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Putri AI, de Sabbata K, Agusni RI, Alinda MD, Darlong J, de Barros B, Walker SL, Zweekhorst MBM, Peters RMH. Understanding leprosy reactions and the impact on the lives of people affected: An exploration in two leprosy endemic countries. PLoS Negl Trop Dis 2022; 16:e0010476. [PMID: 35696438 PMCID: PMC9191760 DOI: 10.1371/journal.pntd.0010476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Leprosy reactions, Type-1 and erythema nodosum leprosum, are immune-mediated complications of leprosy, which play a significant role in the morbidity associated with the disease. A considerable amount of literature has been published on the impact of leprosy in general but few studies focus specifically on leprosy reactions. This study aimed to investigate the impact of leprosy reactions on physical, psychological, and social aspects of the lives of people affected by analysing their life experiences and perspectives about leprosy reactions.
Methods/Principal findings
This qualitative study involved people affected by leprosy reactions and their family members in two leprosy endemic countries. The data were collected through 66 interviews and 9 focus group discussions (4–6 participants each) in Surabaya, Indonesia, and Purulia, India. Content analysis and conversational analysis were performed. This study found that both types of leprosy reactions were perceived as an unpredictable and painful condition. Leprosy reactions restricted physical activities of the participants, such as going to bathroom, sleeping, eating, and cooking. In the interviews, the respondents expressed a range of emotions and feelings including confusion, sadness, anxiety, and anger. Some recounted that they felt stigmatized and lost opportunities to socialise and earn money. Differences between the two settings were identified. The majority of Indonesian participants preferred to stay at home, and some concealed the diagnosis of leprosy, while most of the Indian respondents continued working up to the time of hospitalization.
Conclusion
Leprosy reactions are a distressing complication of leprosy and adversely affect the lives of those affected. Individuals reported physical discomfort, distress, anxiety, stigma, and financial hardship and these negative impacts in the physical, psychological, and social spheres reinforced each other. These findings provide important information about a need for early detection and sustained commitment to follow-up care for people with a history of leprosy reactions. More research on new drugs for reactional episodes, tools to measure knowledge, attitude, and practice, and costing study on leprosy reactions treatment are needed. We recommend the development and testing of holistic strategies to improve the management of leprosy reactions.
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Affiliation(s)
- Annisa Ika Putri
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, Netherlands
- Department of dermatology, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
- * E-mail:
| | - Kevin de Sabbata
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, Netherlands
- School of Law, Keele University, Keele, Newcastle, United Kingdom
| | - Regitta I. Agusni
- Department of dermatology, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | - Medhi Denisa Alinda
- Department of dermatology, Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia
| | | | - Barbara de Barros
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephen L. Walker
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Ruth M. H. Peters
- Athena Institute, Faculty of Science, VU University Amsterdam, Amsterdam, Netherlands
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Erisman JC, de Sabbata K, Zuiderent-Jerak T, Syurina EV. Navigating complexity of child abuse through intuition and evidence-based guidelines: a mix-methods study among child and youth healthcare practitioners. BMC Fam Pract 2020; 21:157. [PMID: 32738894 PMCID: PMC7395977 DOI: 10.1186/s12875-020-01226-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 07/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Dutch child and youth health care (CYHC) practitioners monitor and assess the well-being of children. One of their main concerns is identifying cases of child abuse, which is an arduous and sensitive task. In these contexts, CYHC-practitioners use both evidence-based guidelines aimed at increasing the quality of care through rationalised decision-making, and intuition. These two practices are seen as being at odds with each other, yet empirical research has shown that both are necessary in healthcare. This study aims to unravel how intuition is perceived and used by Dutch CYHC-practitioners when identifying and working with cases of child abuse, and how this relates to their evidence-based guidelines. METHODS A sequential exploratory mixed-methods design: in-depth semi-structured interviews with CYHC-physicians focused on perceptions on intuition, which were followed by a survey amongst CYHC-practitioners on the recognition and use of the concept. RESULTS The majority of CYHC-practitioners recognise and use intuition in their daily work, stating that it is necessary in their profession. CYHC-practitioners use intuition to 1) sense that something is 'off', 2) differentiate between 'normal' and 'abnormal', 3) assess risks, 4) weigh secondary information and 5) communicate with parents. At the same time, they warn of its dangers, as it may lead to 'tunnel vision' and false accusations. CONCLUSION Intuition is experienced as an integral part of the work of CYHC-practitioners. It is understood as particularly useful in cases of child abuse, which are inherently complex, as signs and evidence of abuse are often hidden, subtle and unique in each case. CYHC-practitioners use intuition to manage and navigate this complexity. There is an opportunity for guidelines to support reflection and intuition as a 'good care' practice.
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Affiliation(s)
- Jetske C Erisman
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan, 1085 1081, Amsterdam, HV, The Netherlands
| | - Kevin de Sabbata
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan, 1085 1081, Amsterdam, HV, The Netherlands
| | - Teun Zuiderent-Jerak
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan, 1085 1081, Amsterdam, HV, The Netherlands
| | - Elena V Syurina
- Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan, 1085 1081, Amsterdam, HV, The Netherlands.
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