Bukachi Salome A, Wandibba Simiyu, Nyamongo Isaac K
Institute of Anthropology, Gender and African Studies, University of Nairobi, Nairobi, Kenya.
PLoS Negl Trop Dis. 2017 Oct 26;11(10):e0006002. doi: 10.1371/journal.pntd.0006002. eCollection 2017 Oct.
Human African Trypanosomiasis (HAT), a disease caused by protozoan parasites transmitted by tsetse flies, is an important neglected tropical disease endemic in remote regions of sub-Saharan Africa. Although the determination of the burden of HAT has been based on incidence, mortality and morbidity rates, the true burden of HAT goes beyond these metrics. This study sought to establish the socio-economic burden that households with HAT faced and the coping strategies they employed to deal with the increased burden.
A mixed methods approach was used and data were obtained through: review of hospital records; structured interviews (152); key informant interviews (11); case narratives (12) and focus group discussions (15) with participants drawn from sleeping sickness patients in the south western HAT foci in Kenya. Quantitative data were analysed using descriptive statistics while qualitative data was analysed based on emerging themes.
Socio-economic impacts included, disruption of daily activities, food insecurity, neglect of homestead, poor academic performance/school drop-outs and death. Delayed diagnosis of HAT caused 93% of the affected households to experience an increase in financial expenditure (ranging from US$ 60-170) in seeking treatment. Out of these, 81.5% experienced difficulties in raising money for treatment resorting to various ways of raising it. The coping strategies employed to deal with the increased financial expenditure included: sale of agricultural produce (64%); seeking assistance from family and friends (54%); sale/lease of family assets (22%); seeking credit (22%) and use of personal savings (17%).
Coping strategies outlined in this study impacted negatively on the affected households leading to further food insecurity and impoverishment. Calculation of the true burden of disease needs to go beyond incidence, mortality and morbidity rates to capture socio-economic variables entailed in seeking treatment and coping strategies of HAT affected households.
人类非洲锥虫病(HAT)是一种由采采蝇传播的原生动物寄生虫引起的疾病,是撒哈拉以南非洲偏远地区流行的一种重要的被忽视的热带病。尽管对HAT负担的确定一直基于发病率、死亡率和发病率,但HAT的真正负担超出了这些指标。本研究旨在确定HAT家庭所面临的社会经济负担以及他们为应对增加的负担所采用的应对策略。
采用混合方法,通过以下方式获取数据:查阅医院记录;进行结构化访谈(152次);关键 informant 访谈(11次);病例叙述(12个)以及与来自肯尼亚西南部HAT疫源地昏睡病患者的焦点小组讨论(15次)。定量数据采用描述性统计进行分析,而定性数据则根据新出现的主题进行分析。
社会经济影响包括日常活动中断、粮食不安全、家园被忽视、学业成绩差/辍学以及死亡。HAT的延迟诊断导致93%的受影响家庭在寻求治疗时财政支出增加(从60美元至170美元不等)。其中,81.5%的家庭在筹集治疗资金方面遇到困难,不得不采取各种筹资方式。为应对增加的财政支出所采用的应对策略包括:出售农产品(64%);向家人和朋友求助(54%);出售/租赁家庭资产(22%);寻求信贷(22%)以及动用个人储蓄(17%)。
本研究中概述的应对策略对受影响家庭产生了负面影响,导致进一步的粮食不安全和贫困。疾病真正负担的计算需要超越发病率、死亡率和发病率,以涵盖寻求治疗和HAT受影响家庭应对策略中所涉及的社会经济变量。