Risk factors of perceived stigma in leprosy affected persons and unaffected community persons in Western Nepal

Abstract

Background: Stigma is a social process of interpretation of an attribute. Leprosy has been seen as the epitome of stigmatization. The psychosocial impact a person has to bear in a society after the diagnosis weighs heavier than the physical afflictions it causes which does not get cured with the mere medical treatment. There are various factors which construct the perception of stigma in both leprosy affected persons and unaffected persons. The main purpose of this study was to determine the level of perceived stigma and the risk factors contributing to it among leprosy affected person attending the Green Pastures Hospital and the community members living in the same community of ward 15, Pokhara municipality. Methods: Cross-sectional study was conducted among 135 people affected by leprosy in Green Pastures Hospital and Rehabilitation Centre and 281 leprosy unaffected community persons above the age of 18 were studied. 2 sets of questionnaire form with additional Explanatory Model Interview Catalogue (EMIC) for each group were used in both affected and unaffected persons. Results: Among 135 leprosy affected persons, the median score of perceived stigma was 10 while it ranged from 0 to 34. Concerning their baseline characteristics, the higher perceived stigma score was found in (54.8%) illiterate (p=0.008), persons who (66.7%) felt economic inadequacy (p=0.014) and who (46.7%) changed their occupation due to leprosy (p=0.018). Similarly, lack of knowledge on information (p=0.025), leprosy cause (p=0.02) and transmission (p=0.046) followed by perception that difficulty to treat (p=0.001) and severe disease (p=0.001) had higher perceived stigma score. Presence of disfigurement (p=0.014) and ulcer (p=0.022) had higher perceived stigma score. Among 281 community members, the median score of perceived stigma was 12 while it ranged from 0-30. Ethnic group, Brahmin (15.7%) and Dalits (18.5%) had higher perceived stigma compared to the rest (p=0.001), community members living at the distance more than 2km (27.4%) had higher stigma compared to living closer to the hospital (p=0.019) and nuclear family (33.1%) had higher perceived stigma than joint family (p=0.014). Lack of information on leprosy (49.8%) had higher perceived stigma (p=0.002) followed by perception that difficulty treatment (p<0.001) and severe disease (p<0.001) had higher perceived stigma. Conclusion: Stigma in leprosy was found highly associated with the lack of knowledge and their perception regarding leprosy. Stigma reduction strategies should focus on health education, targeting to alleviate their perception about the disease with their active participation.