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Non-Commercial Use Only Journal of Public Health in Africa 2011 ; volume 2:e10 Social stigma as an epidemio- lack of self-esteem, tribal stigma and complete rejection by society. From the 480 structured Correspondence: Dr. Dickson S. Nsagha, logical determinant for leprosy questionnaires administered, there were over- Department of Public Health and Hygiene, elimination in Cameroon all positive attitudes to lepers among the study Medicine Programme, Faculty of Health Sciences, population and within the divisions (P=0.0). University of Buea, PO Box 63, Buea, Cameroon. Dickson S. Nsagha,1,2 The proportion of participants that felt sympa- Tel. +237. 77499429.E-mail: [email protected] [email protected] Anne-Cécile Z.K. Bissek,3 thetic with deformed lepers was 78.1% [95% 4 confidence interval (CI): 74.4-81.8%] from a Sarah M. Nsagha, Key words: leprosy, social stigma, attitudes, elim- Anna L. Njunda,5 total of 480. Three hundred and ninety nine ination, Cameroon. Jules C.N. Assob,6 (83.1%) respondents indicated that they could Earnest N. Tabah,7 share a meal or drink at the same table with a Acknowledgements: the authors are grateful to Elijah A. Bamgboye,2 deformed leper (95% CI: 79.7-86.5%). Four Mr. Nsagha BN, Mr. Nsagha IG and Late Papa hundred and three (83.9%) participants indi- James Nsagha, who sponsored this study. The Alain Bankole O.O. Oyediran,2 cated that they could have a handshake and authors also thank Mr. Agyngi CT & Mr. Ideng DA Peter F. Nde,1 embrace a deformed leper (95% CI: 80.7- of the Benakuma Health Center; Mr. David Alfred K. Njamnshi3 87.3%). A total of 85.2% (95.0% CI: 81.9-88.4%) Nfiekwe, Mr. Abel Sande, Mr. Ngam, Dr 1Department of Public Health and participants affirmed that they could move Zimmermann R of the Mbingo leprosarium, Dr. Jerry Fluth of the Health Services of the Hygiene, Faculty of Health Sciences, with a deformed leper to the market or church. Cameroon Baptist Convention and Nwabang University of Buea, Cameroon; A high proportion of 71.5% (95.0% CI: 67.5%- Caessian of Bamenda for data collection. 2Department of Epidemiology, Medical 75.5%) participants stated that they could offer Statistics and Environmental Health a job to a deformed leper. The results indicate Conflict of interest: the authors report no con- (Formerly Department of Preventive and that Menchum division had the lowest mean flicts of interest. Social Medicine), Faculty of Public score of 3.3 on positive attitudes to leprosy compared with Mezam (4.1) and Boyo (4.8) Received for publication: 1 December 2010. Health, College of Medicine, University Accepted for publication: 20 January 2011. of Ibadan, Nigeria; divisions. only The high proportion of positive attitudes 3Department of Internal Medicine and This work is licensed under a Creative Commons among the participants and in different divi- Attribution 3.0 License (by-nc 3.0). Specialties (Dermatology and sions is a positive indicator that the elimina- Neurology), Faculty of Medicine and tion of leprosy social stigma is progressing in ©Copyright D.S. Nsagha et al., 2011 Biomedical Sciences, University the right direction. Quantification of stigmause to Licensee PAGEPress, Italy Journal of Public Health in Africa 2011; 2:e10 of Yaounde 1, Cameroon; assess the elimination struggle is a new 4 doi:10.4081/jphia.2011.e10 Department of Educational Psychology, research area in public health. Faculty of Education, University of Buea, Cameroon; disease itself by leprosy patients.11 Leprosy is 5Department of Medical Laboratory still a public health problem in Essimbiland of Sciences, Faculty of Health Sciences, Introduction Cameroon even though the country has University of Buea, Cameroon; attained the elimination threshold set by the 6Department of Biomedical Sciences, Leprosy has been described as a neglected WHO.12 In this study we investigated the role University of Buea, Cameroon; tropical disease and social killer because it of social stigma as a determinant for leprosy 7National Programme for Leprosy, Buruli causes disability, has economic implications elimination in this endemic focus in Ulcer and Yaws Control, Ministry and results in social exclusion compared with Cameroon. of Public Health, Yaounde, Cameroon other diseases like malaria that are serial killers.1 Goffman2 has provided the most wide- ly accepted definition and description of stig- ma referring to bodily signs designed to Materials and Methods Abstract Non-commercialexpose something unusual or bad about the moral status of the signifier. Stigma itself is a Study area Leprosy has been eliminated as a public complex issue, with the capacity to affect all The study area and methods have been 3 health problem in most countries of the world facets of a leprosy-affected person's life. described elsewhere in detail.12 Briefly, the according to the WHO, but the social stigma to Many examples of social exclusion are avail- participants were drawn from Boyo and 4-7 the disease is still very high. The present study able in the literature. Menchum divisions of north-western was performed to investigate the role of social Today, leprosy is clinically cured relatively Cameroon because they had the highest preva- stigma as a determinant for leprosy elimina- easily, yet, the effects that it has on a patient's lence of leprosy (3.4/10,000 and 4.5/10,000, tion in a leprosy endemic region of Cameroon. life can carry on indefinitely.3 The stigmatising respectively).13-15 These divisions still have the Focus group discussions, in-depth interviews condition can lead to the person affected being highest leprosy prevalence (1.7/10,000 for and structured questionnaires were used to rejected and excluded from society.8 In the past Menchum and 2/10,000 for Boyo) in the North investigate leprosy social stigma among lep- two decades effective treatment has reduced West Region of Cameroon.16 In Boyo division, ers, their contacts and a control group consist- leprosy prevalence in the world.9,10 However, the study was concentrated in the Mbingo lep- ing of patients attending a health facility for the number of people living with its effects is rosarium and surrounding villages and in reasons other than leprosy. Informed consent counted in millions and prejudice still remains Menchum division, it was concentrated in was sought and gained prior to starting the a burden to those affected which directly or Benakuma and surrounding villages of study. Focus group discussions and in-depth indirectly affect its elimination. Leprosy social Essimbiland. This study was conducted from interviews identified three types of stigma: stigma has been described as worse than the June 1998 to October 2002. [page 38] [Journal of Public Health in Africa 2011; 2:e10] Article Design and setting was administered to all 480 respondents. rejection by society. Majority of contacts The study was a descriptive observational Those who could read or write the English lan- shunned interactions that could entail person- case-control study that was community-based guage filled the questionnaire and those who to-person contact especially with deformed in one low (Mezam division) and two high could not were communicated to through an patients. Most contacts said they could tolerate (Menchum and Boyo divisions) leprosy-preva- interpreter in Bikom and Essimbi dialects. handshake with a leper. Only few contacts lent areas. Leprosy patients constituted the The questionnaire contained socio-demo- accepted the idea of marrying a leper. The FGD cases and the contacts were a high-risk group graphic variables on age, sex, marital status, views of the participants on the social stigma for developing leprosy. The control group con- religion, geographical location and profession. of leprosy are presented in Table 1. Among the sisted of patients attending a health facility for Attitudinal questions on social stigma of lep- graphic comments made on the social stigma reasons other than leprosy. Leprosy patients, rosy constituted the dependent variables. to leprosy by contacts, the following was perti- their contacts and controls were matched for nent and frequently mentioned. geographical location, age and sex. Ethical approval and clearance “There is rejection and people despise them The authorization to carry out the work was because they cannot contribute to the develop- Inclusion and exclusion criteria for obtained from the Cameroonian Ministry of ment of the society; they lack proper lodging”. leprosy patients, contacts and controls Public Health (Nº D76/A/MSP/SESP/SG/DRH/ All community-based rehabilitation workers (contacts of patients) commented that social All intra-familial contacts (wife, children SDGP/SFS). Informed consent was obtained from all respondents before discussions/inter- stigma was a stumbling block to leprosy elimi- and other relatives) and extra-familial con- nation as expressed in the following com- tacts (friends, peers, colleagues and villagers) views were conducted, questionnaires admin- istered and from the patient whose picture is ments. were involved in the study. Controls were those “The leprosy patient rejects his/herself first who attended the Bamenda Hospital in Mezam presented. by shying away from people and sitting at cor- division for reasons other than leprosy who ners in gatherings, followed by the family and were selected based on a well-structured, guid- Data management and analysis the community”. ed questionnaire; those who either live or lived The audiotapes from FGDs and IDIs were “There are 13 villages in my area. These vil- with a leper in the same household or quarter replayed and transcribed, and the different lages have their traditional taboos. In some, were eliminated from the study. responses to the questions on social stigma theonly patients are rejected in “Manjong” houses were analysed manually using a code tree. (Manjong is a social gathering), they don’t Content and construct validity were checked Selection techniques for focus drink from the same pot with others.
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