RESUMO
The consequences of leprosy are often disability and impairments. The physical health ramifications that are evident in the studies, as well as the stigma attached to the disease have implications for a person’s mental health. Depression, among other mental health issues, are frequent among persons with leprosy. This study aims to assess the burden of depression among patients suffering from the consequences of Leprosy (Disability) and its association with demographic and clinical factors. The study was conducted in the Premananda Memorial Leprosy Hospital in Kolkata, West Bengal. During the period of study, 99 consecutive patients aged 18 years and above attending the outpatient clinic were assessed for depression using Patient Health Questionnaire-9 (PHQ-9). The questionnaires were administered in the patient’s language, either in Bengali or Hindi.PHQ-9 is a validated tool to screen for depression that carries nine questions, each with a score of 3. The clinician had administered the questionnaire. Descriptive statistics were used to report the findings, and multivariate linear regression was applied to study the association between depression and other factors. The burden of depression among these 99 leprosy patients attending Tertiary Care Hospital as screened with the PHQ9 was about 53.5%. People with grade 1 and grade 2 disabilities had 2.6% and 5.6% more chances of developing signs of mental ill-health than those without any disability.The duration of disease and levels of disability wereobserved tohave a strong positive relation with depression among persons with leprosy. There is a need for effective counselling services at Tertiary care centres for reducing the psychosocial consequences.
RESUMO
To compare the factors associated with the participation restriction of person affected by leprosy in cross cultural contexts, this study was carried out from four states viz. Uttar Pradesh (UP), Chhattisgarh (CG), Andhra Pradesh (AP) and Tamil Nadu (TN) during the period from 2016 to 2017. Cross sectional study design was used in this study using the standardized Participation scale, along with socio-demographic variables were analysed for a total of 379 persons affected by leprosy. The findings from each state were compared with other states. The study concludes that participation restrictions are highly influenced by education and type of occupation in most of the states. The variables such as gender, age, locality and disability are moderately affecting the participation restrictions in some states. Income groups and Type of membership are affecting the participation restrictions in some states compared with others. The variables such as marital status, Religion and caste has no specific influence on participation restriction. Diverse influence of independent factors observed among various states indicates the need of independent strategies for each state to address the underlying cultural issues and challenges.
RESUMO
Dehabilitation of leprosy affected persons (LAP) is unique for the disease and totally undesirable. This becomes more regrettable with availability of MDT, integrated services, and proper referral care. This study has been carried out to determine the specific factors through qualitative data analysis, contributing towards Dehabilitation of the leprosy affected persons and to identify community based solutions to prevent the phenomenon. All the qualitative methods of social science research viz. observation, in-depth interview and focus group discussions (FGDs) have been used in the study for conducting case studies. A total of 13 case studies of dehabilitated patients have been carried out in two states of India, Uttar Pradesh and West Bengal. A brief summary of case studies and findings have been presented in the paper. The case findings show various reasons such as delayed due to ignorance, economic and financial problems, defaulted from treatment due to side effects of MDT, embarrassing look of dressings of ulcers, miss interpretation of leprosy as mental illness and lack of immediate improvement after taking MDT etc., are responsible for dehabiliation of leprosy affected individuals. The qualitative analysis of case studies gives rise to the following inferences: Qualitative findings provide evidence for delay i.e. starting of proper treatment after development of deformity is a common phenomenon among the deformed, the specific phenomenon found to be prevented through special approaches include-delay of treatment after reporting to treatment centre and getting dehabilitated while treatment is going on, delay in reporting for treatment after noticing the symptoms has been found to be due to the reasons viz. ignorance, economic problem and carelessness of the family members (husband), defaulting of MDT is due to various reasons viz. psycho-social, economic and nature of treatment facilities etc. in the PHC. Discussion with the patient's family members and the neighborhoods brought out their perceptions on how to prevent the phenomenon of defaulting, which is the primary reason for Dehabilitation. The study also highlights various specific factors of the above phenomenon, with special reference to female patients and the factors promoting colonization of the dehabilitated. The community activities that have been proved to be successful in preventing/managing dehabilitation and replicable in similar situations are of three broad categories viz. Patient Involved Community Actions (PICA) such as - cured patients convincing of family members with ignorance, disbelief on MDT treatment, Financial support, Nonpatient Involved Community Actions (NICA) including - somebody from family accompanying the patient to proper treatment centre, community's willingness to accept patient's family and Actions of Social Institutions (ASI) that include - IEC with details of RCS and facilities of colony, knowledge about regularity and side effects of MDT, counselling to family members about their required appropriate involvement in patient's treatment.