Understanding leprosy reactions and the impact on the lives of people affected: An exploration in two leprosy endemic countries

Background

Leprosy reactions, Type-1 and erythema nodosum leprosum, are immune-mediated complications of leprosy, which play a significant role in the morbidity associated with the disease. A considerable amount of literature has been published on the impact of leprosy in general but few studies focus specifically on leprosy reactions. This study aimed to investigate the impact of leprosy reactions on physical, psychological, and social aspects of the lives of people affected by analysing their life experiences and perspectives about leprosy reactions.

Methods/Principal findings

This qualitative study involved people affected by leprosy reactions and their family members in two leprosy endemic countries. The data were collected through 66 interviews and 9 focus group discussions (4–6 participants each) in Surabaya, Indonesia, and Purulia, India. Content analysis and conversational analysis were performed. This study found that both types of leprosy reactions were perceived as an unpredictable and painful condition. Leprosy reactions restricted physical activities of the participants, such as going to bathroom, sleeping, eating, and cooking. In the interviews, the respondents expressed a range of emotions and feelings including confusion, sadness, anxiety, and anger. Some recounted that they felt stigmatized and lost opportunities to socialise and earn money. Differences between the two settings were identified. The majority of Indonesian participants preferred to stay at home, and some concealed the diagnosis of leprosy, while most of the Indian respondents continued working up to the time of hospitalization.

Conclusion

Leprosy reactions are a distressing complication of leprosy and adversely affect the lives of those affected. Individuals reported physical discomfort, distress, anxiety, stigma, and financial hardship and these negative impacts in the physical, psychological, and social spheres reinforced each other. These findings provide important information about a need for early detection and sustained commitment to follow-up care for people with a history of leprosy reactions. More research on new drugs for reactional episodes, tools to measure knowledge, attitude, and practice, and costing study on leprosy reactions treatment are needed. We recommend the development and testing of holistic strategies to improve the management of leprosy reactions.

How do Positive Deviants Overcome Health-Related Stigma? An Exploration of Development of Positive Deviance Among People With Stigmatized Health Conditions in Indonesia

A constructivist grounded theory approach was used to understand how some people living with stigmatized health conditions develop positive deviance to overcome stigma. We examined interviews from 13 identified positive deviants living with four different stigmatized health conditions (HIV, leprosy, schizophrenia, and diabetes) in Indonesia. Positive deviance develops in the form of psychological empowerment through improvement of self-belief and perception (intrapersonal component), development of understanding and skill to exert control in life (interactional component), and self-discovery of successful behaviors and strategies to avert stigma (behavioral component). Positive deviants, after being empowered, start empowering others affected by sharing their knowledge and fostering social awareness and acceptance. The findings revealed the presence of problem-solving ability and agency within the community of stigmatized individuals in Indonesia and warrant researchers to partner with the community to expedite the diffusion of transferable positive deviant strategies within and outside the communities.

Risk of Agricultural Pesticide Exposure to Malaria Incidence and Anopheles Susceptibility at an Endemic Area in Central Java, Indonesia – A Case–control Study

BACKGROUND: Malaria is an infectious disease caused by Plasmodium sp. This disease often occurs in tropical countries and has sometimes been reported in agricultural countries. This vector-borne disease is associated with environmental factors and the presence of vectors. Some studies found that Anopheles is resistant to insecticide, and this topic was encouraged by the WHO for malaria control. AIM: This research aimed to explain the causal effects of agricultural pesticide exposure on malaria incidence and Anopheles susceptibility in an endemic area of Indonesia. METHODS: A case–control study was conducted between September and October 2016 in Purworejo, Central Java. The case group involved 131 individuals who had malaria in 2016 based on their medical records, whereas the control group comprised 131 individuals who were neighbors of the cases and never had a history of malaria. Cases were selected randomly from hospital medical records. Both case and control groups were interviewed using the same questionnaire, and data were analyzed using logistic regression. Insecticide susceptibility test was used to test the 80 mosquito samples collected from the neighborhood of recent malaria cases. RESULTS: The quantity of agricultural pesticide remains a potential health risk to malaria (odds ratio = 2.15; 95% confidence interval 1.000–4.638), which was adjusted by confounders (sex, resting place, and insecticide net). The susceptibility test indicated that Anopheles was resistant to both permethrin (86.25%) and bendiocarb (68.75%). CONCLUSIONS: The quantity of agricultural pesticide contributes as a risk factor to malaria incidences, and Anopheles was indicated to be resistant to bendiocarb in Purworejo, Central Java.

Qualitative Exploration of Experiences and Consequences of Health-related Stigma among Indonesians with HIV, Leprosy, Schizophrenia and Diabetes

Health-related stigma causes a negative impact on the lives of affected people and undermines the effectiveness of public health programs. This study aimedto explore experiences and consequences of stigma among people affected by four health conditions relevant in Indonesia– HIV (Human ImmunodeficiencyVirus), leprosy, schizophrenia and diabetes. In this qualitative study 40 people affected by the four health conditions in Jakarta and West Java, Indonesia–,were interviewed between March and June 2018. Data were analyzed thematically by following an integrative inductive-deductive approach. The experiencesand consequences of people with stigma were similar, but such experience were more severe among people affected by HIV, leprosy, and schizophrenia.Those with diabetes either experienced no or less severe stigma. The participants revealed that they experienced enacted stigma in healthcare, employment,and social interactions in the structural and interpersonal levels. They also experience the stigma in the form of internalized and anticipated stigma at an individual level. Incidences of human rights violations were evident. Social, behavioral, psychological, and medical consequences were also reported.