Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Anuradhapura, Sri Lanka.
Section of Infectious Diseases, Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut, United States of America.
PLoS Negl Trop Dis. 2023 May 12;17(5):e0010939. doi: 10.1371/journal.pntd.0010939. eCollection 2023 May.
BACKGROUND: Knowledge of early clinical manifestations, people's perceptions and behaviours is crucial in preventing and controlling neglected tropical diseases (NTDs). Cutaneous leishmaniasis is an NTD that causes skin lesions and affects millions worldwide. Delayed healthcare-seeking behaviour leading to prolonged treatment periods and complications is rife among people with cutaneous leishmaniasis. This study examined the patient-reported early clinical manifestations of cutaneous leishmaniasis, local interpretations and associated health behaviours within the socio-cultural context of rural Sri Lanka. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a qualitative study among people with cutaneous leishmaniasis in three rural communities in the Anuradhapura district, Sri Lanka. Participants' experiences were explored through a study-bespoke participant experience reflection journal and in-depth interviews. We analysed the data using a narrative-thematic approach. The study included 30 people with cutaneous leishmaniasis (12 females and 18 males) aged between 18 and 75 years. We identified four major themes during the analysis: 1) patient-reported early clinical manifestations of cutaneous leishmaniasis, 2) local interpretations of the early skin lesion(s), 3) associated actions and behaviours, and 4) the time gap between the initial notice of symptoms and seeking healthcare for cutaneous leishmaniasis. Early clinical manifestations differed among the participants, while the majority misinterpreted them as a mosquito/ant bite, pimple, wart, eczema, macule, or worm infestation. Participants undertook different context-specific self-management actions to cure cutaneous leishmaniasis. We identified an average time gap between the notice of symptoms and the first visit to the healthcare facility ranging from three to twelve months. CONCLUSIONS/SIGNIFICANCE: Diverse early clinical manifestations, local interpretations, and associated behaviours of people with cutaneous leishmaniasis have led to a substantial delay in healthcare-seeking. The study sheds light on the importance of understanding the manifestations of NTDs within the social context. Our findings will inform designing context-specific health interventions to improve awareness and healthcare-seeking in cutaneous leishmaniasis in rural settings.
背景：了解早期临床表现、人们的认知和行为对于预防和控制被忽视的热带病（NTDs）至关重要。皮肤利什曼病是一种 NTD，会导致皮肤损伤，影响全球数百万人。在患有皮肤利什曼病的人群中，存在着寻求医疗保健的延迟行为，导致治疗期延长和并发症增加。本研究在斯里兰卡农村的社会文化背景下，研究了皮肤利什曼病患者报告的早期临床表现、当地的解释以及相关的健康行为。
方法/主要发现：我们在斯里兰卡阿努拉德普勒区的三个农村社区中开展了一项针对皮肤利什曼病患者的定性研究。参与者的经验通过一项研究定制的参与者体验反思日志和深入访谈进行了探索。我们使用叙述性主题分析方法对数据进行了分析。该研究包括 30 名患有皮肤利什曼病的患者（12 名女性和 18 名男性），年龄在 18 至 75 岁之间。在分析过程中，我们确定了四个主要主题：1）患者报告的皮肤利什曼病的早期临床表现，2）对早期皮肤损伤的当地解释，3）相关的行动和行为，以及 4）从最初注意到症状到寻求皮肤利什曼病医疗保健的时间间隔。早期临床表现因参与者而异，而大多数人将其误解为蚊虫/蚂蚁叮咬、粉刺、疣、湿疹、斑点或寄生虫感染。参与者采取了不同的特定于情境的自我管理措施来治疗皮肤利什曼病。我们发现，从注意到症状到第一次去医疗机构就诊的平均时间间隔为三到十二个月。
结论/意义：皮肤利什曼病患者的临床表现、当地解释和相关行为的多样性导致了医疗保健的严重延迟。该研究强调了在社会背景下理解 NTD 表现的重要性。我们的研究结果将为设计针对农村地区皮肤利什曼病的特定于情境的健康干预措施提供信息，以提高对皮肤利什曼病的认识和寻求医疗保健的意识。
PLoS Negl Trop Dis. 2024-1
BMC Public Health. 2020-6-12
Trop Med Int Health. 2013-11-22
BMC Infect Dis. 2018-3-6
BMJ Glob Health. 2023-8
PLoS Negl Trop Dis. 2022-12
PLoS Negl Trop Dis. 2022-9
Trop Dis Travel Med Vaccines. 2022-8-1
J Res Med Sci. 2021-2-27
PLoS Negl Trop Dis. 2021-4
Zotero 插件
