Impact of common skin diseases on children in rural Côte d’Ivoire with leprosy and Buruli ulcer co-endemicity: A mixed methods study

Abstract

Skin-related neglected tropical diseases (skin NTDs) occur against a background of a very high prevalence of common skin diseases in sub-Saharan Africa. In this study, we examined the knowledge, attitude and practices (KAP) and the impact of common skin diseases in children living in a leprosy and Buruli ulcer (BU) co-endemic district in a west African country of Côte d’Ivoire, in order to help inform disease control efforts for skin NTDs. Fourteen focus group discussions (FGDs) with schoolchildren, 5 FGDs with parents of a child affected with skin disease(s), and 27 in-depth semi-structured interviews with key personnel were conducted. The Children’s Dermatology Quality of Life Index (CDLQI) questionnaire was applied to 184 schoolchildren with skin diseases. We found that there was ignorance or neglect towards skin diseases in general, due to their high prevalence and also the perceived minimal impact on children’s daily lives. While the median score for the CDLQI questionnaire was 5 (IQR 2–9) out of 30, a range of scores was observed. Symptoms such as pruritus and experiencing bullying by classmates contributed to reduction in their quality of life. Poor hygiene was considered as a major cause of skin diseases. Despite their high impact on affected populations, we observed a high level of ignorance and neglect toward common skin diseases. There is a critical need to increase awareness of skin diseases, or skin health promotion, which supports changing of the health-seeking behaviour for skin conditions. This will aid in early detection and treatment of the skin NTDs, in addition to providing benefits for those affected by other skin diseases. Educational opportunities should be utilized to their utmost. One would be associated with WASH strategies, but careful messages need to be developed and delivered. Areas endemic for skin-related neglected tropical diseases, or skin NTDs, also show high prevalence rates for other skin diseases. It is important to gauge the understanding of the people’s knowledge, attitudes and practices towards these more common skin diseases as well as their impact. This study was conducted in communities of the western African country, Côte d’Ivoire where there is co-endemicity of skin NTDs, including leprosy and Buruli ulcer. Ignorance and neglect of skin diseases in general were observed, due to the high prevalence and also their perceived minimal impact on children’s daily lives. However, some children were shown to have been affected significantly by their skin disease through our interviews and questionnaires. Our study results suggest a critical need for awareness raising activities, or skin health promotion, which supports changing health seeking behavior for skin conditions to aid in early detection and treatment of the skin NTDs. This may also be advantageous for those affected by other skin diseases. Messages need to be developed with care during delivery of education to avoid creating negative images of diseases, and further, stigma and discrimination.