A Comparative Study of Lymphatic Filariasis-Related Perceptions among Treated and Non-Treated Individuals in the Ahanta West Municipality of Ghana
Abstract
:1. Background
2. Methods
2.1. Study Sites
2.2. Community Entry
2.3. Study Design and Data Collection
2.4. Quantitative Data Collection
2.5. Qualitative Data Collection
2.6. Data Analysis
2.7. Ethical Approval
3. Results
3.1. Characteristics of Respondents
3.2. Awareness/Knowledge of Elephantiasis
“It (LF) is a common disease here […]. We the Ahanta people do not call it ‘Gyepim’. We say the person has ‘Dugba’. The Fantes call it ‘Gyepim’ and the Ahanta people call it ‘Dugba’ […] when we want to make fun of the condition then we refer to it as ‘Egyake Dugba’”.(P6, FGD, Male treated, Bonsukrom)
“We know it (LF). We can see that one leg will be swollen/bigger than the other. And it will limit the person’s movements, that is why we called it Dugba”.(P2, FGD, Male non-treated, Egyambra)
3.3. Signs and Symptoms of LF
“Before the disease will manifest, I was feeling heat and itching on my legs. Sometimes too, I feel pains in my groin and feverish. The big legs, as you see it now, took a long time to develop”.(P4, FGD, Male treated, Bonsukrom)
“The main thing that we know of is that the disease makes the legs of those infected big, usually one is bigger than the other. Some people too have their hand becoming bigger and we are told that it can also make you have Etow (hydrocele)”.(P5, FGD, Female non-treated, Achowa)
3.4. Treatment and Prevention
“We are all aware of the drugs that are given to us every year to treat the disease […] we all take it and whenever I asked, why should a person like me who is not having the disease should take the medicine? I was always told that it will protect me from getting the disease, So I have always taken it with my family […] it helps the children to release worms in their faeces and I think it is good”.(P3, FGD, Female treated, Mpatase)
3.5. Perceived Vulnerability Associated with LF and Infection
“At first you can see a lot of people with the disease in most communities and at that time we used to think that the disease can affect all of us, but now you don’t see many people having it. […] I am sure it is because of the medicine being given to us that has helped to reduce the condition in our communities […]. Now, most of us think that we are no longer as risk of getting the diseases”.(P7, FGD, female treated, Mpatase)
“Although, I don’t always take the medicine for the disease, I believe that it is helping many people and by reducing the number of people with the disease in the community”.(P5, FGD, Male non-treated Bonsukrom)
3.6. Impact of the LF Infection on the Community
“People with the disease cannot do many hard works. They can’t walk about freely, meaning they must sit at one place, and this causes financial problem”.(P2, FGD female non-treated, Mpatase)
“Because the affected person cannot work hard as he used to, the family will suffer because his or her ability to earn money has reduced. And as the man sits at one place, his leg will continue to swell”.(P1, FGD female treated, Mpatase)
“I know someone, his legs swelled and had a very bad odour. It was so bad that he had to carry perfume around. He sprays himself every now and then before he joins his friends to chat. He is always in trousers to cover his legs. It got to a time he began to stay indoors and died eventually, I believe, out of loneliness”.(P5, FGD, Male treated Bonsukrom)
3.7. Importance of Mass Drug Administration
“Every year they bring us some drugs to take and, I believe that is what has been protecting us from this disease […] only few people now have the big legs”.(P4, FGD Female treated, Mpatase)
“Yes, I see that it (MDA drugs) has been very useful. When I was about 20 years old, there were a lot of cases of elephantiasis disease in this community. But nowadays because of the annual drug distribution, it has gone down, though some of us has defaulted on taking the drugs many times”.(P2, FGD, Male non-treated Egyambra)
“The benefits are plenty. I don’t usually take medicine, but I always take the MDA drugs because it deworms me […] it has also eliminated hair lice from the hairs of children in the community, my children used to have lice in their hairs but know, I rarely find one in their hairs”.(P5, FGD female treated, Mpatase)
3.8. Adverse Reaction to MDA Drug
“I had a personal experience after taking the drug […] the next day after I took the drug, my leg and wrists began to swell. So, I showed it to the drug distributor, and he gave me a note to send to the hospital […] when I went, I was made to wait for a long time before they attend to me. The following year, I almost refused to take it but when I took it nothing happened to me”.(P7, FGD female treated, Mpatase)
“I personally stop taking the drug because on two occasions when I took it, I had rashes and vomit with blood in my vomitus. I also had swollen face and legs, I was very weak that I could not to anything […] I suffered for about 4 days and when I talked to the CDD, he said to me that they will go by themselves and that I do not need any treatment”.(P4, FGD, Male non-treated, Asemkor)
3.9. Adverse Effect and Its Treatment at the Health Facility
“The days that my brother went to the hospital with his reactions and was treated for free is not the same as we have it today. Today if you go to the hospital with such a problem you will pay. If you do not have health insurance, you will not be attended to. […] you are given a drug, which is making you sick and you must pay for treatment, it is not encouraging, and I think, this is one of the main reasons why some people have stopped taking the drug. I think we must be given a card to present at the health facility when we have reactions from the drug, this will be good”.(P5, FGD, Male treated, Bonsukrom)
3.10. Barriers to MDA Coverage and Uptake
“I have stop taking the drugs because I had a bad experience […] I suffered from fever and weakness after taking the drug when I was in school. You know, I was not sick before taking the drug, then suddenly, I felt sick. That is why I stop taking it”.(P3, FGD Male non-treated, Bonsukrom)
“Some complain of feeling sick, especially weakness after taking the medicine, hence do not take it. The men will leave home early to avoid the drug, other will pretend that they have taken alcohol. As for my fellow women, they may even say that they are pregnant busy with other household chores”.(P2, FGD, female treated, Asemkor)
“One of the reasons why some of us have not been taking the medicine regularly is that we are not inform on time to enable us to stay at home and wait for the distributors […] you will come from the farm or sea and then you are told that the drug distributors came in your absence. Sometimes too the information comes to the community only a day or two before the distribution, by which time you have planned your work activities already […] you must feed your family, so you leave home”.(P6, FGD, Male non-treated, Nyameyekrom)
“I will say that part of the problem is from those who bring the drugs to us […] the volunteers, I can say that they are not committed to the work because they are always complaining that they are not pay for the work, so nobody should worry them […]. At one time I got angry and refused to take the drug, but my son spoke to me to take it because it is good for me”.(P4, FGD, Male treated, Egyambra)
3.11. MDA Participation among Both Groups
3.12. Strategies to Increase MDA Coverage
“The dates and times should be communicated to us earlier just like the nurses do for weighing (child welfare clinic). In most cases, you will be in the house and the drug distributor will come and say that the time for you to take the drug has come. […] the timing should be communicated to us at least a week before they come”.(P5, FGD, Male treated, Bonsukrom)
“It will be good to make announcement using the local FM stations, whenever the drugs are to be distributed […] this will help us to plan and make ourselves available on the day that they will bring the drug to us”.(P3, FGD female non-treated, Mpatase)
“I believe that there is a need for sensitization and information to be done first to make sure that people are well informed about the need for the drugs […]. They understand why everybody should take the drug, also they need to stress the point that when you take the drug and have problems (adverse reaction) you will be taken care of for free at the health facility. I believe that this will encourage people to take the drugs”.(P2, FGD, Male treated, Nyameyekrom)
“I believe that if the engagement is done well by having time for them to explain the importance of the MDA drugs to them, majority of them will take it […] those doing the dialogue must be prepared to visit even in the night like between 7 and 9 pm, so that they can meet them, especially the men at home”.(P4, FGD, Female treated, Asemkor)
“That will be a very good thing to do for us […] I will take the drug now because I now understand the importance of the drug to be useful for preventing infection and I know that many people like me will take it if you come to us at the right time when we are at home, like today”.(P3, FGD, Male non-treated, Mpatase)
“I believe that some people would like to test to be sure that they have the disease before they will accept to take the drug, especially those young men who have small education and think that they know everything”.(P2, FGD, Male treated Egyambra)
“I am sure that people like me (non-treated) will like to be tested before taking the treatment […], this is a good thing because I will also know whether I have the disease in my blood or not […], I do not think that anybody will refuse the treatment when they know that they have the disease in their blood”.(F4, FGD, Male non-treated, Bonsukrom)
3.13. Influencing Non-Treated to Take MDA Medication
“I believe that the chief is the one that everybody listens to, when he speaks, so if he talks to those of us who refused to take the drugs, I believe we shall obey him […] I must add that parents and husbands and sometimes teachers can influence people to take the drug […] pastors or imams can also do same but I must add that for grownups like me, we have the responsibility for ourselves”.(P3, FGD, Female non-treated, Achowa)
“I think that the chief can only influence people to take the drugs when they put in place some forms of punishment for those who do not take the drug […], you see, the chief can only influence people by enforcing the rule that has been put in place to punish defaulters, especially those that intentionally refused to take the drug […]. I believe that parents can influence their younger children to take the drug, none of my children can refuse to take the drug when I have taken it myself”.(P5, FGD, Male treated, Egyambra)
4. Discussion
5. Conclusions and Recommendations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Variable | Treated n (%) | Non-Treated n (%) | Total n (%) | Chi Square p-Value |
---|---|---|---|---|
Gender | 0.200 | |||
Male | 91 (42.1%) | 108 (48.2%) | 199 (45.2%) | |
Female | 125 (57.9) | 116 (51.8%) | 241 (54.8%) | |
Age group | <0.001 | |||
18–34 | 68 (31.5%) | 112 (50.0%) | 180 (40.9%) | |
35–64 | 115 (53.2) | 98 (43.8%) | 213 (48.4%) | |
65+ | 33 (15.3%) | 14 (6.2%) | 47 (10.7%) | |
Level of education | 0.630 | |||
No education | 56 (25.9%) | 49 (21.9%) | 105 (23.9%) | |
Primary | 47 (21.8%) | 59 (26.3%) | 106 (24.1%) | |
Junior High School or above | 112 (51.9%) | 115 (51.3%) | 227 (51.6%) | |
Others | 1 (0.5%) | 1 (0.4%) | 2 (0.5%) | |
Employment Status | 0.350 | |||
Employed | 194 (89.8%) | 191 (86.4%) | 385 (88.1%) | |
Unemployed | 15 (6.9%) | 24 (10.9%) | 39 (8.9%) | |
Others (retired, student) | 7 (3.2%) | 6 (2.7%) | 13 (3.0%) |
Community | Type of Participants | Data Collection Strategy | Sex | Number of Participants | |
---|---|---|---|---|---|
Achonwa | 4 Treated | 3 non-treated | FGD | Females | 7 |
Asemkor | 5 Treated | 2 non-treated | FGD | Females | 7 |
Bonsukrom | 4 Treated | 2 non-treated | FGD | Males | 6 |
Egyambra | 5 Treated | 2 non-treated | FGD | Males | 7 |
Mpatase | 5 Treated | 2 non-treated | FGD | Females | 7 |
Nyameyekrom | 5 Treated | 3 non-treated | FGD | Males | 8 |
Treated (n = 216) | Non-Treated (n = 224) | Total | |
---|---|---|---|
Causes Reported * | n (%) | n (%) | n (%) |
Poor hygiene/Dirty environment | 157 (72.7) | 181 (80.8) | 338 (76.8) |
Don’t know | 59 (26.6) | 43 (19.2) | 102 (23.2) |
Mosquitoes | 34 (15.7) | 26 (11.6) | 60 (13.6) |
Worms | 10 (4.6) | 12 (5.4) | 22 (5.0) |
Rain/Standing water | 7 (3.2) | 11 (4.9) | 18 (4.1) |
Drinking from streams or rivers | 11 (5.1) | 7 (3.1) | 18 (4.1) |
Walking barefoot | 11 (5.1) | 5 (2.2) | 16 (3.6) |
Long contact with sea water | 7 (3.2) | 3 (1.3) | 10 (2.3) |
Pollution | 5 (2.3) | 2 (0.9) | 7 (1.6) |
Hereditary | 6 (2.8) | 1 (0.5) | 7 (1.6) |
Witchcraft/Curse/Spiritual | 16 (7.4) | 17 (7.6) | 6 (1.4) |
Oily foods/peanuts | 5 (2.2) | 5 (1.1) | |
Bad wind | 2 (0.9) | 2 (0.5) | |
Sweet foods/sugar | 1 (0.5) | 1 (0.2) |
Treated (n= 216) | Non-Treated (n = 224) | Chi2/p * | |
---|---|---|---|
Frequency(%) | Frequency (%) | ||
Swollen legs | 209 (96.8) | 206 (91.9) | 4.718/0.209 |
Sores on the body | 13 (6.0) | 18 (8.0) | 0.683/1.000 |
Don’t know | 6 (2.8) | 15 (6.7) | 3.715/0.377 |
Swollen scrotum (hydrocele) | 4 (1.9) | 3 (1.3) | 0.185/1.000 |
Swollen arms and hands | 4 (1.8) | 3 (1.3) | 0.185/1.000 |
Others | 2 (0.9) | 3 (1.3) | 0.167/1.000 |
High body temperature (fever) | 0 (0.0) | 3 (1.3) | 2.913/0.703 |
Swollen breasts | 0 (0.0) | 2 (0.9) | 1.937/1.000 |
Treated (n = 175) | Non-Treated (n = 162) | Chi2/p * | |
---|---|---|---|
Means to control or prevent | Frequency (%) | Frequency (%) | |
Mass Drug Administration (MDA) | 148 (84.6) | 124 (76.5) | 3.483/0.372 |
Keeping clean environment | 11 (6.3) | 19 (11.7) | 3.073/0.478 |
Don’t know | 13 (7.4) | 17 (10.5) | 0.975/1.000 |
Use/Drink clean water | 2 (1.1) | 7 (4.3) | 3.269/0.424 |
Bednet/Insecticide spray/Mosquito coil usage | 8 (4.6) | 5 (3.1) | 0.500/1.000 |
Others | 3 (1.7) | 5 (3.1) | 0.683/1.000 |
Treated | Non-Treated | Total | Chi2/p * | |
---|---|---|---|---|
n (%) | n (%) | n (%) | ||
6.0 Ever React to Drugs (n = 433) | ||||
Yes | 42 (19.5%) | 63 (28.9%) | 105(24.3%) | 5.1673/0.023 |
No | 173 (80.5%) | 155 (71.1%) | 328(75.7) | |
6.1 Reaction to drugs # (n = 105) | ||||
Weakness | 6 (14.3%) | 15 (23.8%) | 21 (20.0%) | 1.429/1.000 |
Rashes | 8 (19.1%) | 11 (17.5%) | 19 (18.1%) | 0.043/1.000 |
Swelling | 8 (19.1%) | 10 (15.9%) | 18 (17.4%) | 0.179/1.000 |
Itching | 9 (21.4%) | 8 (12.7%) | 17 (16.2%) | 1.415/1.000 |
Worm discharge | 7 (16.7%) | 10 (15.9%) | 17 (16.2%) | 0.012/1.000 |
Nausea | 2 (4.8%) | 8 (12.7%) | 10 (9.5%) | 1.842/1.000 |
Dizziness | 3 (7.1%) | 7 (11.1%) | 10 (9.5%) | 0.461/1.000 |
stomach-ache | 1 (2.4%) | 4 (6.4%) | 5 (4.8%) | 0.875/1.000 |
Severe headache | 0 (00%) | 3 (4.8%) | 3 (2.9%) | 2.059/1.000 |
Others | 3 (7.1%) | 14 (22.2%) | 17 (16.2%) | 4.223/0.399 |
6.2 Visit to health facility (n = 105) | 0.0305/0.861 | |||
Yes | 12 (29.0%) | 19 (30.0%) | 31(29.5) | |
No | 30 (71.0%) | 44 (70.0%) | 74 (70.5) | 0.0 |
6.2.1 If no, why didn’t you go to the health facility to report the incident? (n = 74) | 10.6149/0.060 | |||
I know that health workers will not pay attention to me | 1 (3%) | 0 (0%) | 1 (1.4) | |
I know the health facility has no medicine for adverse reaction | 0 (0%) | 1 (2%) | 1 (1.4) | |
High cost of treatment at health facility | 0 (0%) | 4 (9%) | 4 (5.4) | |
Don’t like hospitals | 4 (13%) | 15 (34%) | 19 (25.7) | |
Felt better after some days | 15 (50%) | 12 (27%) | 27 (36.5) | |
Others (specify): | 10 (33%) | 12 (27%) | 22 (29.7) | |
6.2.2 If yes, treatment given at health facility (n = 31) | 233.7281/0.000 | |||
Given medicine which I don’t know it name | 9 (75.0%) | 16 (84.2%) | 25 (80.7%) | |
Injection | 7 (50.0%) | 1 (5.3%) | 7 (22.6%) | |
Given Piriton to stop the itching | 1 (8.3%) | 1 (5.3%) | 2 (6.5%) | |
Given pain killers for headache | 0 (0.0%) | 1 (5.3%) | 1 (3.2%) | |
Given ointment for swelling | 0 (0.0%) | 1 (5.3%) | 1 (3.2%) | |
Others | 1 (8.3%) | 1 (5.3%) | 2 (6.5%) |
Issue Identified | Recommendations |
---|---|
Education | Education needs to be improved for the health workers, CDDs and for the communities to address the misconceptions surrounding the transmission of the disease. |
Information on MDA | Providing adequate information on the importance of MDA through information, education and communication (IEC) materials could help increase intake of the drugs. The information should include the fact that most, if not all, medicines are likely to activate some reactions in some people, which is part of the natural characteristics of medicine. |
Timing of MDA | More time needs to be given for the MDA or more appropriate time identified to enable community members participate in the process. |
Response to adverse events | The recommended protocols for addressing adverse events to treatment need to be enforced, as respondents complained of being asked to pay for treatment during adverse events. |
Number of non-treated | An important percentage of non-treated exists in the district, with reasons not related to the absence during MDA. These individuals will need to be targeted to assess the level of infection in this population. |
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Ahorlu, C.S.; Otchere, J.; Sedzro, K.M.; Pi-Bansa, S.; Asemanyi-Mensah, K.; Opare, J.L.; Alomatu, B.; Long, E.F.; de Souza, D.K. A Comparative Study of Lymphatic Filariasis-Related Perceptions among Treated and Non-Treated Individuals in the Ahanta West Municipality of Ghana. Trop. Med. Infect. Dis. 2022, 7, 273. https://doi.org/10.3390/tropicalmed7100273
Ahorlu CS, Otchere J, Sedzro KM, Pi-Bansa S, Asemanyi-Mensah K, Opare JL, Alomatu B, Long EF, de Souza DK. A Comparative Study of Lymphatic Filariasis-Related Perceptions among Treated and Non-Treated Individuals in the Ahanta West Municipality of Ghana. Tropical Medicine and Infectious Disease. 2022; 7(10):273. https://doi.org/10.3390/tropicalmed7100273
Chicago/Turabian StyleAhorlu, Collins Stephen, Joseph Otchere, Kojo M. Sedzro, Sellase Pi-Bansa, Kofi Asemanyi-Mensah, Joseph L. Opare, Bright Alomatu, Elizabeth F. Long, and Dziedzom K. de Souza. 2022. "A Comparative Study of Lymphatic Filariasis-Related Perceptions among Treated and Non-Treated Individuals in the Ahanta West Municipality of Ghana" Tropical Medicine and Infectious Disease 7, no. 10: 273. https://doi.org/10.3390/tropicalmed7100273