Socio-cultural determinants of timely and delayed treatment of Buruli ulcer: Implications for disease control
Identifieur interne : 000698 ( Main/Exploration ); précédent : 000697; suivant : 000699Socio-cultural determinants of timely and delayed treatment of Buruli ulcer: Implications for disease control
Auteurs : Mercy M. Ackumey [Ghana, Suisse] ; Margaret Gyapong [Ghana] ; Matilda Pappoe [Ghana] ; Cynthia Kwakye Maclean [Ghana] ; Mitchell G. Weiss [Suisse]Source :
- Infectious Diseases of Poverty [ 2049-9957 ] ; 2012.
Abstract
Public health programmes recommend timely medical treatment for Buruli ulcer (BU) infection to prevent pre-ulcer conditions from progressing to ulcers, to minimise surgery, disabilities and the socio-economic impact of BU. Clarifying the role of socio-cultural determinants of timely medical treatment may assist in guiding public health programmes to improve treatment outcomes. This study clarified the role of socio-cultural determinants and health system factors affecting timely medical treatment for BU in an endemic area in Ghana.
A semi-structured explanatory model interview based on the explanatory model interview catalogue (EMIC) was administered to 178 BU-affected persons. Based on research evidence, respondents were classified as timely treatment (use of medical treatment 3 months from awareness of disease) and delayed treatment (medical treatment 3 months after onset of disease and failure to use medical treatment). The outcome variable, timely treatment was analysed with cultural epidemiological variables for categories of distress, perceived causes of BU, outside-help and reasons for medical treatment in logistic regression models. The median time for the onset of symptoms to treatment was computed in days. Qualitative phenomenological analysis of respondents’ narratives clarified the meaning, context and dynamic features of the relationship of explanatory variables with timely medical treatment.
The median time for initiating treatment was 25 days for pre-ulcers, and 204 days for ulcers. Income loss and use of herbalists showed significantly negative associations with timely treatment. Respondents’ use of herbalists was often motivated by the desire for
Findings highlight the importance of an integrated approach to BU control and management considering the social and economic features that influence delayed treatment and factors that encourage timely medical treatment. This approach should consider periodic screening for early case-detection, collaboration with private practitioners and traditional healers, use of mobile services to improve access, adherence and treatment outcomes.
Url:
DOI: 10.1186/2049-9957-1-6
PubMed: 23849228
PubMed Central: 3710079
Affiliations:
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Ackumey</name><affiliation wicri:level="4"><nlm:aff id="I1">School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>School of Public Health, College of Health Sciences, University of Ghana, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation><affiliation wicri:level="1"><nlm:aff id="I2">Swiss Tropical and Public Health Institute, Basel, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Swiss Tropical and Public Health Institute, Basel</wicri:regionArea><wicri:noRegion>Basel</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">University of Basel, Basel, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>University of Basel, Basel</wicri:regionArea><wicri:noRegion>Basel</wicri:noRegion></affiliation></author><author><name sortKey="Gyapong, Margaret" sort="Gyapong, Margaret" uniqKey="Gyapong M" first="Margaret" last="Gyapong">Margaret Gyapong</name><affiliation wicri:level="4"><nlm:aff id="I1">School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>School of Public Health, College of Health Sciences, University of Ghana, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation><affiliation wicri:level="1"><nlm:aff id="I4">Dodowa Health Research Centre, Ghana Health Service, Dodowa, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Dodowa Health Research Centre, Ghana Health Service, Dodowa</wicri:regionArea><wicri:noRegion>Dodowa</wicri:noRegion></affiliation></author><author><name sortKey="Pappoe, Matilda" sort="Pappoe, Matilda" uniqKey="Pappoe M" first="Matilda" last="Pappoe">Matilda Pappoe</name><affiliation wicri:level="4"><nlm:aff id="I1">School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>School of Public Health, College of Health Sciences, University of Ghana, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName><orgName type="university">Université du Ghana</orgName></affiliation></author><author><name sortKey="Maclean, Cynthia Kwakye" sort="Maclean, Cynthia Kwakye" uniqKey="Maclean C" first="Cynthia Kwakye" last="Maclean">Cynthia Kwakye Maclean</name><affiliation wicri:level="3"><nlm:aff id="I5">Amasaman Hospital, Ghana Health Service, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>Amasaman Hospital, Ghana Health Service, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation></author><author><name sortKey="Weiss, Mitchell G" sort="Weiss, Mitchell G" uniqKey="Weiss M" first="Mitchell G" last="Weiss">Mitchell G. Weiss</name><affiliation wicri:level="1"><nlm:aff id="I2">Swiss Tropical and Public Health Institute, Basel, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Swiss Tropical and Public Health Institute, Basel</wicri:regionArea><wicri:noRegion>Basel</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">University of Basel, Basel, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>University of Basel, Basel</wicri:regionArea><wicri:noRegion>Basel</wicri:noRegion></affiliation></author></analytic><series><title level="j">Infectious Diseases of Poverty</title><idno type="eISSN">2049-9957</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>Public health programmes recommend timely medical treatment for Buruli ulcer (BU) infection to prevent pre-ulcer conditions from progressing to ulcers, to minimise surgery, disabilities and the socio-economic impact of BU. Clarifying the role of socio-cultural determinants of timely medical treatment may assist in guiding public health programmes to improve treatment outcomes. This study clarified the role of socio-cultural determinants and health system factors affecting timely medical treatment for BU in an endemic area in Ghana.</p></sec><sec><title>Methods</title><p>A semi-structured explanatory model interview based on the explanatory model interview catalogue (EMIC) was administered to 178 BU-affected persons. Based on research evidence, respondents were classified as timely treatment (use of medical treatment 3 months from awareness of disease) and delayed treatment (medical treatment 3 months after onset of disease and failure to use medical treatment). The outcome variable, timely treatment was analysed with cultural epidemiological variables for categories of distress, perceived causes of BU, outside-help and reasons for medical treatment in logistic regression models. The median time for the onset of symptoms to treatment was computed in days. Qualitative phenomenological analysis of respondents’ narratives clarified the meaning, context and dynamic features of the relationship of explanatory variables with timely medical treatment.</p></sec><sec><title>Results</title><p>The median time for initiating treatment was 25 days for pre-ulcers, and 204 days for ulcers. Income loss and use of herbalists showed significantly negative associations with timely treatment. Respondents’ use of herbalists was often motivated by the desire for <italic>quick recovery</italic> in order to continue with work and because herbalists were relatives and easily accessible. However, drinking unclean water was significantly associated with timely treatment and access to health services encouraged timely treatment (OR 8.5, p = 0.012). Findings show that health system factors of access are responsible for non-compliance to treatment regimes.</p></sec><sec><title>Conclusions</title><p>Findings highlight the importance of an integrated approach to BU control and management considering the social and economic features that influence delayed treatment and factors that encourage timely medical treatment. This approach should consider periodic screening for early case-detection, collaboration with private practitioners and traditional healers, use of mobile services to improve access, adherence and treatment outcomes.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Webb, Bj" uniqKey="Webb B">BJ Webb</name></author><author><name sortKey="Hauck, Fr" uniqKey="Hauck F">FR Hauck</name></author><author><name sortKey="Houp, E" uniqKey="Houp E">E Houp</name></author><author><name sortKey="Portaels, F" uniqKey="Portaels F">F Portaels</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Renzaho, Am" uniqKey="Renzaho A">AM Renzaho</name></author><author><name sortKey="Woods, Pv" uniqKey="Woods P">PV Woods</name></author><author><name sortKey="Ackumey, Mm" uniqKey="Ackumey M">MM Ackumey</name></author><author><name sortKey="Harvey, Sk" uniqKey="Harvey S">SK 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Carranza</name></author><author><name sortKey="Hale, M" uniqKey="Hale M">M Hale</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Williamson, Hr" uniqKey="Williamson H">HR Williamson</name></author><author><name sortKey="Benbow, Me" uniqKey="Benbow M">ME Benbow</name></author><author><name sortKey="Nguyen, Kd" uniqKey="Nguyen K">KD Nguyen</name></author><author><name sortKey="Beachboard, Dc" uniqKey="Beachboard D">DC Beachboard</name></author><author><name sortKey="Kimbirauskas, Rk" uniqKey="Kimbirauskas R">RK Kimbirauskas</name></author><author><name sortKey="Mcintosh, Md" uniqKey="Mcintosh M">MD McIntosh</name></author><author><name sortKey="Quaye, C" uniqKey="Quaye C">C Quaye</name></author><author><name sortKey="Ampadu, Eo" uniqKey="Ampadu E">EO Ampadu</name></author><author><name sortKey="Boakye, D" uniqKey="Boakye D">D Boakye</name></author><author><name sortKey="Merritt, Rw" uniqKey="Merritt R">RW Merritt</name></author><author><name sortKey="Small, Pl" uniqKey="Small P">PL Small</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Marsollier, L" uniqKey="Marsollier L">L Marsollier</name></author><author><name sortKey="Aubry, J" uniqKey="Aubry J">J Aubry</name></author><author><name sortKey="Saint Andre, Jp" uniqKey="Saint Andre J">JP Saint-Andre</name></author><author><name sortKey="Robert, R" uniqKey="Robert R">R Robert</name></author><author><name sortKey="Legras, P" uniqKey="Legras P">P Legras</name></author><author><name sortKey="Manceau, Al" uniqKey="Manceau A">AL Manceau</name></author><author><name sortKey="Bourdon, S" uniqKey="Bourdon S">S Bourdon</name></author><author><name sortKey="Audrain, C" uniqKey="Audrain C">C Audrain</name></author><author><name sortKey="Carbonnelle, B" uniqKey="Carbonnelle B">B Carbonnelle</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Samuelsen, H" uniqKey="Samuelsen H">H Samuelsen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nyika, A" uniqKey="Nyika A">A Nyika</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Ghana</li><li>Suisse</li></country><region><li>Région du Grand Accra</li></region><settlement><li>Accra</li></settlement><orgName><li>Université du Ghana</li></orgName></list><tree><country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Ackumey, Mercy M" sort="Ackumey, Mercy M" uniqKey="Ackumey M" first="Mercy M" last="Ackumey">Mercy M. Ackumey</name></region><name sortKey="Gyapong, Margaret" sort="Gyapong, Margaret" uniqKey="Gyapong M" first="Margaret" last="Gyapong">Margaret Gyapong</name><name sortKey="Gyapong, Margaret" sort="Gyapong, Margaret" uniqKey="Gyapong M" first="Margaret" last="Gyapong">Margaret Gyapong</name><name sortKey="Maclean, Cynthia Kwakye" sort="Maclean, Cynthia Kwakye" uniqKey="Maclean C" first="Cynthia Kwakye" last="Maclean">Cynthia Kwakye Maclean</name><name sortKey="Pappoe, Matilda" sort="Pappoe, Matilda" uniqKey="Pappoe M" first="Matilda" last="Pappoe">Matilda Pappoe</name></country><country name="Suisse"><noRegion><name sortKey="Ackumey, Mercy M" sort="Ackumey, Mercy M" uniqKey="Ackumey M" first="Mercy M" last="Ackumey">Mercy M. Ackumey</name></noRegion><name sortKey="Ackumey, Mercy M" sort="Ackumey, Mercy M" uniqKey="Ackumey M" first="Mercy M" last="Ackumey">Mercy M. Ackumey</name><name sortKey="Weiss, Mitchell G" sort="Weiss, Mitchell G" uniqKey="Weiss M" first="Mitchell G" last="Weiss">Mitchell G. Weiss</name><name sortKey="Weiss, Mitchell G" sort="Weiss, Mitchell G" uniqKey="Weiss M" first="Mitchell G" last="Weiss">Mitchell G. Weiss</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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