What parents should know while their child is on MDT: Insights from a qualitative study in Eastern India

Lal,; S, Pal; Nk, Haldar; Pk, Mandal; Srinivas, G

doi:10.47276/lr.85.2.81

Cited by 6 publications

(5 citation statements)

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“…---------------------------------------------------------------------------- drugs. Therefore, education of chemoprophylactic regimens for parents and teachers should be integrated into treatment programmes to promote a positive attitude and supportive environment for children (33). The present study has some limitations.…”

Section: Discussionmentioning

confidence: 89%

A 5‑year evaluation of chemoprophylactic treatment in elementary school children with subclinical leprosy

Astari

Sari

Nanang³

et al. 2021

Biomed Rep

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Subclinical leprosy is an infectious disease in which the immune system remains infected with Mycobacterium leprae (M. leprae). The progress of subclinical leprosy to clinical cases within 1 year of infection is 1.5%, with an increase to 6% in the following 4 years. Rifampicin is frequently used for prevention of leprosy, and clarithromycin has a bactericidal effect on M. leprae. Thus, the combination of both is expected to improve disease control in patients with subclinical leprosy. The aim of the present study was to evaluate the efficacy of a chemoprophylactic treatment involving rifampicin and clarithromycin against subclinical leprosy in elementary school children from endemic areas of East Java over a 5-year period. The study was performed between 2011 and 2015. Samples were collected from 2,548 healthy elementary school children in Nguling (Pasuruan) and Raas (Sumenep), and analysed using ELISA for anti-PGL (phenolic glycolipid)-1 IgM antibodies. Children who were seropositive for anti-PGL-1 IgM antibodies received a chemoprophylactic regimen consisting of rifampicin (300 mg/day) and clarithromycin (250 mg/day) daily for the initial 10 days, followed by the same regimen every 2 weeks for 3 months. Clinical and serological evaluations were performed annually for 5 years. Amongst the 2,548 healthy elementary school children, 200 were seropositive. The anti-PGL-1 IgM antibody levels significantly decreased between 2011 and 2015 in Nguling (from 1,066.7 to 137.4 U/ml) and Raas (from 773.1 to 563.4 U/ml), the levels decreased every year. In addition, the proportion of patients with decreased anti-PGL-1 IgM antibody levels was consistently higher than patients with increased anti-PGL-1 IgM antibody levels in all periods, except during 2013-2014, in Nguling and Raas. Chemoprophylactic treatment involving rifampicin and clarithromycin may thus be effective against subclinical leprosy amongst elementary school children.

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Section: Discussionmentioning

confidence: 89%

A 5‑year evaluation of chemoprophylactic treatment in elementary school children with subclinical leprosy

Astari

Sari

Nanang³

et al. 2021

Biomed Rep

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“…30 This was addressed in most qualitative studies. 19,21,22 These found that hyperpigmentation due to clofazimine had a negative influence on adherence predominantly due to stigma and perceptions of beauty. In these settings, fair skin is perceived as more desirable, and development of darkened skin was very concerning to patients due to the associated social stigma.…”

Section: Medication-related Factorsmentioning

confidence: 98%

“…Lal et al found that this stigma was the most common effect reported by parents of children with leprosy, and was manifested in their children being bullied in school. 22 Not only did this result in non-adherence to MDT, but also absenteeism from school.…”

Section: Medication-related Factorsmentioning

confidence: 99%

“…Studies found that the patient's definition of 'cure' was total resolution of symptoms and, in some cases, patients' physical health returning to what is was prior to diagnosis. 19,20,22,23,31 However, the physical symptoms of leprosy can be permanent or take a long time to heal, and adherence issues arise when patients are unaware of this. Not seeing improvement in signs and symptoms subsequently leads to patients losing patience and questioning the effectiveness of MDT.…”

Section: Patient-related Factorsmentioning

confidence: 99%

“…This concern was shared by one of the parents of a child with leprosy interviewed by Lal et al, who asked "my child has been taking treatment properly for a long time, then why has the patch remained white?" 22 It is this loss in confidence in MDT that results in non-adherence in many cases.…”

Section: Patient-related Factorsmentioning

confidence: 99%

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What factors influence adherence and non-adherence to multi-drug therapy for the treatment of leprosy within the World Health Organisation South East Asia region? A systematic review

Meadows

Davey

2022

LEPROSY

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Introduction Leprosy is an infection caused by Mycobacterium leprae. Despite curative treatment being available, leprosy is still prevalent worldwide, with little change in annual cases observed in the past decade. The WHO South East Asia region is the worst affected, accounting for over 70% of new cases. One reason leprosy transmission still occurs is non-adherence to multi-drug therapy. This project aims to determine the factors that influence adherence. Methods A systematic review was performed using 6 databases. This returned 402 unique results. Screening of the title and abstract resulted in 362 of these being excluded. From the remaining 40, full-text analysis identified 17 studies that met the inclusion criteria and formed the review. Both qualitative and quantitative methods of collecting and analyzing data were used to form a non-quantitative synthesis of the findings. Results Four factors influenced adherence: medication-related, healthcare-related, patient-related and society-related. From these, lack of knowledge about leprosy and multi-drug therapy was a predominant barrier to adherence, which related to all of these factors. Stigma and being female were also seen as important barriers to adherence -these manifested in numerous ways. ConclusionThe review identified diverse barriers to adherence to MDT and no simple intervention will overcome these. Rather, wider issues such as continuous access to healthcare (particularly for women), stigma reduction and patient education need to be addressed. Improving these will increase patient confidence in, and access to, MDT, which will ultimately result in improved adherence to therapy.

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Lepra und Buruli-Ulkus

Adamczick

Schwienhorst

2015

Monatsschr Kinderheilkd

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Hintergrund Trotz internationaler Bemühungen zu Kontrolle und Elimination vernachlässigter tropischer Erkrankungen ("neglected tropical diseases", NTD) stellen diese für viele in Armut lebende Menschen nach wie vor eine massive Bedrohung dar. Lepra und Buruli-Ulkus, 2 mykobakterielle Erkrankungen, betreffen noch heute teilweise überproportional die pädiatrische Bevölkerung. Fälle in Deutschland werden vereinzelt bei Migranten diagnostiziert. Ziel der Arbeit Spät behandelte Fälle münden häufig in chronische Verläufe mit bleibenden Behinderungen. Exemplarisch wird auf die Herausforderungen bezüglich Übertragung, klinischer Betreuung, Behandlung und Prävention von Behinderungen sowie auf aktuelle Forschungsthemen eingegangen. Material und Methoden Die Arbeit beruht auf einer selektiven Literaturrecherche bei PubMed und in der WHO-Dokumentenbank sowie auf persönlicher Feld-und Klinikerfahrung beider Autorinnen mit Patientenkontakt und Austausch mit Gesundheitspersonal vor Ort. Schlussfolgerung Langfristige Investitionen in Forschung und Stärkung von Strukturen der Gesundheitssysteme in Endemiegebieten von Lepra und Buruli-Ulkus, mit Fokus auf die Ausbildung von Gesundheitspersonal, können durch Früherkennung und Einleitung adäquater Therapie bei komplizierten Krankheitsverläufen chronische Behinderungen verhindern helfen. Das Wissen um Übertragung, klinische Erscheinungsbilder, verschiedene Verlaufsformen und Behandlungsmöglichkeiten ist relevant für Pädiater, die Patienten mit Migrationshintergrund betreuen. = Background Despite international efforts to control and eliminate neglected tropical diseases, these diseases still represent a considerable risk to people living in poverty conditions. The mycobacterial infections leprosy and Buruli ulcer are sometimes a disproportional threat to the pediatric population. In Germany, cases are mainly observed among migrants. Aim Cases which are discovered late often follow a chronic course and can frequently result in different forms of disabilities. Diseases such as leprosy and Buruli ulcer represent a challenge with regard to transmission, clinical care, treatment and prevention of disabilities and are discussed in this article with a focus on the latest research results. Material and methods This study was based on a selective literature search in PubMed and World Health Organization (WHO) documents online, supported by personal experiences of the authors in the field and in clinics, as well as personal exchanges with healthcare staff on site. Conclusion Prevention of disability can be achieved by long-term investment in research and supporting healthcare systems in regions where leprosy and Buruli ulcer are endemic as well as more research. Training healthcare personnel in early diagnosis plays a key role in a timely initiation of adequate treatment. Knowledge of transmission, the clinical presentation, courses of the disease and treatment options is essential for pediatricians treating migrants.

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What parents should know while their child is on MDT: Insights from a qualitative study in Eastern India

Cited by 6 publications

References 0 publications

A 5‑year evaluation of chemoprophylactic treatment in elementary school children with subclinical leprosy

A 5‑year evaluation of chemoprophylactic treatment in elementary school children with subclinical leprosy

What factors influence adherence and non-adherence to multi-drug therapy for the treatment of leprosy within the World Health Organisation South East Asia region? A systematic review

Lepra und Buruli-Ulkus

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