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Barriers to social participation for people with disabilities in NTD-endemic areas of Benin and Côte d’Ivoire: Assessing scope and associated factors
research-article
Author(s):
Yévèdo Borel Tossou
1
,
*
,
,
Paule Héléna Biaka
2 ,
Fifamin Noël Christelle Gbaguidi
1 ,
Vignon Bedie
3 ,
Sonagnon Inès Elvire Agbo
1 ,
Fernand Aimé Guedou
1 ,
Kouakou Jerôme Kouadio
2 ,
Sèdjro Gimatal Esaï Anagonou
1 ,
Franck Zinsou Mignanwande
1 ,
Parfait Djossou
1 ,
Brunelle Vanessa Yemadje
1 ,
Flora Sylvie Houndjrebo
1 ,
Jeanne d’Arc Natacha Lessanh Arrawo
1 ,
Yvette Faihoun
1 ,
Harvey Johnson
1 ,
Ghislain Emmanuel Sopoh
3 ,
Jean Gabin Houezo
4 ,
Mamadou Kaloga
5 ,
Agui Sylvestre Dizoe
6 ,
Mark Nichter
7 ,
Anna Gine-March
8 ,
Roch Christian Johnson
1
,
9
Publication date (Electronic):
27 December 2024
Journal:
PLOS Global Public Health
Publisher:
Public Library of Science
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Abstract
People with disabilities (PWDs) due to neglected tropical diseases (NTDs) or other causes experience restrictions on social participation (RSPs). This study aimed to investigate the magnitude of these restrictions and associated factors in NTD-endemic communities in Benin and Côte d’Ivoire. This cross-sectional quantitative and qualitative study was conducted from 2021 to 2022 among 841 people with disabilities (PWDs) and 90 community members and stakeholders. Questionnaires and interview guides were used for data collection. The World Health Organization P-scale score adapted to the local context, was used to assess RSPs. Univariate and multivariate analyses were performed to identify associated factors. Qualitative data were processed using triangulation or data comparison, categorized, cross-referenced, and synthesized by theme, hypothesis and indicator. Of the 841 PWDs, 65.9% had experienced RSPs. The median age (Q1; Q3) was 38 (22; 52) years, and the M/F ratio was 1.45. Of the respondents, 89.2% had a monthly income between 0 and 50,000 FCFA (76 euros); 43.7% were married, and 64.4% were uneducated. Only 98 (11.7%) were disabled due to NTDs. Factors (OR [95%IC], p-value) associated with RSPs were age (30 to 44 years (1.66 [1.06–2.59], p = 0.026), 45 to 59 years (2.26 [1.43–3.58], p = 0.001), and 60 to 74 years (2.35 [1.29–4.27], p = 0.005); Secondary/University level of education ((0.42 [0.28–0.65], p = 0.000); occupation (shopkeeper/housekeeper (0.40 [0.17–0.91]), p = 0.029), farmer (0.21 [0.11–0.40], p = 0.000), and other professions (0.44 [0.20–0.96], p = 0.038)); and income-generating activities (IGAs) (1.53 [1.06–2.22], p = 0.023). Our results demonstrate that the magnitude of RSPs among PWDs is high. The associated factors were age, education level, occupation, and IGAs.
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Most cited references25
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An African way of networking around disability
Gubela Mji, Siphokazi Gcaza, Leslie Swartz … (2011)
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- Abstract: found
- Article: found
Persisting Social Participation Restrictions among Former Buruli Ulcer Patients in Ghana and Benin
Janine de Zeeuw, Till Omansen, Marlies Douwstra … (2014)
Introduction Buruli ulcer (BU) is a skin condition caused by Mycobacterium ulcerans, which is the third most prevalent mycobacterial disease in immuno-competent humans, after the diseases caused by Mycobacterium tuberculosis and Mycobacterium leprae [1]. BU presents as a small nodule or a plaque sometimes accompanied by edema. At a later stage, the lesion breaks open with ulceration typically presenting with undermined edges [2]. The World Health Organization (WHO) has classified lesions as category I: lesions cross-sectional diameter of less than 5 cm; as category II: lesions of 5–15 cm and category III: lesions of >15 cm; category III also includes lesions on important sites (for example eyes) and multiple lesions. The exact mode of transmission remains unclear, though it is generally accepted that infection is associated with living close to stagnant water [3]. BU has been found in more than 30 countries predominantly with tropical or subtropical climates; the most burdened region is West Africa. In 2011, Côte d'Ivoire, Ghana and Benin reported the highest numbers of new cases [4]. In Benin, the prevalence varies from 5.4 cases/10,000 to 60.7/10,000 inhabitants depending on altitude of villages [5] while the national BU prevalence in Ghana is 20.7 cases/100,000 inhabitants [6]. Since 2005, standard medical treatment entails antimicrobial therapy sometimes complemented with surgery [7]. Prevention of Disability (POD) programs have been developed by the WHO, which are implemented in endemic countries to reduce disabilities. Essential components are wound management, and positioning and mobilization of the affected extremity. Nevertheless, studies have revealed that people still develop physical disabilities such as scarring, contractures, deformities, and sometimes require amputation [8], [9] or are otherwise left with functional limitations [10], [11]. Not only may BU lead to physical consequences, but also stigmatization is perceived by former BU patients, even years after healing [12]. Magico-religious ideas on the cause of BU, fear of contracting the disease and its visible signs are suggested to be the most important distinctive features of this stigma [13]. In other stigmatized health conditions such as leprosy and leishmaniasis, participation restrictions in social life after treatment are common [14]–[18]. Participation restrictions are defined as ‘any problem an individual may experience in involvement in life situations' [19]. For example, a person may encounter restrictions related to employment, meeting new people, visiting public places or attending social events in the community. Participants of a qualitative study have expressed that scarring and physical disabilities as a result of BU disease may result in problems with marriage and employment [20]. In addition, community members expressed persisting negative attitudes towards BU patients resulting in social exclusion as victims are believed to have no social responsibilities and should be restricted in attending social events [21]. Social problems are of particular importance because of their impact on a person's well-being and quality of life [22]. The aim of this study was to explore participation restrictions among former BU patients and to gain insight into the factors that predict participation restrictions. Methods Study population From January to October 2012 data for this cross-sectional study were collected in Ghana and Benin. Eligible for inclusion were former BU patients aged at least 15 years, who were treated between 2005 and 2011, and whose treatment was completed at least 3 months before the study commenced. Medical records of the Centre de Dépistage et de traitement de l'Ulcère de Buruli de Lalo in Benin and Agogo Presbyterian Hospital in Ghana were screened for potential participants. In the absence of an address system and with no phone numbers recorded, potential participants had to be sought in the villages. In Benin a high number of potential participants were found, and therefore primary health care posts surrounding the hospital were chosen as study sites. Posts were selected if a high number of cases was found, from the medical records, in the catchment area of the post and if they were relatively easy to access (in terms of distance and road circumstances). In Ghana, former BU patients who participated in another follow-up study of the BURULICO trial in Ghana [23] were excluded. Healthy community controls without any history of BU or without a visible disability were recruited from villages located in the study area. In both countries, we aimed to include at least 50 healthy controls. Community controls representing the same age (+5/−5 years), female/male ratio and geographical location as the former BU patients were recruited. Questionnaires Socio-demographic factors To obtain information on socio-demographic variables a questionnaire was developed containing questions on current medical status, age, sex, location of residence, educational level, occupation and living situation. History of BU disease was traced from the BU01 forms and/or medical records. A visible deformity was established by the interviewers before the interview. Participation restrictions Participation restrictions were assessed with the Participation Scale (P-scale). The P-scale consists of 18 items covering eight major life domains distinguished by the International Classification of Functioning, Disability and Health (ICF) [24]. The instrument is generic and uses a peer-comparison to diminish cultural influences. The participants are asked to compare themselves to someone who is similar in all social-cultural, economic and demographic aspects, except for the disease or disability. Each item entails an objective question (responses; yes, no, sometimes or not specified, not answered or irrelevant) and a subjective question to grade participation restrictions (responses; ‘no problem’ (1)’, ‘small problem’ (2), ‘medium problem’ (3) and ‘a large problem’ (5)). Item scores are summed for the total score (range 0–90). Higher scores signify more participation restrictions. The cut-off value, based on local reference data, for participation restrictions was established to be 12 in the development study [24]. We decided to calculate a cut-off value, an approach which was recommended for this instrument, which was developed and validated in other cultural contexts [24]. Functional limitations The Buruli Ulcer Functional Limitation Score (BUFLS) [25], [26] was employed to establish perceived functional limitations. Questions aim to gain insight into patients' perception of ability in 19 daily tasks divided into four groups: food preparation, personal care, daily work activities and mobility. The BUFLS uses an ordinal response scale; 0 points reflect an activity is performed without problems, 1 point indicates an activity is performed with difficulty and 2 points denote that an activity is impossible to perform. The total score, ranging from 0 to 100, is the sum score divided by the maximal score applicable for the patient and multiplied by 100. Higher scores denote a higher level of functional limitations. Perceived stigma: A subset of questions (15 in total) of the Explanatory Model Interview Catalogue (EMIC) [27] which has been used earlier [13], [28], was used to explore perceived stigma [29]. Response options are ‘yes’ (3 points), ‘possibly’ (2 points), ‘uncertain’ (1 point) and ‘no’ (0 points). Each question contributes equally to the sum score. Sensitive questions concerning marriage, sexual functioning and fertility were not asked to participants below the age of 20 years. To compensate for items not asked, the total stigma score was calculated as the percentage of the maximum score a participant could receive on the questions applicable for that participant. Higher scores are indicative of a higher level of perceived stigma. Translation Procedures regarding translation of the P-scale are extensively described elsewhere [30] briefly summarized the scale was translated and back translated into Twi (language in Ghana) and French (Benin). Procedures Before data collection, in each country two native language speaking interviewers participated in a training to prevent bias during the interview. The training was provided using the available manuals; the Participation Scale Users Manual (version 6.0) and the BUFLS Manual (2012). During data collection regular discussions were held to reveal difficulties encountered during interviewing. During the interviews no specific problems were encountered with understanding the peer comparison. Former patients with BU were identified with either the assistance of a BU coordinator, a health care worker, or one of the local community volunteers. If eligible former BU patients could not be found or appeared not to be in the village, a second visit was planned to ask for study participation. To ensure privacy during the interviews, private quiet places were used to conduct the interview. Ethical consent Ethical approval was granted by the Medical Ethical Review Committees of the Kwame Nkrumah University of Science and Technology, School of Medical Sciences, Komfo Anokye Teaching Hospital in Ghana (ref: CHRPE/RC/127/12) and the Ministry of Health in Benin (ref: N01961/MS/DC/SGM/DRF/SRAO/SA). Adult participants provided written informed consent. A parent or guardian of any child participant provided informed consent on their behalf. Statistical analysis Data analyses were performed with Statistical Package for the Social Science (SPSS) version 20.0. The cut-off for the P-scale scores was determined calculating the 95th percentile of the P-scale sum scores of healthy community controls [24]. Two outliers in Ghana were removed for this analysis. The resulting cut-off was 16, indicating that participants with scores up to 16 were categorized as not having participation restrictions and participants with scores 17 or higher were categorized as having participation restrictions. Basic features of the data were analyzed using descriptive statistics. As appropriate, Pearson's chi-square test, Fisher's exact test, Mann-Whitney U test, Kruskal-Wallis test and Spearman Ranks correlation were performed to compare for differences in socio-demographic factors and clinical aspects across countries as well as for univariate associations with P-scale sum scores. Factors significantly related (P 0.1). Interaction terms (country x sex, sex x stigma scores, sex x age, and country x stigma score) were explored, also using differences found in the previous analysis [30] between Ghana and Benin. For interpretability, age was centered at 15 years as minimum age of the BU patients was 15 years of age. Results Population In total 121 patients were treated for BU in Agogo Presbyterian Hospital in Ghana between 2005 and 2011 of which 46 could not be found. Reasons were unknown addresses (20), unclear information on name or location (16), had died (6) or were not traced (4) resulting in participation of 75 former patients with BU in Ghana. In Benin, a total of 4 village health centers were visited resulting in 255 patients treated for BU between 2006 and 2011. In total 68 former patients with BU could be traced. Reasons why patients could not be found were not recorded. Significant differences between Ghana and Benin were found in length of time since start of treatment, type of treatment, lesion size, type of lesion, visible deformity, profession, and living situation (Table 1). 10.1371/journal.pntd.0003303.t001 Table 1 Characteristics of former BU patients. Variables Ghana (n = 75) Benin (n = 68) P-value Age at time of inclusion, median (IQR) 27 (19;33) 25 (18;43) .791* Sex (male, %) 33 (44) 31 (46) .859‡ Length of time since start treatment, median in months (IQR) 24 (15;37) 62 (33;71) 1 7 (9) 6 (9) Lesion size, n (%) Category I 56 (82) 36 (53) .001‡ Category II 8 (12) 19 (28) Category III 4 (6) 13 (19) Type of lesion Nodule 31 (41) 2 (3) 1 3 (43) 14 (11;35) 5 (83) 33 (17;47) 8 (62) 22 (12;37) Type of treatment Antibiotic treatment 24 (44) 12 (4;28) .356* 10 (35) 9 (4;25) .503* 34 (41) 10.8 (4;27) .246* Antibiotic and surgery 12 (60) 20 (6;32) 21 (54) 17 (5;32) 33 (56) 19 (6;32) Lesion size Category I 22 (39) 10 (4;24) .159§ 12 (33) 8 (3;25) .024§ 34 (37) 9.5 (3;25) .005§ Category II 5 (63) 8.5 (6;61) 10 (53) 17 (5;24) 15 (56) 17 (5;42) Category III 3 (75) 6.5 (9;34) 9 (69) 31 (13;51) 12 (71) 29 (13–36) Type of lesion Nodule 15 (48) 14 (8;30) .439§ 1 (50) 15.6 (3;-) .428§ 16 (49) 14 (7;29) .807§ Plaque/edema 11 (58) 21 (6;30) 6 (33) 5 (3;42) 17 (46) 11 (3;31) Ulcer 10 (40) 10 (2;25) 24 (50) 16 (6;30) 34 (47) 13 (5;25) Joint involved No 17 (40) 10 (5;27) .171* 14 (38) 8 (3;27) .108* 31 (39) 9.5 (3;27) .056* Yes 16 (67) 20 (9;32) 13 (48) 15 (6;32) 29 (57) 18 (8;32) Visible deformity No 20 (42) 10 (4;25) .082* 13 (36) 8 (3;25) .060* 33 (39) 8.5 (3;25) .023* Yes 1 (100) - 9 (53) 17 (11;39) 10 (56) 19 (11;45) Profession Employed/student 36 (49) 13.5 (6;29) .213* 28 (47) 14 (4;30) .841* 64 (48) 13.5 (5;29) .790* Unemployed 0 - 3 (38) 13.3(5;34) 3 (33) 13 (3;30) Correlation Correlation Correlation Age at time of inclusion 0.21 .073‡ 0.31 .012‡ 0.25 .003‡ Length of time in months since start treatment −0.01 .968‡ −0.08 .515‡ −0.24 .777‡ EMIC score 0.64 15 cm cross-sectional diameter, on important sites or multiple lesions, BUFLS: functional limitations, EMIC: perceived stigma, * age was centered – 15 years of age. Post hoc analysis was performed to determine predictive value of lesion size as dichotomized variable (category I vs category II and III) on participation restrictions. Factors significantly contributing to the regression equation were similar as shown in Table 3 as well as the explained variance of the model. Having a category II or III lesion increases the P-scale score by 6.8 points (P = .010). Discussion We showed persisting participation restrictions in almost half of the former patients with BU in Ghana and Benin. The percentage of former patients with BU with participation restrictions is less compared to previous studies among former leprosy patients positively screened for difficulties in functioning in Indonesia (about 60%) [18], but is higher compared to former leprosy patients in Bangladesh (34%) [17] and Brazil (35%) [16]. Most commonly reported problems as indicated by former BU patients related to employment. This is in line with a previous study on participation restrictions using the P-scale among a total of 20 leprosy affected persons in Nigeria [14] reporting problems in areas related to work, domestic life and interpersonal relations. And a study among recently diagnosed leprosy patients in India showed that many respondents experience restrictions in areas related to work [31]. Finally the results of our study confirm qualitative findings reporting that BU may cause problems with employment [20]. The other areas in which former BU patients experienced restrictions differed between Ghana and Benin. Predictors of participation restrictions were sex, perceived stigma, functional limitations and the size of the lesion. Women were more at risk for participation restrictions, which may be explained by sociocultural perception differences on participation restrictions between men and women. Further the difference can be explained by a different experience of the negative attitudes of community members as indicated in a previous study [21]. Furthermore it is plausible that women have more tasks and relationships as compared to men, however in Indonesia no difference in participation restrictions between men and women was found [18]. Patients affected by larger lesions may lose more muscle or joint function and as a result are more restricted in participation. In addition functional limitations may also affect people's mobility to participate in their community. Finally feeling stigmatized as a result of being a former BU patient may prevent people to interact with others in and outside the community or participate in relationships. To our knowledge, this study was the first to use a prediction model for participation restrictions among former patients with BU as measured with the P-scale. Surprisingly duration between end of treatment and time of interview did not influence participation restrictions. In addition participation restrictions were not significantly different for category III lesions compared to category I lesions. It is plausible that the small sample size of former patients with BU with category III lesions resulted in this outcome. Therefore we performed a post hoc analysis dichotomizing small lesions (category I) and large lesions (category II and III). The results of this analysis showed that having a category II or III lesion increases the P-scale score by 6.8 points. To establish cut-off scores the 95th percentile of the community scores was calculated. Two healthy community controls from Ghana were removed for this analysis because they presented extreme outliers, affecting cut-off tremendously (29 versus 14). The cut-offs varied slightly for Ghana and Benin (18 versus 14) indicating heterogeneity across countries. Though, we decided to calculate 1 cut-off as preferred for future use in the field. Several study limitations should be mentioned. The groups of BU patients in Ghana and Benin were heterogeneous as many factors such as case finding activities and exclusion of potential participants due to participation in another study were beyond our control. As a result, former patients in Ghana were treated much more recently and mainly had category I lesion. Furthermore differences regarding employment related problems were found. However background information regarding these differences is not available as it was not the focus of our study, also because we did not expect these differences. In Benin, we aimed for random sampling of the potential participants, however, logistical reasons led to the decision for a convenience sample in certain villages. It is conceivable that selection bias may have occurred. Furthermore, the cross-sectional design of the study prohibits drawing causal relationships. As such, some of the statistical predictors (perceived stigma and functional limitations) of participation restrictions may also be a result of participation restrictions. This is in line with the ICF model encompassing all the dimensions of disability, showing solely bidirectional associations. Finally, due to unknown reasons visible deformity was filled out less frequently leading to missing data and its influence on the P-scale could therefore not be analyzed in the linear regression. To conclude, we have shown persisting participation restrictions among former patients with BU, even long after treatment had finished and wounds had healed. Unfortunately the introduction of the antibiotic treatment in 2005 has not been able to prevent long-term consequences on the capability to participate in the community. The results indicate active case finding is required, as former patients with BU that presented with small lesions experienced less participation restrictions. POD programs, including stigma reduction strategies and physical and social rehabilitation are needed even after ‘successful’ completion of medical treatment. Such programs should pay extra attention to work integration. Before the development of these POD programs mixed methods studies should be performed to study local meanings of participation restrictions. Supporting Information Checklist S1 STROBE checklist. ** √ = what is described in the manuscript, NA = Not applicable. (DOC) Click here for additional data file.
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Aspects of social participation and neighborhood perception: ELSI-Brazil
ABSTRACT OBJECTIVE To determine the impact of the physical and social surroundings of the neighborhood, which are presented as facilitators or barriers for the social participation of Brazilian older adults. METHODS The study was conducted in a probabilistic representative sample of the Brazilian population aged 50 years and older and who lived in urban areas (n = 7,935). The response variable was social participation, which was defined from two questions about activities performed with other persons: visited friends or relatives in their homes in the last 12 months (yes, no); went out with other persons to public places, such as restaurant, movies, club, park, in the last 12 months (yes, no). The explanatory variables included fear of falling because of defects in sidewalks, concern about the difficulty to get on a bus, subway, or train, difficulty to cross streets, and perception of violence in the neighborhood. Potential confounding variables included age, marital status, education level, self-rated health, living in an asphalted or paved street, time living in the municipality, and socioeconomic position score. Prevalence ratios and respective confidence intervals were estimated using Poisson regression. RESULT Difficulty to cross streets presented an independent association with restricted social participation (PR = 0.95; 95%CI 0.93–0.98) among both women (PR = 0.96; 95%CI 0.92–0.99) and men (PR = 0.94; 95%CI 0.90–0.99). Concern about the difficulty to get on a bus, subway, or train was associated with the outcome only among men (PR = 0.95; 95%CI 0.91–0.99). The fear of falling because of defects in sidewalks and the perception of violence in the neighborhood were not associated with social participation. CONCLUSIONS Urban characteristics that hinder the crossing of streets and accessibility to public transport can be inferred as important barriers for the social participation of Brazilian older adults.
Author and article information
Contributors
Yévèdo Borel Tossou:
ORCID: https://orcid.org/0009-0009-9533-898X
Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole:
MethodologyRole: Project administrationRole: SoftwareRole: SupervisionRole: Writing
– original draftRole: Writing – review & editing
Paule Héléna Biaka: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole:
MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole:
Writing – review & editing
Fifamin Noël Christelle Gbaguidi: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole:
MethodologyRole: Project administrationRole: SoftwareRole: SupervisionRole: Writing
– original draftRole: Writing – review & editing
Vignon Bedie:
ORCID: https://orcid.org/0000-0003-3121-9550
Role: InvestigationRole: Methodology
Sonagnon Inès Elvire Agbo: Role: Formal analysisRole: MethodologyRole: Project administrationRole: SupervisionRole:
Writing – original draftRole: Writing – review & editing
Fernand Aimé Guedou: Role: Formal analysisRole: MethodologyRole: ValidationRole: VisualizationRole: Writing
– original draftRole: Writing – review & editing
Kouakou Jerôme Kouadio: Role: Formal analysisRole: MethodologyRole: ValidationRole: VisualizationRole: Writing
– original draftRole: Writing – review & editing
Sèdjro Gimatal Esaï Anagonou:
ORCID: https://orcid.org/0000-0002-3779-8795
Role: Formal analysisRole: Writing – original draftRole: Writing – review & editing
Franck Zinsou Mignanwande:
ORCID: https://orcid.org/0000-0002-9965-3989
Role: Formal analysisRole: Writing – original draftRole: Writing – review & editing
Parfait Djossou:
ORCID: https://orcid.org/0000-0003-2657-9543
Role: Writing – original draftRole: Writing – review & editing
Brunelle Vanessa Yemadje: Role: Writing – original draft
Flora Sylvie Houndjrebo: Role: Writing – original draft
Jeanne d’Arc Natacha Lessanh Arrawo: Role: Formal analysisRole: Writing – original draftRole: Writing – review & editing
Yvette Faihoun: Role: Writing – original draftRole: Writing – review & editing
Harvey Johnson: Role: Writing – original draft
Ghislain Emmanuel Sopoh:
ORCID: https://orcid.org/0000-0003-1237-1047
Role: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draftRole:
Writing – review & editing
Jean Gabin Houezo: Role: ValidationRole: Visualization
Mamadou Kaloga: Role: ValidationRole: Visualization
Agui Sylvestre Dizoe: Role: ValidationRole: Visualization
Mark Nichter:
ORCID: https://orcid.org/0000-0002-4112-3010
Role: ConceptualizationRole: MethodologyRole: ValidationRole: VisualizationRole: Writing
– review & editing
Anna Gine-March:
ORCID: https://orcid.org/0000-0002-1348-2905
Role: ValidationRole: Visualization
Roch Christian Johnson: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole:
MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole:
VisualizationRole: Writing – original draftRole: Writing – review & editing
Lydia Mosi: Role: Editor
Journal
Journal ID (nlm-ta): PLOS Glob Public Health
Journal ID (iso-abbrev): PLOS Glob Public Health
Journal ID (publisher-id): plos
Title:
PLOS Global Public Health
Publisher:
Public Library of Science
(San Francisco, CA USA
)
ISSN
(Electronic):
2767-3375
Publication date
(Electronic):
27
December
2024
Publication date Collection: 2024
Volume: 4
Issue: 12
Electronic Location Identifier: e0004104
Affiliations
[1
]
Centre Interfacultaire de Formation et de Recherche en Environnement pour le développement
Durable, Université d’Abomey-Calavi, Abomey-Calavi, Benin
[2
]
Institut des Sciences Anthropologiques de Développement, Université Félix Houphouet
Boigny de Cocody, Abidjan, Côte d’Ivoire
Author notes
Author information
Yévèdo Borel Tossou
https://orcid.org/0009-0009-9533-898X
Vignon Bedie
https://orcid.org/0000-0003-3121-9550
Sèdjro Gimatal Esaï Anagonou
https://orcid.org/0000-0002-3779-8795
Franck Zinsou Mignanwande
https://orcid.org/0000-0002-9965-3989
Parfait Djossou
https://orcid.org/0000-0003-2657-9543
Ghislain Emmanuel Sopoh
https://orcid.org/0000-0003-1237-1047
Mark Nichter
https://orcid.org/0000-0002-4112-3010
Anna Gine-March
https://orcid.org/0000-0002-1348-2905
Article
Publisher ID: PGPH-D-24-00763DOI: 10.1371/journal.pgph.0004104
PMC ID: 11676828
PubMed ID: 39729418
SO-VID: c00d6c45-b5d2-473c-827e-52bfea68e834
License:
This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
History
Date
received
: 3
May
2024
Date
accepted
: 28
November
2024
Page count
Figures: 0,
Tables: 4,
Pages: 23
Funding
Funded by:
Fondation Anesvad, Bilbao, Spain
Award Recipient
:
Roch Christian Johnson
Funded by:
funder-id http://dx.doi.org/10.13039/501100019122, Fondation Raoul Follereau;
Award Recipient
:
Roch Christian Johnson
This work was supported by the Fondation Raoul Follereau (FRF;
http://www.raoul-follereau.org) and the Fondation ANESVAD (
http://www.anesvad.org/fr/) to YBT; PHB; FNCG; VB; SIEA; FAG; KJK; SGEA; FZM; PD; BVY; FSH; JANLA; YF; HJ; GES;
JGH; MK; ASD; MN; RCJ. The funders had no role in study design, data collection and
analysis, decision to publish, or preparation of the manuscript.
Categories
Subject:
Research Article
Subject:
Medicine and Health Sciences
Subject:
Medical Conditions
Subject:
Disabilities
Subject:
People and Places
Subject:
Population Groupings
Subject:
Professions
Subject:
Social Sciences
Subject:
Sociology
Subject:
Education
Subject:
Schools
Subject:
Medicine and Health Sciences
Subject:
Medical Conditions
Subject:
Tropical Diseases
Subject:
Neglected Tropical Diseases
Subject:
Medicine and Health Sciences
Subject:
Medical Conditions
Subject:
Infectious Diseases
Subject:
Bacterial Diseases
Subject:
Buruli Ulcer
Subject:
Medicine and Health Sciences
Subject:
Medical Conditions
Subject:
Tropical Diseases
Subject:
Neglected Tropical Diseases
Subject:
Buruli Ulcer
Subject:
People and Places
Subject:
Geographical Locations
Subject:
Africa
Subject:
Benin
Subject:
Social Sciences
Subject:
Sociology
Subject:
Human Families
Subject:
Social Sciences
Subject:
Sociology
Subject:
Education
Subject:
Educational Attainment
Custom metadata
Data Availability The main data contributing to this manuscript are freely available and accessible
on the website of National Program of Burili Ulcer and Leprosy of Benin:
https://www.pnllub.org/documentheque/.
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