Delay in reporting for possible leprosy diagnosis and a delay in making the diagnosis of leprosy ... more Delay in reporting for possible leprosy diagnosis and a delay in making the diagnosis of leprosy may result in unnecessary complications. Objective: Which factors contribute to late reporting and a missed diagnosis of leprosy? Method: A questionnaire, involving 1243 newly diagnosed patients, was used to explore reasons for possible delay in diagnosis and start of treatment; the patients were being managed in six projects in four leprosy endemic countries, and needed treatment for nerve function impairment, Results/Conclusions: Delays in reporting for diagnosis and in establishing the diagnosis are multifactorial and differ between the research sites. Factors contributing to the delay are person and program related, including concealment of suspected disease, perhpas because of shame,accessibility of the clinic, and expertise within the
Leprosy is slowly decreasing in incidence whereas diabetes is a growing health concern. Despite d... more Leprosy is slowly decreasing in incidence whereas diabetes is a growing health concern. Despite differences in aetiology, both diseases may lead to peripheral neuropathy and subsequent injuries and permanent impairments. There are also indications of similarities in psychosocial consequences. Prevention of Disability (POD) and self-management are often recommended for both diseases. This led to the idea of exploring the feasibility of combined peer-led self-care interventions for people with these disorders. To explore the opinions of health care professionals about combining peer-led self-care interventions for people affected by leprosy or diabetes in leprosy-endemic countries. An exploratory study was conducted to collect quantitative data by means of an e-questionnaire and qualitative data through in-depth semi-structured interviews with key informants. In total, 227 respondents answered the e-questionnaire and 22 in-depth interviews were conducted. Resemblances in physical comp...
Chronic wounds and lymphedema are often secondary complications of chronic diseases. Chronic... more Chronic wounds and lymphedema are often secondary complications of chronic diseases. Chronic wounds and lymphedema cut across diseases, settings, and borders especially in settings with limited resources, and present an opportunity to implement an integrated approach to prevention and care. The following article describes key elements in the design and development of pilot projects based on the principles of the World Health Organization's (WHO) Innovative Care for Chronic Conditions model. The pilot projects will advance the efforts of World Alliance for Wound and Lymphedema Care (WAWLC) to aid health systems in building capacity for effective wound and lymphedema care. .
The International Quarterly of Community Health Education, 2006
An understanding of the socioeconomic and cultural realities of persons infected with tuberculosi... more An understanding of the socioeconomic and cultural realities of persons infected with tuberculosis (TB) in communities is important to re-strategizing control programs because these realities often come as constraints to the use of the directly observed therapy short-course (DOTS) in Nigeria. In-depth interviews and focus group discussion were used to study barriers to attendance at DOTS clinics for both prompt diagnosis and treatment of smear positive cases in Nigerian communities. A number of common and interrelated factors form barriers to use of DOTS clinics. These include perceived causes of the infection, for example witchcraft, that mitigate against an orthodox solution to TB and thereby affect perceived efficacy of DOTS. Another factor is perceived high cost in resource poor settings. Facility staff were noted to have demanded money from patients in spite of the fact that DOTS is advertised as free treatment. Furthermore, community members complain of the hostile attitude of...
The high prevalence of skin diseases in resource-poor settings, where health workers with suffici... more The high prevalence of skin diseases in resource-poor settings, where health workers with sufficient knowledge of skin diseases are scarce, calls for innovative measures. Timely diagnosis and treatment of skin diseases, especially neglected tropical diseases (NTDs) that manifest with skin lesions, such as leprosy, is crucial to prevent disabilities as well as psychological and socioeconomic problems. Innovative technological methods like telemedicine and mobile health (mHealth) can help to bridge the gap between the burden of skin diseases and the lack of capable staff in resource-poor settings by bringing essential health services from central level closer to peripheral levels. Netherlands Leprosy Relief (NLR) has developed a mobile phone application called the ‘SkinApp’, which aims to support peripheral health workers to recognize the early signs and symptoms of skin diseases, including skin NTDs, and to start treatment promptly or refer for more advanced diagnostic testing or dis...
While prednisolone is commonly used to treat recent nerve function impairment (NFI) in leprosy pa... more While prednisolone is commonly used to treat recent nerve function impairment (NFI) in leprosy patients, the optimal treatment duration has not yet been established. In this "Treatment of Early Neuropathy in Leprosy" (TENLEP) trial, we evaluated whether a 32-week prednisolone course is more effective than a 20-week course in restoring and improving nerve function. In this multi-centre, triple-blind, randomized controlled trial, leprosy patients who had recently developed clinical NFI (<6 months) were allocated to a prednisolone treatment regimen of either 20 weeks or 32 weeks. Prednisolone was started at either 45 or 60 mg/day, depending on the patient's body weight, and was then tapered. Throughout follow up, NFI was assessed by voluntary muscle testing and monofilament testing. The primary outcome was the proportion of patients with improved or restored nerve function at week 78. As secondary outcomes, we analysed improvements between baseline and week 78 on the R...
Background In 2007 the first meeting was held for what is now called the World Alliance for Wound... more Background In 2007 the first meeting was held for what is now called the World Alliance for Wound and Lymphedema Care (WAWLC). Several organizations were part of this initiative, notably the Association for the Advancement of Wound Care (AAWC), Health Volunteers Overseas (HVO), the Canadian Association for Wound Care (CAWC),
Skin diseases are common worldwide, though prevalence rates in rural areas are difficult to estim... more Skin diseases are common worldwide, though prevalence rates in rural areas are difficult to estimate, and are primarily based on hospital studies rather than community-based studies. Primary health care providers in rural areas often lack sufficient knowledge about skin diseases, which contributes to poor skin management and subsequently causes considerable morbidity. This study looked at the performance of first-line health care providers in the management of common skin disease, using an algorithmic approach with a flowchart with diagnostic steps. As a reference standard, two dermatologists independently validated the diagnoses and treatment choices made by the providers. The performance of the algorithm was calculated in terms of the sensitivity, specificity, positive predictive value (PPV), and negative predictive value for each skin disease of the algorithm. A total of 19 patent medicine vendors and 12 traditional healers from Kano State in Nigeria diagnosed 4,147 patients with suspected skin symptoms. The most common skin disease was tinea capitis (59.2%), and it was found predominantly among boys below 15 years of age. Together, patent medicine vendors and traditional healers had 82% of the cases correctly diagnosed, and in 82% they prescribed the correct treatment. The sensitivities varied for each skin disease from 94.8% for tinea capitis to 7.1% for contact dermatitis. The specificities varied between 87.0% and 98.6%. Except for tinea capitis, lower PPVs were found for the various skin diseases when compared to earlier studies. In spite of the observed low sensitivities and low PPVs for several diseases, the algorithm seems to offer an improvement in management of common skin diseases at the peripheral level. With adaptations in training, further refinement of the algorithm and refresher training, predictive values and sensitivities can be increased.
To study the role of traditional leaders (Sarakuna) who provide a form of social welfare for pers... more To study the role of traditional leaders (Sarakuna) who provide a form of social welfare for persons with disabilities in the Hausa society of Northern Nigeria. From the results of this study, lessons are derived for cooperation with Sarakuna in (emerging) Community Based Rehabilitation programmes. Methods: A literature study was done using different (non-)electronic sources. In addition, 26 semi-structured interviews were conducted with different stakeholders (e.g., non-governmental organisations, disabled people's organisations), and 8 focus group discussions were held with (leaders of) persons with a disability. Question-led analysis was utilised by considering 4 dimensions: rehabilitation outcomes, rehabilitation services, involvement of beneficiaries, and social acceptability. Results: Not much literature is available on the role of traditional leadership in rehabilitation programmes and social welfare. Nevertheless, this study found indications that traditional leadership is still present in contemporary Northern Nigeria. Some Sarakuna improve the socioeconomic position of persons with disabilities by functioning as mediators and by their ability to provide social insurance. Their cooperation with multiple stakeholders enables them to distribute food and clothes. Also, since they possess essential information, NGOs are helped to access the community of persons with disabilities. Sarakuna are in a position to promote the inclusion and rehabilitation of persons with disabilities, but often lack necessary skills and training; yet, Community Based Rehabilitation programmes often ignore them. Conclusions and Implications: Community Based Rehabilitation programmes should take better note of social contexts and therefore should also work in the
Wounds : a compendium of clinical research and practice, 2010
Chronic wounds and lymphedema are often secondary complications of chronic diseases. Chronic... more Chronic wounds and lymphedema are often secondary complications of chronic diseases. Chronic wounds and lymphedema cut across diseases, settings, and borders especially in settings with limited resources, and present an opportunity to implement an integrated approach to prevention and care. The following article describes key elements in the design and development of pilot projects based on the principles of the World Health Organization's (WHO) Innovative Care for Chronic Conditions model. The pilot projects will advance the efforts of World Alliance for Wound and Lymphedema Care (WAWLC) to aid health systems in building capacity for effective wound and lymphedema care. .
International quarterly of community health education
An understanding of the socioeconomic and cultural realities of persons infected with tuberculosi... more An understanding of the socioeconomic and cultural realities of persons infected with tuberculosis (TB) in communities is important to re-strategizing control programs because these realities often come as constraints to the use of the directly observed therapy short-course (DOTS) in Nigeria. In-depth interviews and focus group discussion were used to study barriers to attendance at DOTS clinics for both prompt diagnosis and treatment of smear positive cases in Nigerian communities. A number of common and interrelated factors form barriers to use of DOTS clinics. These include perceived causes of the infection, for example witchcraft, that mitigate against an orthodox solution to TB and thereby affect perceived efficacy of DOTS. Another factor is perceived high cost in resource poor settings. Facility staff were noted to have demanded money from patients in spite of the fact that DOTS is advertised as free treatment. Furthermore, community members complain of the hostile attitude of...
Delay in reporting for possible leprosy diagnosis and a delay in making the diagnosis of leprosy ... more Delay in reporting for possible leprosy diagnosis and a delay in making the diagnosis of leprosy may result in unnecessary complications. Objective: Which factors contribute to late reporting and a missed diagnosis of leprosy? Method: A questionnaire, involving 1243 newly diagnosed patients, was used to explore reasons for possible delay in diagnosis and start of treatment; the patients were being managed in six projects in four leprosy endemic countries, and needed treatment for nerve function impairment, Results/Conclusions: Delays in reporting for diagnosis and in establishing the diagnosis are multifactorial and differ between the research sites. Factors contributing to the delay are person and program related, including concealment of suspected disease, perhpas because of shame,accessibility of the clinic, and expertise within the
Leprosy is slowly decreasing in incidence whereas diabetes is a growing health concern. Despite d... more Leprosy is slowly decreasing in incidence whereas diabetes is a growing health concern. Despite differences in aetiology, both diseases may lead to peripheral neuropathy and subsequent injuries and permanent impairments. There are also indications of similarities in psychosocial consequences. Prevention of Disability (POD) and self-management are often recommended for both diseases. This led to the idea of exploring the feasibility of combined peer-led self-care interventions for people with these disorders. To explore the opinions of health care professionals about combining peer-led self-care interventions for people affected by leprosy or diabetes in leprosy-endemic countries. An exploratory study was conducted to collect quantitative data by means of an e-questionnaire and qualitative data through in-depth semi-structured interviews with key informants. In total, 227 respondents answered the e-questionnaire and 22 in-depth interviews were conducted. Resemblances in physical comp...
Chronic wounds and lymphedema are often secondary complications of chronic diseases. Chronic... more Chronic wounds and lymphedema are often secondary complications of chronic diseases. Chronic wounds and lymphedema cut across diseases, settings, and borders especially in settings with limited resources, and present an opportunity to implement an integrated approach to prevention and care. The following article describes key elements in the design and development of pilot projects based on the principles of the World Health Organization's (WHO) Innovative Care for Chronic Conditions model. The pilot projects will advance the efforts of World Alliance for Wound and Lymphedema Care (WAWLC) to aid health systems in building capacity for effective wound and lymphedema care. .
The International Quarterly of Community Health Education, 2006
An understanding of the socioeconomic and cultural realities of persons infected with tuberculosi... more An understanding of the socioeconomic and cultural realities of persons infected with tuberculosis (TB) in communities is important to re-strategizing control programs because these realities often come as constraints to the use of the directly observed therapy short-course (DOTS) in Nigeria. In-depth interviews and focus group discussion were used to study barriers to attendance at DOTS clinics for both prompt diagnosis and treatment of smear positive cases in Nigerian communities. A number of common and interrelated factors form barriers to use of DOTS clinics. These include perceived causes of the infection, for example witchcraft, that mitigate against an orthodox solution to TB and thereby affect perceived efficacy of DOTS. Another factor is perceived high cost in resource poor settings. Facility staff were noted to have demanded money from patients in spite of the fact that DOTS is advertised as free treatment. Furthermore, community members complain of the hostile attitude of...
The high prevalence of skin diseases in resource-poor settings, where health workers with suffici... more The high prevalence of skin diseases in resource-poor settings, where health workers with sufficient knowledge of skin diseases are scarce, calls for innovative measures. Timely diagnosis and treatment of skin diseases, especially neglected tropical diseases (NTDs) that manifest with skin lesions, such as leprosy, is crucial to prevent disabilities as well as psychological and socioeconomic problems. Innovative technological methods like telemedicine and mobile health (mHealth) can help to bridge the gap between the burden of skin diseases and the lack of capable staff in resource-poor settings by bringing essential health services from central level closer to peripheral levels. Netherlands Leprosy Relief (NLR) has developed a mobile phone application called the ‘SkinApp’, which aims to support peripheral health workers to recognize the early signs and symptoms of skin diseases, including skin NTDs, and to start treatment promptly or refer for more advanced diagnostic testing or dis...
While prednisolone is commonly used to treat recent nerve function impairment (NFI) in leprosy pa... more While prednisolone is commonly used to treat recent nerve function impairment (NFI) in leprosy patients, the optimal treatment duration has not yet been established. In this "Treatment of Early Neuropathy in Leprosy" (TENLEP) trial, we evaluated whether a 32-week prednisolone course is more effective than a 20-week course in restoring and improving nerve function. In this multi-centre, triple-blind, randomized controlled trial, leprosy patients who had recently developed clinical NFI (<6 months) were allocated to a prednisolone treatment regimen of either 20 weeks or 32 weeks. Prednisolone was started at either 45 or 60 mg/day, depending on the patient's body weight, and was then tapered. Throughout follow up, NFI was assessed by voluntary muscle testing and monofilament testing. The primary outcome was the proportion of patients with improved or restored nerve function at week 78. As secondary outcomes, we analysed improvements between baseline and week 78 on the R...
Background In 2007 the first meeting was held for what is now called the World Alliance for Wound... more Background In 2007 the first meeting was held for what is now called the World Alliance for Wound and Lymphedema Care (WAWLC). Several organizations were part of this initiative, notably the Association for the Advancement of Wound Care (AAWC), Health Volunteers Overseas (HVO), the Canadian Association for Wound Care (CAWC),
Skin diseases are common worldwide, though prevalence rates in rural areas are difficult to estim... more Skin diseases are common worldwide, though prevalence rates in rural areas are difficult to estimate, and are primarily based on hospital studies rather than community-based studies. Primary health care providers in rural areas often lack sufficient knowledge about skin diseases, which contributes to poor skin management and subsequently causes considerable morbidity. This study looked at the performance of first-line health care providers in the management of common skin disease, using an algorithmic approach with a flowchart with diagnostic steps. As a reference standard, two dermatologists independently validated the diagnoses and treatment choices made by the providers. The performance of the algorithm was calculated in terms of the sensitivity, specificity, positive predictive value (PPV), and negative predictive value for each skin disease of the algorithm. A total of 19 patent medicine vendors and 12 traditional healers from Kano State in Nigeria diagnosed 4,147 patients with suspected skin symptoms. The most common skin disease was tinea capitis (59.2%), and it was found predominantly among boys below 15 years of age. Together, patent medicine vendors and traditional healers had 82% of the cases correctly diagnosed, and in 82% they prescribed the correct treatment. The sensitivities varied for each skin disease from 94.8% for tinea capitis to 7.1% for contact dermatitis. The specificities varied between 87.0% and 98.6%. Except for tinea capitis, lower PPVs were found for the various skin diseases when compared to earlier studies. In spite of the observed low sensitivities and low PPVs for several diseases, the algorithm seems to offer an improvement in management of common skin diseases at the peripheral level. With adaptations in training, further refinement of the algorithm and refresher training, predictive values and sensitivities can be increased.
To study the role of traditional leaders (Sarakuna) who provide a form of social welfare for pers... more To study the role of traditional leaders (Sarakuna) who provide a form of social welfare for persons with disabilities in the Hausa society of Northern Nigeria. From the results of this study, lessons are derived for cooperation with Sarakuna in (emerging) Community Based Rehabilitation programmes. Methods: A literature study was done using different (non-)electronic sources. In addition, 26 semi-structured interviews were conducted with different stakeholders (e.g., non-governmental organisations, disabled people's organisations), and 8 focus group discussions were held with (leaders of) persons with a disability. Question-led analysis was utilised by considering 4 dimensions: rehabilitation outcomes, rehabilitation services, involvement of beneficiaries, and social acceptability. Results: Not much literature is available on the role of traditional leadership in rehabilitation programmes and social welfare. Nevertheless, this study found indications that traditional leadership is still present in contemporary Northern Nigeria. Some Sarakuna improve the socioeconomic position of persons with disabilities by functioning as mediators and by their ability to provide social insurance. Their cooperation with multiple stakeholders enables them to distribute food and clothes. Also, since they possess essential information, NGOs are helped to access the community of persons with disabilities. Sarakuna are in a position to promote the inclusion and rehabilitation of persons with disabilities, but often lack necessary skills and training; yet, Community Based Rehabilitation programmes often ignore them. Conclusions and Implications: Community Based Rehabilitation programmes should take better note of social contexts and therefore should also work in the
Wounds : a compendium of clinical research and practice, 2010
Chronic wounds and lymphedema are often secondary complications of chronic diseases. Chronic... more Chronic wounds and lymphedema are often secondary complications of chronic diseases. Chronic wounds and lymphedema cut across diseases, settings, and borders especially in settings with limited resources, and present an opportunity to implement an integrated approach to prevention and care. The following article describes key elements in the design and development of pilot projects based on the principles of the World Health Organization's (WHO) Innovative Care for Chronic Conditions model. The pilot projects will advance the efforts of World Alliance for Wound and Lymphedema Care (WAWLC) to aid health systems in building capacity for effective wound and lymphedema care. .
International quarterly of community health education
An understanding of the socioeconomic and cultural realities of persons infected with tuberculosi... more An understanding of the socioeconomic and cultural realities of persons infected with tuberculosis (TB) in communities is important to re-strategizing control programs because these realities often come as constraints to the use of the directly observed therapy short-course (DOTS) in Nigeria. In-depth interviews and focus group discussion were used to study barriers to attendance at DOTS clinics for both prompt diagnosis and treatment of smear positive cases in Nigerian communities. A number of common and interrelated factors form barriers to use of DOTS clinics. These include perceived causes of the infection, for example witchcraft, that mitigate against an orthodox solution to TB and thereby affect perceived efficacy of DOTS. Another factor is perceived high cost in resource poor settings. Facility staff were noted to have demanded money from patients in spite of the fact that DOTS is advertised as free treatment. Furthermore, community members complain of the hostile attitude of...
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