Department of Internal Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
Medical Department, German Leprosy and TB Relief Association, Enugu State, Nigeria.
PLoS Negl Trop Dis. 2020 Apr 30;14(4):e0008248. doi: 10.1371/journal.pntd.0008248. eCollection 2020 Apr.
There is a dearth of experience in and evidence for cost-effective integrated community-based management of skin neglected tropical diseases (NTDs). The objective of this study was to assess the knowledge, attitude and care-seeking practices including self-care with a view to introducing appropriate community-based interventions for skin NTDs in an endemic setting in Southern Nigeria.
METHODS/PRINCIPAL FINDINGS: This exploratory study adopted a mixed-methods design consisting of cross-sectional surveys of community members and health workers using interviewer-administered questionnaires; and focus group discussions (FGDs) with community members, health care workers and patients with NTDs in Anambra State, Nigeria. The survey was completed by 353 community members (61.8% female) and 15 health care workers (100.0% female). A total of 52 individuals participated in six FGDs. Of the community members, 236 (66.9%) had heard or seen a case of leprosy; 324 (91.8%) and 131 (37.5%) had heard or seen a case of Buruli ulcer and lymphatic filariasis, respectively. Again, 213 (60.3%) of the respondents reported that the diseases were caused by witchcraft or curse. As regards prevention, 241 (68.3%) suggested avoiding handshake with affected persons. Up to 223 (63.2%) of respondents strongly agreed to the seriousness of skin NTDs in their community. Meanwhile, 272 (77.1%) of the respondents believed that the transmission of these skin NTDs can be prevented. Furthermore, 324 (91.7%) desired active community engagement for control of skin NTDs. Regarding community care seeking practices, 197 (55.8%) would first visit the health centre/hospital, followed by 91 (25.8%) traditional healer/herbalist and 35 (9.9%) pharmacy/patent medicine vendor if they develop a skin NTD. Overall, 332 (94.1%) of respondents expressed interest in being taught self-care practices for skin NTDs. Out of 15 healthcare workers, 13 (86.7%) were able to correctly diagnose two of these skin NTDs and 10 (66.7%) would encourage patients to practice self-care. Prominent themes in the FGDs were belief in witchcraft and herbal remedies; as well as the occurrence of physical, social and economic distress.
Our study helped quantify the information gaps that need to be addressed in order to create demand for integrated skin NTDs services in an endemic setting in Nigeria. Individual, structural and socioeconomic challenges to access and delivery of services were identified. Community and health care workers' empowerment and engagement through outreach and regular training, respectively may alleviate these challenges.
在以经济有效的方式整合社区管理皮肤性被忽视热带病（NTD）方面，经验和证据都很匮乏。本研究旨在评估皮肤 NTD 社区成员的知识、态度和求医行为，包括自我护理，以便在尼日利亚南部的流行地区引入适当的社区为基础的干预措施。
方法/主要发现：本探索性研究采用混合方法设计，包括对社区成员和卫生工作者进行横断面调查，使用访谈者管理的问卷；以及在尼日利亚阿南布拉州进行社区成员、卫生保健工作者和 NTD 患者的焦点小组讨论（FGD）。调查由 353 名社区成员（61.8%为女性）和 15 名卫生工作者（100.0%为女性）完成。共有 52 人参加了 6 个 FGD。在社区成员中，236 人（66.9%）听说或见过麻风病病例；324 人（91.8%）和 131 人（37.5%）听说或见过一例布鲁里溃疡和淋巴丝虫病病例。同样，213 名（60.3%）受访者表示，这些疾病是由巫术或诅咒引起的。至于预防，241 名（68.3%）受访者建议避免与受影响的人握手。多达 223 名（63.2%）的受访者强烈认为他们社区的皮肤 NTD 很严重。与此同时，272 名（77.1%）受访者认为这些皮肤 NTD 的传播是可以预防的。此外，324 名（91.7%）的受访者希望积极参与社区活动，以控制皮肤 NTD。关于社区的求医行为，197 人（55.8%）会先去卫生中心/医院就诊，如果出现皮肤 NTD，91 人（25.8%）会选择传统治疗师/草药医生，35 人（9.9%）会选择药店/专利药供应商。总的来说，332 名（94.1%）的受访者表示有兴趣接受皮肤 NTD 自我护理实践的培训。在 15 名卫生工作者中，有 13 名（86.7%）能够正确诊断出其中两种皮肤 NTD，有 10 名（66.7%）会鼓励患者进行自我护理。焦点小组讨论的突出主题是巫术和草药治疗的信念；以及身体、社会和经济痛苦的发生。
我们的研究有助于量化在尼日利亚流行地区为皮肤 NTD 创造综合服务需求方面需要解决的信息差距。确定了获取和提供服务的个人、结构和社会经济挑战。通过外展和定期培训，增强社区和卫生保健工作者的权能和参与，可能会缓解这些挑战。
