ABSTRACT
Aims: This study was conducted to develop de-stigmatising interventions aiming to reduce stigma related to leprosy; to improve the quality of life of the people affected; and to draw out lessons on how to set up such interventions elsewhere. Study Design: Intervention study. Place and Duration of Study: Raj Pracha Samasai Institute and Chaiyaphum province, Thailand, April 2011-December 2012. Methodology: De-stigmatising interventions were carried out by 3 different groups, namely a formal health care group, a local volunteer group and a self-help group. A baseline survey was done using both qualitative and quantitative methods. Qualitative data collection was conducted through semi-structured interviews with people affected with leprosy (n=19), community members (n=24) and health workers who were responsible for leprosy and tuberculosis at a district hospital (n=2), and those who were present at a sub-district promotion hospital at the time of interviewing (n=6). One focus group discussion was conducted among health volunteers who had people affected by leprosy in the areas for which they were responsible (n=6). For the quantitative data collection, community members and health workers were interviewed using the Explanatory Model Interview Catalogue (EMIC) stigma scale. To track the course of the interventions, two sets followup enquiries were conducted. People affected by leprosy, people with other disabilities, health volunteers, local volunteers, nurses, health workers and administrative officers were interviewed. Focus group discussions were held with health volunteers, with local volunteers and with the selfhelp group members. Content analysis was used to analyse qualitative data. A T-test, a Chi-square test and multiple linear regression analysis were used to analyse quantitative data. Observation was also conducted to evaluate the outcomes of self-care practice of people affected by leprosy. Results: Full participation of people affected by leprosy was found in interventions implemented by the self-help group, while little and no participation was found in those of the local volunteer and the formal health care group respectively. Self-esteem and social participation of the self-help group’s beneficiaries changed more than that of the local volunteer group, while there was no change in those taking part in the formal health care group. Conclusion: The findings support the study hypothesis that emphasises the importance of participation of different stakeholders. To maximise the likelihood of significant changes in attitudes, tailor-made education needs to be conducted to address negative attitudes and stigma perceptions found in the course of pre-intervention assessment.
ABSTRACT
The purpose of this hospital-based case-control study is to determine the effect of passive and active smoking on pulmonary TB in adults. The study subjects were 100 new pulmonary TB cases diagnosed at TB Division, and age-sex matched 100 non-TB cases from patients admitted to Taksin Hospital and healthy subjects who came for annual physical check-up at either the outpatient clinic of the TB division or Taksin Hospital, during May 2001 to October 2001. All subjects had blood tests and only persons who were HIV-negative, DM-negative and free of other lung diseases were included. Data were collected by direct interview using questionnaires. Multivariate analysis of cigarette smoking related to pulmonary TB in adults was performed. The factors related to pulmonary TB in adults were current active smoking regardless of passive smoking exposure. There was a significant association between early age at initiation of smoking and TB. Active (current + ex-active) smokers who started smoking at age 15-20 years had a higher risk of pulmonary TB compared to others (OR = 3.18, 95% CI = 1.15-8.77); as well as the long duration of smoking: persons who had smoked >10 years had a higher risk of pulmonary TB (OR = 2.96, 95% CI = 1.06-8.22). There was a relationship between pulmonary TB and the amount of smoking exposure. Those who smoked >10 cigarettes/day (OR = 3.98, 95% CI = 1.26-12.60) or >3 days/week (OR = 2.68, 95% CI = 1.01-7.09) had higher risk of pulmonary TB compared to non-smokers. Passive smokers who were exposed to tobacco smoke >3 times/week outside the home had a higher risk of pulmonary TB than those with exposure < or =3 times/week (OR = 3.13, 95% CI = 1.07-9.17). It was also found that the effects of passive smoking in the office and/or neighborhood were strong. Persons with such exposures had a higher risk of pulmonary TB than no exposure or exposure < or =3 times/week from either or both places (OR = 4.62, 95% CI = 1.68-14.98). Therefore, an effective anti-smoking campaign is expected to have a positive repercussion on TB incidence. Smoking cessation must be considered and promoted by all levels of health care providers.