The Role of a Community Conversation Intervention in Reducing Stigma Related to Lower Limb Lymphoedema in Northern Ethiopia

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2024 Mar 20

PMID 38504232

Authors

Abebayehu Tora

Stephen Bremner

Oumer Ali

Mersha Kinfe

Asrat Mengiste

Vasso Anagnostopoulou

Abebaw Fekadu

Gail Davey

Maya Semrau

Affiliations

Soon will be listed here.

Abstract

Background: Stigma related to lower-limb lymphoedema poses a major psychosocial burden to affected persons and acts as a barrier to them accessing morbidity management and disability prevention (MMDP) services. Community Conversation (CC), which actively engages community members and disseminates health information amongst them, is believed to break the vicious cycle of stigma by enhancing disease-related health literacy at the community level.

Methods: A quasi-experimental study was conducted in Northern Ethiopia to assess the role of the CC intervention in reducing stigma. In two control districts, a comprehensive and holistic MMDP care package was implemented that included physical health, mental health and psychosocial interventions, whilst in the intervention district the CC intervention was added to the MMDP care package. A total of 289 persons affected by lymphoedema and 1659 community members without lymphoedema were included in the study.

Results: Over the course of the intervention, in all sites, community members' knowledge about the causes of lymphoedema increased, and perceived social distance and stigmatizing attitudes towards people with lymphoedema decreased in the community, whilst experienced and internalized stigma decreased amongst affected persons. There were no significant changes for perceived social support. However, the changes were greater in the control sites overall, i.e. those districts in which the holistic care package was implemented without CC.

Conclusion: The findings suggest that the CC intervention provides no additional stigma reduction when used alongside a holistic MMDP care package. Provision of comprehensive and holistic MMDP services may be adequate and appropriate to tackle stigma related to lower-limb lymphoedema in a resource-constrained setting like Ethiopia.

References

Kocalevent R, Berg L, Beutel M, Hinz A, Zenger M, Harter M . Social support in the general population: standardization of the Oslo social support scale (OSSS-3). BMC Psychol. 2018; 6(1):31. PMC: 6050647. DOI: 10.1186/s40359-018-0249-9. View

Tekola F, Bull S, Farsides B, Newport M, Adeyemo A, Rotimi C . Impact of social stigma on the process of obtaining informed consent for genetic research on podoconiosis: a qualitative study. BMC Med Ethics. 2009; 10:13. PMC: 2736170. DOI: 10.1186/1472-6939-10-13. View

Duko B, Geja E, Zewude M, Mekonen S . Prevalence and associated factors of depression among patients with HIV/AIDS in Hawassa, Ethiopia, cross-sectional study. Ann Gen Psychiatry. 2018; 17:45. PMC: 6206652. DOI: 10.1186/s12991-018-0215-1. View

Tora A, Franklin H, Deribe K, Reda A, Davey G . Extent of podoconiosis-related stigma in Wolaita Zone, Southern Ethiopia: a cross-sectional study. Springerplus. 2014; 3:647. PMC: 4233027. DOI: 10.1186/2193-1801-3-647. View

Dellar R, Ali O, Kinfe M, Mengiste A, Davey G, Bremner S . Effect of a Community-Based Holistic Care Package on Physical and Psychosocial Outcomes in People with Lower Limb Disorder Caused by Lymphatic Filariasis, Podoconiosis, and Leprosy in Ethiopia: Results from the EnDPoINT Pilot Cohort Study. Am J Trop Med Hyg. 2022; . PMC: 9490655. DOI: 10.4269/ajtmh.21-1180. View

Ottesen E, Hooper P, Bradley M, Biswas G . The global programme to eliminate lymphatic filariasis: health impact after 8 years. PLoS Negl Trop Dis. 2008; 2(10):e317. PMC: 2556399. DOI: 10.1371/journal.pntd.0000317. View

Tsegay G, Wubie M, Degu G, Tamiru A, Cooper M, Davey G . Barriers to access and re-attendance for treatment of podoconiosis: a qualitative study in northern Ethiopia. Int Health. 2014; 7(4):285-92. DOI: 10.1093/inthealth/ihu085. View

Yakob B, Deribe K, Davey G . High levels of misconceptions and stigma in a community highly endemic for podoconiosis in southern Ethiopia. Trans R Soc Trop Med Hyg. 2008; 102(5):439-44. DOI: 10.1016/j.trstmh.2008.01.023. View

Peters R, Dadun , van Brakel W, Zweekhorst M, Damayanti R, Bunders J . The cultural validation of two scales to assess social stigma in leprosy. PLoS Negl Trop Dis. 2014; 8(11):e3274. PMC: 4222778. DOI: 10.1371/journal.pntd.0003274. View

10.

Ton T, Mackenzie C, Molyneux D . The burden of mental health in lymphatic filariasis. Infect Dis Poverty. 2015; 4:34. PMC: 4520254. DOI: 10.1186/s40249-015-0068-7. View

11.

Davey G, Burridge E . Community-based control of a neglected tropical disease: the mossy foot treatment and prevention association. PLoS Negl Trop Dis. 2009; 3(5):e424. PMC: 2682702. DOI: 10.1371/journal.pntd.0000424. View

12.

Ayode D, Tora A, Farrell D, Tadele G, Davey G, McBride C . Dual Perspectives On Stigma: Reports of Experienced and Enacted Stigma by Those Affected and Unaffected by Podoconiosis. J Public Health Res. 2016; 5(2):689. PMC: 5062755. DOI: 10.4081/jphr.2016.689. View

13.

Peters R, Dadun , Zweekhorst M, Bunders J, Irwanto , van Brakel W . A Cluster-Randomized Controlled Intervention Study to Assess the Effect of a Contact Intervention in Reducing Leprosy-Related Stigma in Indonesia. PLoS Negl Trop Dis. 2015; 9(10):e0004003. PMC: 4979763. DOI: 10.1371/journal.pntd.0004003. View

14.

Tora A, Davey G, Tadele G . A qualitative study on stigma and coping strategies of patients with podoconiosis in Wolaita zone, Southern Ethiopia. Int Health. 2013; 3(3):176-81. DOI: 10.1016/j.inhe.2011.06.006. View

15.

Douglass J, Hailekiros F, Martindale S, Mableson H, Seife F, Bishaw T . Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial. J Clin Med. 2020; 9(12). PMC: 7766500. DOI: 10.3390/jcm9124077. View

16.

Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M . Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet. 2009; 373(9661):408-15. DOI: 10.1016/S0140-6736(08)61817-6. View

17.

Semrau M, Ali O, Deribe K, Mengiste A, Tesfaye A, Kinfe M . EnDPoINT: protocol for an implementation research study to integrate a holistic package of physical health, mental health and psychosocial care for podoconiosis, lymphatic filariasis and leprosy into routine health services in Ethiopia. BMJ Open. 2020; 10(10):e037675. PMC: 7566734. DOI: 10.1136/bmjopen-2020-037675. View

18.

Deribe K, Brooker S, Pullan R, Sime H, Gebretsadik A, Assefa A . Epidemiology and individual, household and geographical risk factors of podoconiosis in Ethiopia: results from the first nationwide mapping. Am J Trop Med Hyg. 2014; 92(1):148-158. PMC: 4288951. DOI: 10.4269/ajtmh.14-0446. View

19.

Bisetegn T, Mihretie G, Muche T . Prevalence and Predictors of Depression among Pregnant Women in Debretabor Town, Northwest Ethiopia. PLoS One. 2016; 11(9):e0161108. PMC: 5019395. DOI: 10.1371/journal.pone.0161108. View

20.

Ali O, Deribe K, Semrau M, Mengiste A, Kinfe M, Tesfaye A . A cross-sectional study to evaluate depression and quality of life among patients with lymphoedema due to podoconiosis, lymphatic filariasis and leprosy. Trans R Soc Trop Med Hyg. 2020; 114(12):983-994. PMC: 7738660. DOI: 10.1093/trstmh/traa130. View