Keywords

bullous chromoblastomycosis Cosmetic Erythema nodosum leprosum Finger prosthesis FRAP GSH lactation Latex leprosy reaction low-cost malondialdehyde multibacillary leprosy oxidative stress post-partum sclerotic bodies systemic antifungals thalidomide

Volume - 86, Issue - 1

Editorial
Pages 1 - 5
Original Papers
Pages 6 - 20
  • What stops people completing multi-drug therapy? Ranked perspectives of people with leprosy, their head of family and neighbours - across four Indian states

    • M.S. Raju
    • Annamma S. John
    • Pim Kuipers
    Volume 86, Issue 1

    | Published on March 2015

    To maximise successful completion of multi-drug therapy (MDT) and optimise treatment outcomes for people with leprosy, it is vital to understand the relative importance of perceived factors which prevent them from completing the required number of doses in time.

    Objective:

    To explore personal, family, social, community, attitudinal, practical, geographical, cultural and traditional factors which may influence adherence to treatment, a two-phase study was undertaken comprising issue identification via focus groups, and a ranking exercise via individual interview.

    Study Design:

    The perspectives of 895 respondents (320 people affected by leprosy who were not able to complete treatment, 302 of their ‘operational heads of family’, and 273 of their nearby community members) across four states of India namely i.e. Andhra Pradesh (Salur), Chhattisgarh (Chandkhuri), Maharashtra (Kothara) and Uttar Pradesh (Barabanki) were collected, using a checklist interview method.

    Results:

    Findings suggest that seeing positive changes in their symptoms as well as not seeing improvement can lead to non-completion of MDT. Problems with scheduling and travel expenses were also key issues. Better management of the expectations of people affected by leprosy and reducing the burden of treatment may be important strategies. The importance of stigma and poverty were noted through a number of issues, none of which were particularly highly ranked.

    Conclusions:

    The nature and diversity of perceived issues identified across respondent type and particularly region, suggest that the determinants of adherence are complex and multi-factorial. More community based approaches with greater coordination at the community level are recommended.

Original Papers
Pages 21 - 36
  • The patient perspective of the diagnostic process for leprosy in Brazil. An exploratory study

    • Katherine Teasdale
    • Gilles de Wildt
    • Pranab Kumar Das
    • Marcos da Cunha Lopes Virmond
    • Noemi Garcia de Almeida Galan
    • Renata Bilion Ruiz Prado
    • Mary Henry
    • Harpreet Amar
    Volume 86, Issue 1

    | Published on March 2015

    Objectives:

    To explore the patient experience of being diagnosed with leprosy and the support provided during this process in selected populations in Brazil. To understand the information needs of patients during diagnosis. To identify characteristics of patients with different diagnostic experiences. To add to the evidence base used for improving the diagnostic process for leprosy patients.

    Design:

    A self-constructed questionnaire delivered to 116 participants, at three leprosy health centres, across three states in Brazil.

    Results:

    Most participants felt under-informed during diagnosis; 68.1% wanted more information about leprosy. Nearly one-quarter of patients reported feeling unable to ask questions at diagnosis. Almost half of patients reported being worried about treatment, yet 43.3% reported not having the chance to talk about their concerns. Younger participants were significantly more likely to report feeling unable to ask questions and talk about their worries. The majority of participants (59.5%) reported not being given any written information to take away with them. 36.5% reported not being given advice about how to reduce the chance of other family members becoming ill with leprosy. Older males were most likely to be given this advice despite females being in most contact with family members in most cultures.

    Conclusions:

    It is recommended that patients are encouraged to ask questions and invited to talk about their concerns, particularly younger patients. It is recommended that a simple information leaflet be provided to all patients. These suggestions may require some financial input, more staff and longer consultations but should significantly improve the diagnostic process.

Original Papers
Pages 37 - 53
  • Lay and peer counsellors to reduce leprosy-related stigma – lessons learnt in Cirebon, Indonesia

    • Mimi Lusli
    • Ruth M.H. Peters
    • Marjolein B.M. Zweekhorst
    • Wim H. Van Brakel
    • Francisia S.S.E. Seda
    • Joske F.G. Bunders
    • Irwanto
    Volume 86, Issue 1

    | Published on March 2015

    Objective:

    Counselling has been identified as a promising strategy to reduce stigma. Lay and peer counsellors have provided counselling in various fields, but this has not yet been studied in the field of leprosy. The Stigma Assessment and Reduction of Impact (SARI) project in Cirebon District, Indonesia took up this endeavour. This paper describes the initial experiences based on the perspectives of the lay and peer counsellors and aims to provide lessons learnt for future initiatives.

    Methods:

    The selection of lay and peer counsellors was based upon pre-defined criteria such as completed junior high school and level of confidence. This study draws on the notes of seven monitoring and evaluation meetings and 21 group discussions the main researcher facilitated with the lay and peer counsellors and the notes written by the lay and peer counsellors on the sessions with their clients.

    Results:

    In total, 198 people affected by leprosy were offered counselling by the 11 lay and 12 peer counsellors; 145 accepted this offer. The other 53 either did not need counselling or did not want to participate for example due to worries about disclosure. Effective communication skills such as listening and asking effective questions were important, but also difficult to acquire for the lay and peer counsellors. Sharing personal experiences was highly appreciated by clients and stimulated a deepened reflection.

    Conclusion:

    Challenges related to concealment and effective skills exist, but some people affected by leprosy and others can become effective counsellors making it at the outset a challenging but nevertheless promising intervention.

Original Papers
Pages 54 - 61
  • Comparing the perception of community members towards leprosy and tuberculosis stigmatisation

    • Silatham Sermrittirong
    • Wim H. Van Brakel
    • Niyom Kraipui
    • Siripun Traithip
    • J.F.G. Bunders-Aelen
    Volume 86, Issue 1

    | Published on March 2015

    Background:

    Health professionals at all levels gradually recognise the impact of stigma on case detection and treatment of various health conditions such as leprosy and tuberculosis. These diseases are identified as chronic diseases which are prone to stigmatisation.

    Purpose:

    To assess the perception of community members towards stigma related to leprosy and tuberculosis, in order to verify and compare the existence of stigma towards these two diseases in the community, and to provide baseline data for the evaluation of future de-stigmatising interventions.

    Methods:

    This study was done in four sub-districts of Chaiyaphum province. Community members were interviewed using the EMIC stigma scale. Frequency was used to identify the percentage of community members who perceived stigma. A T-test was applied to compare the mean EMIC scores of community members between leprosy and tuberculosis. A P-value of <0.05 was considered indicative of a statistically significant difference or association.

    Results:

    It was found that community members perceived that people affected by leprosy or tuberculosis were stigmatised by the community. However, community members perceived more stigma towards leprosy than towards tuberculosis, particularly in terms of shame, embarrassment, and problems in getting married. The difference was highly significant (P = 0.001, paired t-test).

    Conclusion:

    The communitys perceived stigma against people affected by either leprosy or tuberculosis may affect many aspects of their lives. The authors recommend use of strategically targeted de-stigmatising interventions that take local attitudes and perceptions into consideration.

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