the use of topical corticosteroids. Ivermectin is critical for successfully treating crusted scabies. However, a higher cure rate has been reported with the combination of oral ivermectin and topical permethrin. In our study, we chose to use a plan suitable for grade two scabies, resulting in a subtotal regression of the lesions. Crusted scabies is a highly contagious parasitic cutaneous disease, and there are few reports in the national and international literature. It is necessary to suspect this presentation form in order to establish a timely diagnosis and detect and treat associated comorbidities.
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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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Simpson H, Konan DO, Brahima K, Koffi JD, Kashindi S, Edmiston M, Weiland S, Halliday K, Pullan RL, Meite A, Koudou BG, Timothy J. Effectiveness of community-based burden estimation to achieve elimination of lymphatic filariasis: A comparative cross-sectional investigation in Côte d'Ivoire. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000760. [PMID: 36962795 PMCID: PMC10022321 DOI: 10.1371/journal.pgph.0000760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/23/2022] [Indexed: 11/19/2022]
Abstract
For lymphatic filariasis (LF) elimination, endemic countries must document the burden of LF morbidity (LFM). Community-based screening (CBS) is used to collect morbidity data, but evidence demonstrating its reliability is limited. Recent pilots of CBS for LFM alongside mass drug administration (MDA) in Côte d'Ivoire suggested low LFM prevalence (2.1-2.2 per 10,000). We estimated LFM prevalence in Bongouanou District, Côte d'Ivoire, using a comparative cross-sectional design. We compared CBS implemented independently of MDA, adapted from existing Ministry of Health protocols, to a population-based prevalence survey led by formally trained nurses. We evaluated the reliability of case identification, coverage, equity, and cost of CBS. CBS identified 87.4 cases of LFM per 10,000; the survey identified 47.5 (39.4-56.3; prevalence ratio [PR] 1.84; 95% CI 1.64-2.07). CBS identified 39.7 cases of suspect lymphoedema per 10,000; the survey confirmed 35.1 (29.2-41.5) filarial lymphoedema cases per 10,000 (PR 1.13 [0.98-1.31]). CBS identified 96.5 scrotal swellings per 10,000; the survey found 91.3 (83.2-99.8; PR 1.06 [0.93-1.21]); including 33.9 (27.7-38.8) filarial hydrocoele per 10,000 (PR of suspect to confirmed hydrocele 2.93 [2.46-3.55]). Positive predictive values for case identification through CBS were 65.0% (55.8-73.5%) for filarial lymphoedema; 93.7% (89.3-96.7%) for scrotal swellings; and 34.0% (27.3-41.2%) for filarial hydrocoele. Households of lower socioeconomic status and certain minority languages were at risk of exclusion. Direct financial costs were $0.17 per individual targeted and $69.62 per case confirmed. Our community-based approach to LFM burden estimation appears scalable and provided reliable prevalence estimates for LFM, scrotal swellings and LF-lymphoedema. The results represent a step-change improvement on CBS integrated with MDA, whilst remaining at programmatically feasible costs. Filarial hydrocoele cases were overestimated, attributable to the use of case definitions suitable for mass-screening by informal staff. Our findings are broadly applicable to countries aiming for LF elimination using CBS. The abstract is available in French in the S1 File.
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Affiliation(s)
- Hope Simpson
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Daniele O Konan
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Kouma Brahima
- Ministère de la Sante et de l'Hygiène Publique, Programme national de lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive (PNLMTN-CP) en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Jeanne d'Arc Koffi
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Saidi Kashindi
- American Leprosy Missions, Greenville, South Carolina, United States of America
- AIM Initiative, Accra, Ghana
| | - Melissa Edmiston
- American Leprosy Missions, Greenville, South Carolina, United States of America
- AIM Initiative, Accra, Ghana
| | - Stefanie Weiland
- American Leprosy Missions, Greenville, South Carolina, United States of America
- AIM Initiative, Accra, Ghana
| | - Katherine Halliday
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Rachel L Pullan
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Aboulaye Meite
- Ministère de la Sante et de l'Hygiène Publique, Programme national de lutte contre les Maladies Tropicales Négligées à Chimiothérapie Préventive (PNLMTN-CP) en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | | | - Joseph Timothy
- Department for Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
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