Treatment Seeking Behaviour of LeprosyPatients attending Out-patient,   Department of Dermatology,     K.G.H. Visakhapatna...
INTRODUCTION                 Social                 stigma Deformity      &                        Fear Disfiguring       ...
Quote by a patient   I and my family are suffering with this condition as    a result of my sins I did in my early life  ...
Research Question 1   What are the socio-demographic(*) factors    leading to delay in seeking treatment of    leprosy pa...
Research question 2   What are the factors affecting treatment    seeking behaviour in terms of diagnosis,place    of see...
Materials & Methods   Study site: Out-patient,Department of    Dermatology.   Study period & size: 01-05-2011 to 31-05-2...
Results   Distribution of study population according to    sex(n=65)                 23                                  ...
   Distribution of study population according to    residence                  23                                        ...
   Disrtibution of study population according to    marital status        70                                          62 ...
   Distribution of study population according to    occupation      45        40      40      35      30      25      20 ...
   Distribution of study population according to    diagnosis        56                                    54        54  ...
   Distribution of study population according to place    of seeking treatment                  31                       ...
   Distribution of study population according to delay    in seeking treatment      12-24 months       8       2-12 month...
   Distribution of study population according to age    vs average delay in seeking treatment       9                    ...
   Distribution of study population according to sex vs    average delay in seeking treatment         7                  ...
   Distribution of study population according to    occupation vs average delay in seeking treatment        9       8    ...
   Distribution of study population according to    diagnosis vs average delay in seeking treatment        7             ...
Conclusion   Factors affecting delay in seeking treatment   include   age(51-65),sex(males) ,occupation(daily   labore...
ASSESSMENT OF STIGMA ASSOCIATEDWITH LEPROSY IN PATIENTS USINGEMIC AND ISMI SCALES    EMIC-Explanatory Model Interview Cata...
Over 11-12 million (1)sufferers worldwide  More than 1000 leper colonies in the countryDisability adjusted life years (DAL...
New RESEARCH QUESTION   What are the beliefs and attitudes    associated with stigma leading to delay    in seeking treat...
MATERIALS AND METHODS   Study site: Out-patient,Department of    Dermatology.   Study period & size: 01-05-2011 to 31-05...
Conceptual ApproachQualitative in-depth narrative accounts are required todevelop queries, scales and instruments at the o...
Measurement Model                          AffectedCondition   Community                   Impact                         ...
RESULTS          Distribution of study population using EMIC- stigma scale          (community & affected)                ...
RESULTS                        Distribution of study population using ISMI                        stigma scale(individual)...
Impact of stigma            Assessment of marital life among study population                                     Yes   No...
RESULTS               Impact of stigma (on education and employement among study population)                              ...
CONCLUSION   “The biggest disease today is not leprosy or    tuberculosis but rather the feeling of being    unwanted, un...
For many people stigma is synonymous with leprosy.This is due to Leprosy often causing severe disfigurement &  deformity...
The key message that can overcome stigma are There is no need to discriminate against people  affected by leprosy Lepros...
   EMIC and ISMI scales are useful tools to assess stigma    associated with leprosy.   However very few studies have be...
Future Prospective   Such scales can be used effectively in assessing    stigma against HIV/AIDS and also to assess impac...
References1.    WHO global statistics [WHO-2010].2.    Elimination of leprosy as a public health problem      Noordeen, SK...
Acknowledgements   I would like to thank the Department of Community    Medicine and Department of Dermatology of    Andh...
Thank you!             ashokkanuri@gmail.com
treatment seeking behaviour of leprosy patients
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treatment seeking behaviour of leprosy patients

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this is my 1st research on leprosy.,i have presented it in 2 parts in medicon 2012 and empower 2012 international conferences

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treatment seeking behaviour of leprosy patients

  1. 1. Treatment Seeking Behaviour of LeprosyPatients attending Out-patient, Department of Dermatology, K.G.H. Visakhapatnam Ashok Kanuri ,Dr.G.Krishna Babu M.D.(SPM) Andhra Medical College & King George Hospital Visakhapatnam
  2. 2. INTRODUCTION Social stigma Deformity & Fear Disfiguring Leprosy Severe HumiliationManifestation Delay in seeking treatment
  3. 3. Quote by a patient I and my family are suffering with this condition as a result of my sins I did in my early life  M.Guruvulu,58 M The name has been changed
  4. 4. Research Question 1 What are the socio-demographic(*) factors leading to delay in seeking treatment of leprosy patients in terms of age, sex, occupation ,marital status and place of living? * People are unwilling to divulge their social status, religion and income
  5. 5. Research question 2 What are the factors affecting treatment seeking behaviour in terms of diagnosis,place of seeking treatment and completion of treatment
  6. 6. Materials & Methods Study site: Out-patient,Department of Dermatology. Study period & size: 01-05-2011 to 31-05-2011,65 Study tools: Quantitative:- pre tested questionnaire Qualitative:- observation, in depth-interviews Variables: Treatment seeking behaviour, diagnosis of leprosy, follow up Analysis: Is done using percentages,no tests of significance are applied
  7. 7. Results Distribution of study population according to sex(n=65) 23 Males 77 Females
  8. 8.  Distribution of study population according to residence 23 Rural Urban 77
  9. 9.  Disrtibution of study population according to marital status 70 62 60 50 45 40 Yes 30 20 No 20 10 3 0 Refused Marriage separated/Divorced
  10. 10.  Distribution of study population according to occupation 45 40 40 35 30 25 20 15 15 15 10 6 8 8 5 5 3 Series 1 0
  11. 11.  Distribution of study population according to diagnosis 56 54 54 52 50 48 Series 1 46 46 44 42 Pauci-Bacillary Multi-Bacillary
  12. 12.  Distribution of study population according to place of seeking treatment 31 Government 69 Private
  13. 13.  Distribution of study population according to delay in seeking treatment 12-24 months 8 2-12 months 54 Series 1 0-2 months 30 Zero 8 0 20 40 60
  14. 14.  Distribution of study population according to age vs average delay in seeking treatment 9 8 8 7 6 6 6 5 4 4 Series 1 3 2 1 0 25-34 35-44 45-54 55-64
  15. 15.  Distribution of study population according to sex vs average delay in seeking treatment 7 6 6 5 4 4 3 Series 1 2 1 0 Females Males
  16. 16.  Distribution of study population according to occupation vs average delay in seeking treatment 9 8 8 8 7 6 6 5 4 4 4 4 3 2 2 2 Series 1 1 0
  17. 17.  Distribution of study population according to diagnosis vs average delay in seeking treatment 7 6 6 5 4 4 3 Series 1 2 1 0 Pauci-Bacillary Multi-bacillary
  18. 18. Conclusion Factors affecting delay in seeking treatment include age(51-65),sex(males) ,occupation(daily laborers and vegetable sellers)and nature ofdiagnosis(paucibacillary) Though stigma has not been shown in the analysis ,stigma still remains to haunt their day to day life in terms of Quality Of Life and disabilities are not uncommon.
  19. 19. ASSESSMENT OF STIGMA ASSOCIATEDWITH LEPROSY IN PATIENTS USINGEMIC AND ISMI SCALES EMIC-Explanatory Model Interview Catalogue(8) ISMI- Intenalized Stigma of Mental Illness(9)
  20. 20. Over 11-12 million (1)sufferers worldwide More than 1000 leper colonies in the countryDisability adjusted life years (DALY)(2) lost globally dueto leprosy is estimated to be about one million Map showing countries endemic for Leprosy (WHO, 2011)
  21. 21. New RESEARCH QUESTION What are the beliefs and attitudes associated with stigma leading to delay in seeking treatment among leprosy patients and its impact on their quality of life ?
  22. 22. MATERIALS AND METHODS Study site: Out-patient,Department of Dermatology. Study period & size: 01-05-2011 to 31-05-2011,65 Study tools: Quantitative:- questionnaire, stigma scales Qualitative:- observation, in depth-interviews Variables: Treatment seeking behaviour, diagnosis of leprosy, follow up Analysis: Is done using percentages,tests of significance are applied where ever necessary
  23. 23. Conceptual ApproachQualitative in-depth narrative accounts are required todevelop queries, scales and instruments at the outset, sothat they may ensure the validity of large quantitativeassessments of the magnitude of stigma, and thedistribution of particular features, the overall impact anddeterminants of stigma” (Weiss, 2004) Perceived stigma-EMIC affected scale Internalized stigma-ISMI scale Impact of stigma EMIC-Explanatory Model Interview Catalogue(8) ISMI- Intenalized Stigma of Mental Illness(9)
  24. 24. Measurement Model AffectedCondition Community Impact person Self efficacy Perceived Perceived stigma ParticipationLeprosy Experienced Enacted Self esteem stigma Internalized Well being Rensen et al., 2010
  25. 25. RESULTS Distribution of study population using EMIC- stigma scale (community & affected) Disagree Agree Prompt treatment given by doctors 0 100Affected my educational plans or oppurtunities 30.76 69.22 Others would think less of family 23.09 76.91 People feel sorry for a person with this… 7.69 92.3 Relationship with friends affected negatively 76.91 23.09 Problems in ongoing marriage/spouse 76.91 23.09 Looked down upon by others 7.69 92.3 0 20 40 60 80 100 120
  26. 26. RESULTS Distribution of study population using ISMI stigma scale(individual) Disagree AgreeI can have a good fullfilling life despite this… 30.76 69.22 I avoid getting close to avoid rejection 23.07 76.91 Nobody is interested in getting close 23.07 76.91 People can tell that I have this condition 30.76 69.22 I feel inferior to others 38.45 61.15 Iam embrassed/ashamed 38.45 61.15 0 20 40 60 80 100 120
  27. 27. Impact of stigma Assessment of marital life among study population Yes NoRefused to get married at the time of diagnosis 30.76% 69.23 %Separated/Divorced after diagnosis 95.38%
  28. 28. RESULTS Impact of stigma (on education and employement among study population) Yes NoNot admitted to school/educational institution 0 100% Refused employement 46.15% 53.84% Forced to leave job 38.46% 61.53% 0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00%
  29. 29. CONCLUSION “The biggest disease today is not leprosy or tuberculosis but rather the feeling of being unwanted, uncared for and deserted by everybody” Mother Teresa
  30. 30. For many people stigma is synonymous with leprosy.This is due to Leprosy often causing severe disfigurement & deformity Lack of knowledge about the disease
  31. 31. The key message that can overcome stigma are There is no need to discriminate against people affected by leprosy Leprosy is curable Drug treatment is available free of charge
  32. 32.  EMIC and ISMI scales are useful tools to assess stigma associated with leprosy. However very few studies have been conducted in India using these scales NLEP since its inception has been successfull in bringing down stigma against leprosy by its sustained IEC programs-Previous literature on leprosy suggest that stigma was very high in the 60’s,70’s and 80’s If misconceptions about leprosy are not changed it will be difficult to eliminate leprosy as a public health problem
  33. 33. Future Prospective Such scales can be used effectively in assessing stigma against HIV/AIDS and also to assess impact of lifestyle diseases such as diabetis mellitus,hypertension,stress,cancer etc, Multi-centric studies can be organised in developing countries to assess such impacts on population affected by development.
  34. 34. References1. WHO global statistics [WHO-2010].2. Elimination of leprosy as a public health problem Noordeen, SK Indian Journal of Leprosy [INDIAN J. LEPR.]. Vol. 66, no. 1, pp. 1-10. 1994.3. Stigter D, de Gaus L, Heynders M. Leprosy: between acceptance and segregation. Community behavior towards persons affected by leprosy in eastern Nepal. Leprosy Review, 2000; 71: 492–498.4. Reference list leprosy related stigma-1998-2009.Nations MK[et. al.] stigma, deforming metaphors and patients moral experience of multibacillary leprosy in sobral,ceara state, Brazil ,Cad Saude Publica 2009,25[6]:1215-12245. Strategic framework for reduction of stigma & discrimination by Danlep6. Countries endemic for Leprosy (WHO, 2011)7. Measuring stigma by Wim H. van Brakel, Carlijn Voorend, Carin Rensen8. EMIC by(Mitchell Weiss Swiss Tropical Institute and University of Basel9. ISMI by Boyd formerly Ritsher, Jennifer E, University of California San Francisco
  35. 35. Acknowledgements I would like to thank the Department of Community Medicine and Department of Dermatology of Andhra Medical College for allowing me to conduct my research.
  36. 36. Thank you! ashokkanuri@gmail.com

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