Rewriting the history of leishmaniasis in Sri Lanka: An untold story since 1904

Nuwangi, Hasara; Weerakoon, Kosala; Agampodi, Thilini Chanchala; Price, Helen P.; Dikomitis, Lisa; Agampodi, Suneth Buddhika

doi:10.1371/journal.pntd.0010918

Cited by 5 publications

(5 citation statements)

References 8 publications

(7 reference statements)

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“…In countries like Afghanistan [38][39][40], the stigma associated with CL is more prominent, while in Suriname, stigma is almost non-existent [45,46]. There is a lack of evidence about the stigma in South Asian countries where the disease is endemic [53][54][55].…”

Section: Discussionmentioning

confidence: 99%

Stigma associated with cutaneous and mucocutaneous leishmaniasis: A systematic review

Nuwangi,

Agampodi,

Price

et al. 2023

PLoS Negl Trop Dis

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Background Cutaneous (CL) and mucocutaneous leishmaniasis (MCL) are parasitic diseases caused by parasites of the genus leishmania leading to stigma caused by disfigurations. This study aimed to systematically review the dimensions, measurement methods, implications, and potential interventions done to reduce the CL- and MCL- associated stigma, synthesising the current evidence according to an accepted stigma framework. Methods This systematic review followed the PRISMA guidelines and was registered in PROSPERO (ID- CRD42021274925). The eligibility criteria included primary articles discussing stigma associated with CL and MCL published in English, Spanish, or Portuguese up to January 2023. An electronic search was conducted in Medline, Embase, Scopus, PubMed, EBSCO, Web of Science, Global Index Medicus, Trip, and Cochrane Library. The mixed methods appraisal tool (MMAT) was used for quality checking. A narrative synthesis was conducted to summarise the findings. Results A total of 16 studies were included. The studies report the cognitive, affective, and behavioural reactions associated with public stigma. Cognitive reactions included misbeliefs about the disease transmission and treatment, and death. Affective reactions encompass emotions like disgust and shame, often triggered by the presence of scars. Behavioural reactions included avoidance, discrimination, rejection, mockery, and disruptions of interpersonal relationships. The review also highlights self-stigma manifestations, including enacted, internalised, and felt stigma. Enacted stigma manifested as barriers to forming proper interpersonal relationships, avoidance, isolation, and perceiving CL lesions/scars as marks of shame. Felt stigma led to experiences of marginalisation, rejection, mockery, disruptions of interpersonal relationships, the anticipation of discrimination, fear of social stigmatisation, and facing disgust. Internalised stigma affected self-identity and caused psychological distress. Conclusions There are various manifestations of stigma associated with CL and MCL. This review highlights the lack of knowledge on the structural stigma associated with CL, the lack of stigma interventions and the need for a unique stigma tool to measure stigma associated with CL and MCL.

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Section: Discussionmentioning

confidence: 99%

Stigma associated with cutaneous and mucocutaneous leishmaniasis: A systematic review

Nuwangi,

Agampodi,

Price

et al. 2023

PLoS Negl Trop Dis

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“…Assuming diploidy is the ancestral state within the L. ( Viannia ) subgenus (2), the genome-wide distribution of alternate allele frequencies at heterozygous sites should approximate 0.5. Visual inspection of frequency plots confirmed a unimodal distribution centered around 0.5 for 244 isolates.…”

Section: Supplementary Figuresmentioning

confidence: 99%

“…It is a spectral disease with many clinical manifestations, including visceral and various forms of cutaneous leishmaniasis (CL) (1). While visceral leishmaniasis is potentially fatal if the patient is not treated, CL is the most common form of the disease and causes a large burden due to social stigma and humiliation (2). It is estimated that globally about 700,000 to 1.2 million CL cases occur each year (3).…”

Section: Introductionmentioning

confidence: 99%

Evolutionary genomics of a zoonotic parasite across the Neotropical Realm

Heeren,

Sanders,

Shaw

et al. 2024

Preprint

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The Neotropical realm, one of the most biodiverse regions on Earth, houses a broad range of zoonoses that pose serious public health threats. Protozoan parasites of theLeishmania(Viannia)braziliensisspecies complex cause zoonotic leishmaniasis in Latin America with clinical symptoms ranging from simple cutaneous to destructive, disfiguring mucosal lesions. We present the first comprehensive genome-wide continental study including 257 cultivated isolates representing most of the geographical distribution of this major human pathogen. TheL. braziliensisspecies complex is genetically highly heterogeneous, consisting of divergent parasite groups that are associated with different environments and vary greatly in diversity. Apart from several small ecologically isolated groups with little diversity, our sampling identifies two major parasite groups, one associated with the Amazon and the other with the Atlantic Forest biomes. These groups show different recombination histories, as suggested by high levels of heterozygosity and effective population sizes in the Amazonian group in contrast to high levels of linkage and clonality in the Atlantic group. We argue that these differences are linked to strong eco-epidemiological differences between the two regions. In contrast to geographically focused studies, our study provides a broad understanding of the molecular epidemiology of zoonotic parasites circulating in tropical America.

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“…Similarly, in Tunisia, there have been reports of dissatisfaction with self-image and an anticipation of rejection [ 14 ]. In Sri Lanka, leishmaniasis has been identified as a disease with public health importance since 1904, the cases were reported in The Annual Administration Reports of Ceylon/Sri Lanka from 1895 to 1970 and the Ceylon Blue Book from 1821 to 1937 [ 15 ]. In 2008, leishmaniasis was re-included in the public health surveillance system [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

The psychosocial burden of cutaneous leishmaniasis in rural Sri Lanka: A multi-method qualitative study

Nuwangi,

Dikomitis,

Weerakoon

et al. 2024

PLoS Negl Trop Dis

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Leishmaniasis is a tropical infectious disease affecting some of the world’s most economically disadvantaged and resource-poor regions. Cutaneous leishmaniasis (CL) is the most common out of the three clinical types of Leishmaniasis. Since 1904 this disease has been endemic in Sri Lanka. CL is considered a disfiguring stigmatising disease with a higher psychosocial burden. However, there needs to be a more in-depth, holistic understanding of the psychosocial burden of this disease, both locally and internationally. An in-depth understanding of the disease burden beyond morbidity and mortality is required to provide people-centred care. We explored the psychosocial burden of CL in rural Sri Lanka using a complex multimethod qualitative approach with community engagement and involvement. Data collection included participant observation, an auto-ethnographic diary study by community researchers with post-diary interviews, and a Participant Experience Reflection Journal (PERJ) study with post-PERJ interviews with community members with CL. The thematic analysis revealed three major burden-related themes on perceptions and reflections on the disease: wound, treatment, and illness-experience related burden. Fear, disgust, body image concerns, and being subjected to negative societal reactions were wound-related. Treatment interfering with day-to-day life, pain, the time-consuming nature of the treatment, problems due to the ineffectiveness of the treatment, and the burden of attending a government hospital clinic were the treatment-related burdens. Anxiety/worry due to wrongly perceived disease severity and negative emotions due to the nature of the disease made the illness experience more burdensome. Addressing the multifaceted psychosocial burden is paramount to ensure healthcare seeking, treatment compliance, and disease control and prevention. We propose a people-centred healthcare model to understand the contextual nature of the disease and improve patient outcomes.

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Rewriting the history of leishmaniasis in Sri Lanka: An untold story since 1904

Cited by 5 publications

References 8 publications

Stigma associated with cutaneous and mucocutaneous leishmaniasis: A systematic review

Stigma associated with cutaneous and mucocutaneous leishmaniasis: A systematic review

Evolutionary genomics of a zoonotic parasite across the Neotropical Realm

The psychosocial burden of cutaneous leishmaniasis in rural Sri Lanka: A multi-method qualitative study

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