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Barrett, Carrie (2023) Determining the Distribution of Lymphatic Filariasis, Exploring the Psychosocial Consequences and Impact of an Enhanced Self-Care Intervention in Endemic Communities in Malawi, Thesis (Doctoral), Liverpool School of Tropical Medicine.
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Abstract
Lymphatic filariasis (LF) is a disabling, and disfiguring disease, threatening an estimated 882 million people worldwide. Infection of Wuchereria Bancrofti, causes a variety of clinical symptoms, most commonly hydrocele (scrotal swelling) and lymphoedema (limb swelling). Persons affected by LF are at increased risk of poor mental wellbeing, largely due to experiencing stigma, discrimination and social exclusion, and changes in health seeking behaviour and care.
This research was conducted in Malawi, a country endemic for LF that has spent two decades working towards its elimination as a public health problem. Elimination efforts were achieved through the implementation of mass drug administration (MDA) and morbidity management and disability prevention (MMDP). MMDP is a crucial component of the LF elimination strategy and the care of persons affected need to continue throughout their lifetime due to the chronic progressive nature of hydrocoele and lymphoedema, which cause significant disability, disfigurement and the psychosocial consequences.
This thesis focusses on the MMDP aspect of LF elimination in Malawi, and uses a mixed-method approach to better determine the burden of disease across the country and the impact of an enhanced self-care intervention on the physical, psychological and social aspects of the person affected.
The first aim was to understand the geographical distribution of LF clinical cases and antigenaemia prevalence in Malawi. A two-step geostatistical analysis approach was taken using climate information, available antigenaemia prevalence data and programmes case data collected across approximately 35% of the country. The models estimated 20,938 (95% CrI 18,091 to 24,071) clinical cases in unmapped areas (70.3%) in addition to the 8,856 programme-identified cases in mapped areas (29.7%), giving a total country estimate of 29,794 (95% CrI 26,957 to 32,927). The highest burden of disease was found in Southern districts (Chikwawa and Nsanje) and in the Northern Karonga district.
The second aim was to determine the prevalence of and risk factors associated with depressive symptoms and poor quality of life (QOL) amongst persons with filarial lymphoedema and evaluate the impact of the enhanced self-care intervention. A prospective cohort study of adults with filarial lymphoedema from two regions of Malawi was conducted over 6-months in 2021. Depressive symptoms and quality of life were assessed at baseline (pre-intervention), 3- and 6-months. 311 affected individuals were surveyed with 23% (95%CI, 18%-29%) reporting mild/moderate depressive symptoms and 31% (95%CI, 26%-37%) reporting moderately low/low QOL. Individuals with higher depressive symptoms (Adjusted Odds Ratios (AOR) 0.93, 95% CI 0.93-0.93) and lower QOL (AOR 0.98, 0.98-0.98) showed greatest improvement in mental health indicators over 3-months but this was not sustained at the same level at 6-months.
The third aim was to critically evaluate the syndemic relationship between mental distress and LF drawing on life history interviews. Additionally, I considered the impact of the enhanced self-care intervention from the perspective of persons affected by LF. The findings suggest that for people living with filarial lymphoedema, inequalities in healthcare provision or treatment, absent referral pathways, and limited knowledge of LF drive the syndemic interaction. This relationship is exacerbated by stigma and social exclusion, and shaped by intersections of gender, generation, poverty and extreme climate conditions.
Collectively, this research highlights the physical and mental health burden associated with LF that is still present in Malawi, despite LF being eliminated as a public health problem. The LF programme will need to address the physical, psychological and social implications of
disease. This requires an integrated holistic approach to MMDP for lymphoedema management, with emphasis on centering the needs of persons affected. Enhanced self-care for lymphoedema management complements existing health services, increasing sustainability and availability of accessible, acceptable and affordable health-care options in Malawi
| Item Type: | Thesis (Doctoral) | ||||
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| Subjects: | WA Public Health > WA 30 Socioeconomic factors in public health (General) WC Communicable Diseases > WC 20 Research (General) WC Communicable Diseases > Tropical and Parasitic Diseases > WC 880 Filariasis and related conditions (General) |
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| Faculty: Department: | Clinical Sciences & International Health > International Public Health Department | ||||
| Depositing User: | Lynn Roberts-Maloney | ||||
| Date Deposited: | 19 Jun 2024 11:33 | ||||
| Last Modified: | 19 Sep 2024 03:13 | ||||
| URI: | https://archive.lstmed.ac.uk/id/eprint/24777 |
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