Deutsche Lepra- und Tuberkulosehilfe

This study examines the impact of leprosy on those affected by leprosy in Sindh, Pakistan, exploring their care-seeking behavior, treatment experiences, well-being, stigma and coping mechanisms. By highlighting the lived experiences of persons affected by leprosy (PAL), this study aims to inform strategies that address not only the biological aspects of leprosy, but also the social and psychological challenges faced by this marginalized population. Fifteen in-depth interviews were conducted with persons affected by leprosy from Sindh, Pakistan. A combined inductive and deductive thematic analysis approach was applied inspired by the “conceptual framework of the bio-psycho-social impact and coping mechanisms of patients” by Han et al. Participants reported delays in diagnosis of up to twenty years, significantly influenced by limited awareness and socio-economic barriers. These delays increased the risk of physical disability and worsened mental health problems such as depression and anxiety, largely fueled by stigma and misinformation. While both genders experienced stigma, women were more likely to express their mental health problems, highlighting gender differences in discussing such issues. Peer support and community storytelling emerged as effective strategies to mitigate stigma, while the role of religious beliefs shaped both societal perceptions and personal coping mechanisms. The findings highlight the need for comprehensive, culturally sensitive interventions that address the bio-psycho-social challenges faced by PAL. Implementing people-centered strategies that use storytelling, community engagement and digital health tools are essential to reduce delays in diagnosis and improve the overall well-being of PAL. Further research is needed to refine these interventions and ensure that they are aligned with the needs and beliefs of those affected by leprosy.

Leprosy, a neglected tropical disease, remains a major global health concern. If left untreated, it can lead to permanent disabilities and severe social stigma, profoundly impacting the well-being of those affected and their families. Leprosy is a public health concern in Sierra Leone, affecting hundreds of people each year. A significant number of individuals are already living with disabilities at the time of diagnosis, indicating delays in detection and treatment. These delays contribute to a vicious cycle of poverty, social exclusion, and long-term health complications. This study employed a qualitative approach to explore healthcare-seeking behaviors among people affected by leprosy in Sierra Leone's Western Area. Eighteen semi-structured interviews were conducted with individuals affected by leprosy, traditional healers, and community health workers in the Western Area of Sierra Leone in May and June 2024. An inductive thematic analysis was used to identify key patterns and factors influencing healthcare-seeking decisions. This methodology provided an in-depth understanding of the sociocultural and systemic barriers affecting early diagnosis and treatment. The study found that healthcare-seeking behavior is shaped by factors at the individual, community and healthcare system levels. Individually, misconceptions about leprosy, stigmatization and financial hardship delay care. Social attitudes in communities reinforce stigmatization and isolation. At the healthcare system level, poor access, limited services, and economic motives hinder treatment. These factors, compounded by widespread poverty, create significant obstacles to timely diagnosis and care. The complex interplay of individual, societal, and healthcare-related factors underscores the need for a multi-faceted approach to improving leprosy care in Sierra Leone. Multi-dimensional strategies involving people affected, traditional healers, healthcare workers, community leaders and public health policymakers are needed to address the factors contributing to diagnostic delays. Strengthening community awareness, integrating traditional healing practices with biomedical medicine, and enhancing healthcare accessibility and affordability are critical to ensuring early detection and reducing the burden of leprosy in Sierra Leone.

Leprosy is an infectious neglected tropical disease that can result in chronic immune mediated nerve damage. When this involves the facial nerve, this can lead to lagophthalmos, with the later stages requiring surgical correction. If untreated lagophthalmos can cause keratopathies leading to visual impairment and eventual blindness. However, to date no paper has systematically reviewed the surgical management of lagophthalmos in those affected by leprosy. A systematic review was conducted on the 16/11/2024 with data from PubMed, Infolep, Web of Sciences Core Collection and Medline ALL. Data extraction and analysis followed PRISMA guidelines. Included were English-language studies on the outcomes of surgical procedures for the surgical management of lagophthalmos, regardless the year of publication. The 12 papers identified contained data from seven countries. The majority of papers studied Temporalis Muscle transfer. Gillies technique or modifications of this technique were reported in five papers. Three papers reported modifications of Johnson's method of temporalis tendon transfer. One paper reported TMT using a silicone sling. Patients also received TMT using the Brown-McDonnell and the McCord-Cordner techniques. Lagophthalmos was also corrected using gold or steel weight implant techniques. One paper each studied lateral tarsal strip, modified tarsorrhaphy and scapha graft. Treatment of lagophthalmos is vital to preserve vision in those affected by leprosy, however, it is important to take into consideration the practical advantages of the five broad techniques identified by this review. Factors such as the type of anaesthesia, level of expertise, success rate, incidence and risk of complications, and longevity and stability of the results, are vital to consider when conducting these surgical procedures in reduced resource settings. Therefore, operations which are more cost effective, show a reduced complication rate and yield better long-term results without complicated follow-up are more likely to be adopted in lower resource settings.

Declared as one of the ten most pressing threats to global health in 2019, the complexity around vaccine acceptance and hesitancy has once again gained great momentum following the COVID-19 pandemic. Lack of vaccine acceptance may endanger the mission of improving vaccine uptake globally to tackle pandemics, reduce morbidity and mortality of preventable diseases and to prevent antibiotic resistance worldwide. Countries of the global south, including South Asian Association for Regional Cooperation (SAARC) countries are especially affected by the dangers of low vaccination uptake and continue to show decreases in coverage in recent years. This paper examines factors contributing to vaccine hesitancy in south Asia and the extent to which they are context and disease specific, guided by a modified version of the WHO SAGE 5 C model by Razai et al. Three databases were searched for peer-reviewed articles by using a comprehensive search strategy. Results from 44 quantitative, qualitative and mixed-method studies were included in the systematic review and appraised for quality, thematically analyzed and mapped onto the 5 C model. findings from India, Pakistan, Bangladesh, Nepal and Afghanistan showed vaccine hesitancy to be context and vaccine-specific within different settings of the countries. The main factors contributing to vaccine hesitancy can be identified as narrow confidence in vaccines, miscommunication, and lack of knowledge embedded into overarching constraints and contexts. To tackle vaccine hesitancy in SAARC countries, interventions need to be co-created by communities and mutual trust needs to be ensured, for instance through increased equity in knowledge distribution.

BackgroundRecent epidemiological data shows significant rates of grade 2 disability at point-of-diagnosis among new leprosy cases in Pakistan. This indicates a feature of extensive diagnostic delay; the disability burden appears unmoving and disproportionate to the falling leprosy incidence rates. Therefore, this study was required to understand reasons for delay in diagnosis and treatment of leprosy.MethodsA qualitative design of 7 semi-structured interviews was employed to reveal perceptions and understandings of various leprosy stakeholders in Pakistan, termed “leprosy experts”. Subsequent inductive analysis was used to identify themes and subthemes concerned with delay in the diagnosis and treatment of leprosy.ResultsLeprosy experts identified three main areas, or domains, to which delay can be attributed: 1. Awareness and beliefs about leprosy, within the general population, 2. Knowledge and clinical experience of leprosy, among healthcare professionals, 3. Leprosy control program infrastructure, allocation of resources and institutional funding. These domains were each viewed as consequent to the larger theme of ‘low-endemicity’. Strong correlations between diagnostic delay and socioeconomic status, gender, geography and health system challenges, were also mentioned, and which intersected the three major themes.ConclusionReasons for diagnostic delay are evident in all tiers of the healthcare hierarchy in Pakistan. Thus, an approach at multiple levels is justified, to improve the general awareness of leprosy, education of healthcare professionals, and organizational structuring. Additionally, cultural features relevant to different communities in Pakistan which might be different from other care access frameworks demonstrated a need for further study into the health beliefs of Pakistani patients in a wide range of communities.