Effectiveness of self-care interventions for integrated morbidity management of skin neglected tropical diseases in Anambra State, Nigeria

Chinwe C Eze,Chukwuka Alphonsus,Linda Lehman,Charles C Nwafor,Joy Ikebudu,Larry Sawers,Moses C Anyim,Anthony O Meka,Eileen Stillwaggon,Ngozi Ekeke,Joseph N Chukwu,Kingsley N Ukwaja

doi:10.1186/s12889-021-11729-1

Abstract

BackgroundLymphatic filariasis (LF), Buruli ulcer (BU) and leprosy are neglected tropical diseases (NTDs) of the skin co-endemic in some communities in Nigeria. Not enough is known about the effectiveness of integrated morbidity management and disability prevention in people with these conditions. An integrated self-care intervention was carried out for people with these skin NTDs in two endemic communities of Anambra state, Nigeria. The objective of the study was to assess the effectiveness of self-care practices on costs of care, disability status and health-related quality of life.MethodsThis study utilised a quasi-experimental pre-test/post-test design to assess the effectiveness of the self-care interventions for people affected by NTDs to care for these impairments at home. Data were collected using questionnaires administered at the beginning and at the end of the intervention on monthly cost of morbidity care, and on participants’ disability status and their quality of life (QoL). Focus group discussions (FGDs) were held with both the participants and healthcare workers at follow-up.ResultsForty-eight participants were recruited. Thirty participants (62.5%) continued the self-care interventions until the end of the project. Of those, 25 (83%) demonstrated improvement from their baseline impairment status. The mean household costs of morbidity care per participant decreased by 66% after the intervention, falling from US$157.50 at baseline to US$53.24 after 6 months of self-care (p = 0.004). The mean disability score at baseline was 22.3; this decreased to 12.5 after 6 months of self-care (p < 0.001). Among the 30 participants who continued the interventions until the end of the project, 26 (86.7%) had severe disability score (i.e. a score of 10–46) at baseline, and the number with severe disability fell to 18 (60%) of the 30 after the intervention. The mean QoL score increased from 45.7 at baseline to 57.5 at the end of the intervention (p = 0.004).ConclusionsThe 6-month self-care intervention for participants affected by BU, leprosy, or LF led to lower costs of care (including out-of-pocket costs and lost earnings due to morbidity), improved QoL scores, and reduced disability status.Trial registrationISRCTN Registry: ISRCTN20317241; 27/08/2021, Retrospectively registered.

Highlights

Lymphatic filariasis (LF), Buruli ulcer (BU) and leprosy are neglected tropical diseases (NTDs) of the skin co-endemic in some communities in Nigeria
This paper reports on a pilot project of a community self-care intervention for morbidity management and disability prevention (MMDP) for participants with leprosy, BU, or lymphatic filariasis (LF). and assessed the effectiveness of the intervention on participants’ costs, disability status, and health-related quality of life
Of the 30 participants who completed self-care, 21 were previously laboratory-confirmed NTD cases (1 LF, 1 leprosy and 19 BU), while 9 were non-laboratory confirmed NTD cases or participants who had other conditions with impairments that could profit from self-care

Summary

Introduction

Lymphatic filariasis (LF), Buruli ulcer (BU) and leprosy are neglected tropical diseases (NTDs) of the skin co-endemic in some communities in Nigeria. NTDs are commonly found in settings with a high level of poverty, poor living conditions, and poor sanitation [1, 2] They are often associated with physical impairment and disability, accounting for 25% of Disability Adjusted Life Years globally [3, 4]. Most of the 20 NTDs are endemic in Africa They can be grouped into 3 categories depending on whether their effective control can be achieved through mass delivery of preventive chemotherapy (e.g. onchocerciasis, schistosomiasis), intensified disease management (e.g. Chagas disease, leishmaniasis), or both measures, as in the case of lymphatic filariasis (LF), trachoma and yaws [1,2,3,4]. The World Health Organization (WHO) published a training guide on cutaneous NTDs for front-line health workers to help countries adopt the integrated strategy [9]

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