淋巴丝虫病(LF)引起毁容和致残性淋巴水肿,这可能导致精神困扰,需要终身自我护理治疗。本研究应用共病理论来了解马拉维的LF与精神困扰之间的生物社会关系。采用深入的定性方法,我们通过21个生活史访谈批判性地评估精神困扰和LF的经历,从受LF影响的人的角度讲述经历,并了解增强自我护理(ESC)的淋巴水肿管理如何破坏联合关系。对卫生部LF计划工作人员进行了补充关键线人访谈,以进一步了解干预措施和卫生系统的提供。所有采访都被记录下来,转录,翻译,然后进行主题分析。我们的研究结果表明,对于马拉维受LF影响的人来说,在接受ESC培训之前,缺乏转诊途径,医疗保健提供或可用治疗方面的不平等,对病情(LF)的知识有限,导致了LF和精神困扰的联合。耻辱和社会排斥往往加剧了痛苦,由性别的交集塑造,代,贫穷,和极端的气候条件。我们认为,通过以受影响者的需求为中心的干预措施来解决与LF和精神困扰相关的联合痛苦对于有效和公平的LF护理至关重要。
Lymphatic filariasis (LF) causes disfiguring and disabling lymphoedema, which can lead to mental distress and requires life-long self-care treatment. This study applies syndemic theory to understand the biosocial relationship between LF and mental distress in Malawi. Using in-depth qualitative methods, we critically evaluate experiences of mental distress and LF through 21 life-history interviews, to narrate experiences from the perspective of persons affected by LF, and to understand how enhanced self-care (ESC) for lymphoedema management disrupts the syndemic relationship. Complementary key informant interviews with Ministry of Health LF programme staff were conducted to further understand intervention and health system delivery. All interviews were recorded, transcribed, and translated, and then subject to thematic analysis. Our findings suggest that for persons affected by LF in Malawi, before being trained in ESC, absent referral pathways, inequalities in healthcare provision or available treatment, and limited knowledge of the condition (LF) drove the syndemic of LF and mental distress. Distress was often exacerbated by stigma and social exclusion, and shaped by intersections of gender, generation, poverty, and extreme climate conditions. We argue that addressing the syndemic suffering associated with LF and mental distress through interventions which center the needs of persons affected is critical in effective and equitable LF care delivery.