Effectiveness of self-care interventions for integrated morbidity management of skin neglected tropical diseases in Anambra State, Nigeria

Abstract

Background Lymphatic filariasis (LF), Buruli ulcer (BU) and leprosy are neglected tropical diseases (NTDs) of the skin co-endemic in some communities in Nigeria. Not enough is known about the effectiveness of integrated morbidity management and disability prevention in people with these conditions. An integrated self-care intervention was carried out for people with these skin NTDs in two endemic communities of Anambra state, Nigeria. The objective of the study was to assess the effectiveness of self-care practices on costs of care, disability status and health-related quality of life. Methods This study utilised a quasi-experimental pre-test/post-test design to assess the effectiveness of the self-care interventions for people affected by NTDs to care for these impairments at home. Data were collected using questionnaires administered at the beginning and at the end of the intervention on monthly cost of morbidity care, and on participants’ disability status and their quality of life (QoL). Focus group discussions (FGDs) were held with both the participants and healthcare workers at follow-up. Results Forty-eight participants were recruited. Thirty participants (62.5%) continued the self-care interventions until the end of the project. Of those, 25 (83%) demonstrated improvement from their baseline impairment status. The mean household costs of morbidity care per participant decreased by 66% after the intervention, falling from US$157.50 at baseline to US$53.24 after 6 months of self-care (p = 0.004). The mean disability score at baseline was 22.3; this decreased to 12.5 after 6 months of self-care (p < 0.001). Among the 30 participants who continued the interventions until the end of the project, 26 (86.7%) had severe disability score (i.e. a score of 10–46) at baseline, and the number with severe disability fell to 18 (60%) of the 30 after the intervention. The mean QoL score increased from 45.7 at baseline to 57.5 at the end of the intervention (p = 0.004). Conclusions The 6-month self-care intervention for participants affected by BU, leprosy, or LF led to lower costs of care (including out-of-pocket costs and lost earnings due to morbidity), improved QoL scores, and reduced disability status. Trial registration ISRCTN Registry: ISRCTN20317241; 27/08/2021, Retrospectively registered.

What the snake leaves in its wake: Functional limitations and disabilities among snakebite victims in Ghanaian communities

“…In a semi-urban region in Nigeria, a history of snakebite was associated with poor quality of life in psychological and social domains of the World Health Organization Quality of Life (WHOQOL)-BREF [ 41 ]. Among 48 patients with skin neglected tropical diseases (NTDs) in Nigeria, the 12-item WHODAS instrument also showed a higher disease burden on the level of cognition, mobility, life activities, and participation in society domains [ 44 ]. Aside from the physical burden, these findings highlight similar mental health and psychosocial challenges of snakebite victims to victims of other NTDs.…”

“…Acknowledging the high risk of mental health conditions, the WHO advocates for the use of psychosocial and rehabilitation interventions to holistically address the health needs of NTD victims [ 45 , 46 ]. Findings from a brief psychosocial intervention for snakebite victims and self-care intervention for other NTDs victims have proved effective in reducing psychiatric symptoms and disability, and improving disease impairment status among patients [ 44 , 47 ]. These findings suggest that NTDs with similar disease pattern and effects can benefit from strong collaborative and integrated interventions which can be implemented as part of first lines of care.…”

Behavior of patients with leprosy in disability prevention through patients’ self care: A literature review

“…Findings Ramasamy et al (2019) The majority of these 90 clients or 83% were multibacillary and 23% had Grade 2 disability at the time of diagnosis Eze et al (2021) The average disability score at baseline was 22.3 severe disability (i.e. score 10-46) AR Dos Average time to progression of PD degree (Physical Disability) was 162 months for PB and 151 months for MB leprosy patients.…”

Healthcare Performance of Leprosy Management in Peripheral Health Facilities of Dhanusa and Mahottari, Nepal

“…Finally, patient self-care is one of the main interventions to improve patient disability over time (19). Client satisfaction is a key performance indicator which improves self-care, drug adherence and recovery (20).…”