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孟加拉国淋巴水肿患者的社会及就医经历

Social and healthcare-seeking experiences of people affected with lymphedema in Bangladesh.

作者信息

Koly Kamrun Nahar, Saba Jobaida, Nessa Zinnatun, Luba Farhana Rahman, Hossain Irin, Aktaruzzaman M M, Rabbani Md Golam, Simic Milena, Dean Laura, Eaton Julian

机构信息

Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh.

Department of Occupational and Environmental Health (OEH), National Institute of Preventive & Social Medicine, Mohakhali, Dhaka, Bangladesh.

出版信息

PLoS Negl Trop Dis. 2025 Aug 12;19(8):e0013384. doi: 10.1371/journal.pntd.0013384. eCollection 2025 Aug.

Abstract

BACKGROUND

Neglected tropical diseases (NTDs) such as lymphatic filariasis (LF) are a significant concern in developing countries like Bangladesh. Understanding the health and social needs of individuals with LF is essential for improving their healthcare-seeking experiences and advancing the health system's capacity. Therefore, this qualitative study aimed to explore the social and care-seeking experiences of persons with LF in Bangladesh.

METHOD

Semi-structured, face-to-face, in-depth interviews were conducted with people with LF in two highly endemic districts in northern Bangladesh. Online key informant interviews were also conducted among stakeholders associated with NTD care. Recorded interviews were analysed using thematic analysis.

RESULT

28 participants (20 with LF and 8 stakeholders) were interviewed, and five major themes emerged after analysis. In terms of disease-related knowledge, the participants perceived lymphedema as a condition characterised by swelling, pain, and fever, which they believed was caused by eating stale food, being infected by others, or being punished by God. Overall, females in particular shared their experiences of negative attitudes from the community. LF adversely affected their daily life, including mental health and well-being. Most respondents sought support from conventional healthcare services; however, their perception of incurable disease led to low medication adherence and dissatisfaction. Lack of knowledge, inaccessibility of healthcare services, financial challenges, and physical disability were major barriers to seeking care. Participants emphasised the importance of financial assistance, community awareness, enhancing the accessibility and quality of care, and occupational rehabilitation scopes with governmental aid.

CONCLUSION

Our findings highlighted the importance of ensuring an accessible and affordable healthcare infrastructure for people with LF. Additionally, the involvement of government and related stakeholders is essential to improve service users' experiences and attain high standards, combined with the need for inclusive well-being-related services. Concentrated efforts should be made to design culturally acceptable interventions to raise awareness and reduce stigma.

摘要

背景

诸如淋巴丝虫病(LF)等被忽视的热带病在孟加拉国等发展中国家是一个重大问题。了解淋巴丝虫病患者的健康和社会需求对于改善他们寻求医疗服务的体验以及提升卫生系统的能力至关重要。因此,本定性研究旨在探索孟加拉国淋巴丝虫病患者的社会和就医体验。

方法

在孟加拉国北部两个高度流行的地区,对淋巴丝虫病患者进行了半结构化、面对面的深入访谈。还对与被忽视热带病护理相关的利益相关者进行了在线关键信息提供者访谈。使用主题分析法对记录的访谈进行了分析。

结果

共访谈了28名参与者(20名淋巴丝虫病患者和8名利益相关者),分析后出现了五个主要主题。在疾病相关知识方面,参与者将淋巴水肿视为一种以肿胀、疼痛和发热为特征的病症,他们认为这是由食用变质食物、被他人感染或受到上帝惩罚引起的。总体而言,尤其是女性分享了她们遭受社区负面态度的经历。淋巴丝虫病对她们的日常生活产生了不利影响,包括心理健康和幸福感。大多数受访者寻求传统医疗服务的支持;然而,他们对疾病无法治愈的认知导致了药物依从性低和不满。知识缺乏、医疗服务不可及、经济挑战和身体残疾是寻求护理的主要障碍。参与者强调了经济援助、社区意识、提高护理的可及性和质量以及在政府援助下的职业康复机会的重要性。

结论

我们研究结果强调了为淋巴丝虫病患者确保可及且负担得起的医疗基础设施的重要性。此外,政府和相关利益相关者的参与对于改善服务使用者的体验并达到高标准至关重要,同时还需要提供与包容性福祉相关的服务。应集中努力设计文化上可接受的干预措施以提高认识并减少耻辱感。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/db79/12342334/a0006779fe30/pntd.0013384.g001.jpg

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