AN EDUCATIONAL DIAGNOSIS OF PERCEIVED HEALTH, PSYCHO-SOCIAL AND ECONOMIC NEEDS OF PERSONS AFFECTED BY HANSEN'S DISEASE IN ENUGU AND EBONYI STATES, NIGERIA.

Abstract

In spite of great advances in Hansen’s disease (HD) control and treatment, the condition remains a major public health challenge in Nigeria. Previous studies focused largely on treatment-related issues to the neglect of the psycho-social and economic burden of the disease. This study was therefore conducted to assess the health, psycho-social and economic needs of Person Affected by Hansen’s Disease (PAHDs) in Enugu and Ebonyi States, Nigeria. Validated interviewer-administered questionnaire was used to collect data from 298 out of 361 PAHDs residing within and outside HD settlements in Oji River (Enugu state) and Mile Four (Ebonyi State) who consented to participate in the study. Six Focus Group Discussions (FGDs) (two each for women and men, and one each for young ladies and young men) were conducted among PAHDs in each of the two settlements using a validated FGD guide. The twelve FGDs were tape-recorded, transcribed and subjected to content analysis. The quantitative data were analyzed using descriptive and Chi square test statistics. Nearly equal proportions of the respondents were from Oji River (50.7%) and Mile Four (49.3%). Most participants (99.0%) were Christians, 52.0% were females and their overall mean age was 50.0 ± 17.2 years. Fifty-two percent (52.0%) had no formal education. The PAHDs’ means of livelihood included church support (59.4%), public donations (51.7%), begging (42.3%) and farming (34.6%). Respondents’ median number of offspring was 4.0 with a range of 1-13, while the median number of dependants was 3.0 with a range of 1-8. Most (93.0%) had at least one HD-associated physical deformity and these included loss of fingers/toes (59.0%), anesthesia of extremities (56.0%), visual defects (38.3%), plantar ulcers (35.2%) and claw fingers (29.9%). Malaria (60.7%) topped the list of the endemic co-morbid conditions experienced by the respondents in the two locations. The perceived most serious social challenges related to HD included insults from people (76.8%), avoidance (73.2%), difficulty in getting married (70.8%), poverty (58.0%), and discrimination (49.7%). More respondents at Oji River (61.6%) had problems getting married compared with those at Mile Four (38.4%) (p < 0.05). Respondents’ psychological challenges Included feelings of worthlessness (Oji River 58.9%; Mile Four 41.1%; p < 0.05) hopelessness (Oji River 62.0%; Mile Four 38.0%; p < 0.05), suicide ideation (Oji RIver 60.4%; Mile Four 39.6%; p < 0.05), feeling of being cursed (66.1%), and sadness (66.0%). The economic problems experienced by PAHDs included lack of money for feeding (92.0%), healthcare (47.3%) and children’s school fees (43.6%). Most FGD discussants were of the view that the most difficult problems associated with HD were, poverty and social rejection. The other major challenges expressed by the discussants included poor quality of life, loss of productivity due to the incapacitating nature of HD and poor quality of health services. Persons with Hansen’s disease in the study areas face debilitating physical, psycho-social and economic problems. Health education, psychotherapy, social support and economic empowerment are needed to address the identified challenges.