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Feenstra S.G.,Rotterdam University | Nahar Q.,ICDDR | Pahan D.,Rural Health Program Nilphamari | Oskam L.,KIT Biomedical Research | Richardus J.H.,Rotterdam University
Leprosy Review | Year: 2011

Objectives: Chemoprophylaxis with single dose rifampicin is a promising intervention to prevent leprosy in close contacts of patients. However, application in control programmes often requires disclosure of the leprosy diagnosis, which is still a stigmatised disease in many countries. Promoting control and treatment of stigmatised diseases without contributing towards stigma of the individuals involved can be very difficult. The objective of this study was to assess the social acceptability of disclosure of the diagnosis and the attitude towards taking prophylactic medicines in a leprosy endemic area in Bangladesh. Design: Qualitative study through focus group discussions with 136 healthy men and women from different age groups and religions, coming from two rural villages and an urban area in northwest Bangladesh, and 14 health workers with extensive experience with leprosy patients. Results: The participants would not object to disclosure of the diagnosis to household members and nearby family if they were diagnosed with leprosy. However, many participants were not willing to share this information with their neighbours and other social contacts due to stigma of the disease. All healthy participants were willing to take chemoprophylaxis if any of their close contacts were diagnosed with leprosy, even after explaining that full protection against leprosy was not guaranteed. Conclusion: It can be concluded that chemoprophylaxis for household contacts of leprosy patients is an effective and socially acceptable addition to the current leprosy control programme. Chemoprophylaxis for other categories of contacts likely to benefit would only be feasible, without disclosure of patient information, if given in the form of mass campaigns for the whole population in the area. © Lepra.

Feenstra S.G.,Rotterdam University | Nahar Q.,Center for Population | Pahan D.,Rural Health Program Nilphamari | Oskam L.,KIT Biomedical Research | Richardus J.H.,Rotterdam University
Journal of Health, Population and Nutrition | Year: 2013

In South Asia, the burden of infectious diseases is high. Socioeconomically and culturally-defined social interaction patterns are considered to be an important determinant in the spread of diseases that are transmitted through person-to-person contact. Understanding of the contact patterns in this region can be helpful to develop more effective control measures. Focus group discussions were used in exploring social contact patterns in northwest Bangladesh. The patterns were assessed for perceived relevance to the spread of airborne infectious diseases, with special focus on diseases, like leprosy and tuberculosis, in which the role of social determinants is well-recognized. Highly-relevant social contact patterns inside the home and the neighbourhood, across age and sex groups, were reported in all group discussions. Outside the home, women and girls reported relevant contacts limited to the close neighbourhood while men mentioned high relevant contacts beyond. This implies that, in theory, infectious diseases can easily be transmitted across age and sex groups in and around the home. Adult men might play a role in the transmission of airborne infectious diseases from outside this confined area since only this group reported highly-relevant social contacts beyond the home. This concept needs further exploration but control programmes in the South Asian region could benefit from considering differences in social contact patterns by gender for risk assessments and planning of preventive interventions. © International Centre For Diarrhoeal Disease Research, Bangladesh.

Feenstra S.G.,Rotterdam University | Nahar Q.,ICDDR | Pahan D.,Rural Health Program Nilphamari | Oskam L.,KIT Biomedical Research | Richardus J.H.,Rotterdam University
PLoS Neglected Tropical Diseases | Year: 2011

Background: Leprosy is remaining prevalent in the poorest areas of the world. Intensive control programmes with multidrug therapy (MDT) reduced the number of registered cases in these areas, but transmission of Mycobacterium leprae continues in most endemic countries. Socio-economic circumstances are considered to be a major determinant, but uncertainty exists regarding the association between leprosy and poverty. We assessed the association between different socio-economic factors and the risk of acquiring clinical signs of leprosy. Methods and Findings: We performed a case-control study in two leprosy endemic districts in northwest Bangladesh. Using interviews with structured questionnaires we compared the socio-economic circumstances of recently diagnosed leprosy patients with a control population from a random cluster sample in the same area. Logistic regression was used to compare cases and controls for their wealth score as calculated with an asset index and other socio-economic factors. The study included 90 patients and 199 controls. A recent period of food shortage and not poverty per se was identified as the only socio-economic factor significantly associated with clinical manifestation of leprosy disease (OR 1.79 (1.06-3.02); p = 0.030). A decreasing trend in leprosy prevalence with an increasing socio-economic status as measured with an asset index is apparent, but not statistically significant (test for a trend: OR 0.85 (0.71-1.02); p = 0.083). Conclusions: Recent food shortage is an important poverty related predictor for the clinical manifestation of leprosy disease. Food shortage is seasonal and poverty related in northwest Bangladesh. Targeted nutritional support for high risk groups should be included in leprosy control programmes in endemic areas to reduce risk of disease. © 2011 Feenstra et al.

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