Although non-fatal and mostly self-healing in the case of Leishmania (L.) major, cutaneous leishmaniasis (CL) is mainly treated to reduce lesion healing time. Less attention is paid to the improvement of scars, especially in aesthetically relevant areas of the body, which can dramatically affect patients’ wellbeing. We explored patients’ perspectives about treatment options and the social and psychological burden of disease (lesion and scar). Individual in-depth interviews were conducted with ten confirmed CL patients at two L. major endemic sites in Southern Tunisia (Sidi Bouzid and Gafsa). Participants were selected using a sampling approach along a spectrum covering e.g. age, sex, and clinical presentation. Patients’ experiences, opinions and preferences were explored, and their detailed accounts gave an insight on the impact of CL on their everyday lives. The impact of CL was found to be considerable. Most patients were not satisfied with treatment performance and case management. They expected a shorter healing time and better accessibility of the health system. Tolerance of the burden of disease was variable and ranged from acceptance of hidden scars to suicidal thoughts resulting from the fear to become handicapped, and the stress caused by close relatives. Some believed CL to be a form of skin cancer. Unexpectedly, this finding shows the big gap between the perspectives of patients and assumptions of health professionals regarding this disease. This study provided valuable information for better case management emphasizing the importance of improving communication with patients, and accessibility to treatment. It generated context-specific knowledge to policy makers in Tunisia to implement effective case management in a country where access to treatment remains a challenge due to socio-economic and geographic barriers despite a long tradition in CL control.
Background The outbreak of coronavirus disease (COVID-19) continues to constitute an international public health concern. Few data are available on the duration and prognostic factors of the disease. We aimed to study the recovery time among a Tunisian cohort of COVID-19 confirmed patients and identify the prognostic factors. Methods A retrospective, nationwide study was conducted from March 2 to May 8, 2020, recruiting all patients who were diagnosed with COVID-19, by RT-PCR methods, in Tunisia. Data were collected via phone call interview. Kaplan-Meir Methods and Cox proportional hazards regression models were, respectively, used to study the recovery time and estimate its prognostic factors. Results One thousand and thirty patients with COVID-19 (aged 43.2 ± 18.2 years, 526 female (51.1%)) were enrolled. Among them 141 (14.8%) were healthcare professionals. Out of 173 patients (17.8%) admitted to the hospital, 47 were admitted in an intensive care unit. Among 827 patients who didn’t require specialized care, 55.5% were self-isolated at home, while the rest were in specialized centers. Six hundred and two patients were symptomatic. A total of 634 (61.6%) patients have recovered and 45 (4.4%) patients died. The median duration of illness was estimated to be 31 days (95% CI: [29–32]). Older age (HR = 0.66, CI:[0.46–0.96], P = 0.031) and symptoms (HR = 0.61, CI:[0.43–0.81], P = 0.021) were independently associated with a delay in recovery time. Being a healthcare professional (HR = 1.52, CI: [1.10–2.08], P = 0.011) and patients in home isolation compared to isolation centers (HR = 2.99, CI: [1.85–4.83], P < 10¯3) were independently associated with faster recovery time. Conclusion The duration of illness was estimated to be 1 month. However, this long estimated duration of illness may not equate to infectiousness. A particular attention must to be paid to elderly and symptomatic patients with closer monitoring.
Background In the context of the COVID-19 pandemic, Vaccine literacy (VL) is considered as an important determinant of vaccine hesitancy and uptake. Cancer patients constitute a target group for COVID-19 vaccination. Thus, we aimed in this study to assess COVID-19 VL among cancer patients in Tunisia. Methods A cross sectional study was conducted, during the month of February 2021, in the Salah Azaiez institute of cancer including all inpatients aged ≥18 years. A standardized VL scale was used, composed of two dimensions: functional VL and interactive-critical VL, using a four point Likert scale. A global score was calculated for each scale (ranging from 1 to 4); A cutoff of 2.5 was defined according to the literature. The students' t and Anova tests were used for comparison of VL mean scores according to the studied characteristics. A p value <0.05 was considered as statistically significant. Results A total of 200 patients were enrolled in this study with a mean age of 54.4±12.7 years. A low VL score (≤ 2.5) was observed among 27.5% and 81.0% participants for functional and interactive critical scales respectively. Higher functional VL score was associated with a higher educational level (3.7±0.5 among individuals with a university degree level vs 2.5±1.2 among illiterate, p < 0.001). Interactive critical VL significantly increased with educational level (p < 0.001) and was significantly higher among healthcare workers (2.5±1.3 vs 1.7± 0.9, p < 0.001), those who accepted to get the COVID-19 vaccine (2.0±0.9 vs 1.6±0.8, p = 0.002), who did not believe that vaccines are unsafe (1.9±0.9 vs 1.4±0.7, p < 0.001) and that there is no need to be vaccinated since natural immunity exists (2.1±1.0 vs 1.7±0.8,p=0.016). Conclusions Vaccine literacy among cancer patients included in this study is weak. Effective communication strategies about COVID-19 vaccination should build VL and consider the level of patient's health literacy to redress vaccine hesitancy and uptake. Key messages This study showed a low interactive-critical vaccine literacy score. Communication strategies in vaccination campaigns should be aligned with people’s vaccine literacy.
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