Background
Methods
The study area
The study sample and sampling strategy
The explanatory model interview catalogue interview
Data Management and analysis
Ethical considerations
Results
Sample characteristics
Demographic Characteristics | Pre-ulcer N = 15 | Ulcer N = 166 | Total N = 181 |
---|---|---|---|
N (%) | N (%) | N (%) | |
Sex
| |||
Males | 7 (46.7) | 80 (48.2) | 87 (48.1) |
Females | 8 (53.3) | 86 (51.2) | 94 (51.9) |
Age of respondents
| |||
Minimum age | 6 | 3 | 3 |
Maximum age | 64 | 87 | 87 |
Mean age | 19 | 22.8 | 22.46 |
Standard deviation | 14.9 | 18.3 | 18.07 |
Education
| |||
No education | 3 (20.0) | 39 (23.5) | 42 (23.2) |
Primary | 8 (53.3) | 90 (54.2) | 98 (54.1) |
Secondary and above | 4 (26.7) | 37 (22.3) | 41 (22.7) |
Occupation
| |||
Pupil/student | 11 (73.3) | 89 (53.6) | 100 (55.2) |
Unskilled labourer | 3 (20.0) | 44 (26.5) | 47 (26.0) |
Skilled labourer/Professional | 1 (6.7) | 12 (7.2) | 13 (7.2) |
Unemployed | 0 | 14 (8.4) | 14 (7.7) |
Other (too young to be either employed or in school) | 0 | 7 (4.2) | 7 (3.9) |
Income
| |||
Regular and dependable | 5 (33.3) | 29 (17.3) | 34 (18.8) |
Uncertain/ Cannot tell | 4 (26.7 | 65 (39.2) | 78 (43.1) |
Irregular | 6 (40.0) | 72 (43.4) | 69 (38.1) |
Marital status
| |||
Never married | 11 (73.3) | 114 (68.7) | 125 (69.0) |
Married | 4 (26.7) | 38 (22.9) | 42 (23.2) |
Separated / divorced | 0 | 5 (3.0) | 5 (2.8) |
Widowed | 0 | 9 (5.4) | 9 (5.0) |
Burden of BU and impact on family well-being
Illness impact | Pre-ulcers, N = 15 | Ulcers, N = 166 | |||||
---|---|---|---|---|---|---|---|
Total % | Spon. % | Mean Prominence | Total % | Spon. % | Mean Prominence | P-values | |
Loss of income | 33.3 | 13.3 | 0.47 | 80.1 | 60.8 | 1.41 | *** |
Sadness, anxiety and worry | 60.0 | 6.7 | 0.67 | 71.7 | 28.9 | 1.01 | |
Concern about course of illness | 66.7 | 26.7 | 0.93 | 81.9 | 35.5 | 1.17 | |
Miss work for care-taking | 26.7 | 0.0 | 0.27 | 85.5 | 54.2 | 1.40 | *** |
None | 26.7 | 20.0 | 0.47 | 1.2 | 1.2 | 0.02 | *** |
Left the family without support | 6.7 | 6.7 | 0.13 | 1.8 | 1.8 | 0.04 |
Gender dimensions of BU-burden and care
Patterns of distress
Categories of distress | Pre-ulcers, N = 15 | Ulcers, N = 166 | |||||||
---|---|---|---|---|---|---|---|---|---|
Total % | Spon. % | Most important % | Mean Prominence | Total % | Spon. % | Most important % | Mean Prominence | P-values | |
Physical problems | 80.0 | 60.0 | 13.3 | 1.80 | 98.2 | 94.6 | 46.4 | 3.32 | *** |
Fever | 26.7 | 13.3 | 0.0 | 0.40 | 28.9 | 9.6 | 0.6 | 0.40 | |
Pain | 66.7 | 46.7 | 6.7 | 1.33 | 86.8 | 72.3 | 14.5 | 2.02 | * |
Smell | 6.7 | 0.0 | 0.0 | 0.07 | 66.3 | 14.5 | 1.2 | 0.84 | *** |
Weight loss | 13.3 | 0.0 | 0.0 | 0.13 | 56.6 | 18.7 | 0.6 | 0.77 | *** |
Loss of appetite | 20.0 | 0.0 | 0.0 | 0.20 | 43.4 | 9.0 | 0.0 | 0.52 | |
Weakness | 26.7 | 6.7 | 0.0 | 0.33 | 37.4 | 8.4 | 0.0 | 0.46 | |
Problems with mobility and use of affected limbs | 40.0 | 13.3 | 6.7 | 0.73 | 83.1 | 68.7 | 29.5 | 2.40 | *** |
Condition is ugly | 13.3 | 6.7 | 0.0 | 0.20 | 41.6 | 3.6 | 0.0 | 0.45 | * |
Social problems
|
40.0
|
26.7
|
40.0
|
1.87
|
89.2
|
67.5
|
36.1
|
2.65
| * |
Rejection from family | 0.0 | 0.0 | 0.0 | 0.00 | 19.3 | 2.4 | 0.0 | 0.22 | |
Rejection by friends / peers | 6.7 | 0.0 | 0.0 | 0.07 | 22.9 | 3.6 | 0.0 | 0.27 | |
Disrupted education | 33.3 | 20.0 | 33.3 | 1.53 | 56.6 | 45.2 | 26.5 | 1.81 | |
Loss of income | 6.7 | 6.7 | 6.7 | 0.33 | 38.0 | 22.3 | 9.6 | 0.89 | * |
Psychological /emotional
|
86.7
|
20.0
|
46.7
|
2.47
|
78.9
|
28.9
|
16.3
|
1.57
| |
Anxiety | 66.7 | 13.3 | 33.3 | 1.80 | 61.5 | 15.1 | 9.6 | 1.05 | |
Fear of surgery | 20.0 | 0.0 | 0.0 | 0.20 | 18.7 | 3.6 | 1.8 | 0.28 | |
Embarrassed about condition | 20.0 | 6.7 | 13.3 | 0.67 | 49.4 | 12.7 | 4.2 | 0.75 | |
Miscellaneous
|
0.0
|
0.0
|
0.0
|
0.00
|
12.7
|
12.7
|
1.2
|
0.29
| |
Disrupted life and sleeplessness | 0.0 | 0.0 | 0.0 | 0.00 | 12.7 | 12.7 | 1.2 | 0.29 |
Perceived causes
Perceived causes | Pre-ulcers, N = 15 | Ulcers, N = 166 | |||||||
---|---|---|---|---|---|---|---|---|---|
Total % | Spon. % | Most important % | Mean Prominence | Total % | Spon.% | Most important % | Mean Prominence | P-values | |
Ingestion | 53.3 | 26.7 | 6.7 | 1.00 | 33.7 | 11.5 | 4.2 | 0.58 | |
Drinking unclean water | 53.3 | 26.7 | 6.7 | 1.00 | 33.7 | 11.5 | 4.2 | 0.58 | |
Illness/ Injury
|
20.0
|
0.0
|
0.0
|
0.20
|
44.0
|
27.1
|
9.0
|
0.98
| * |
Prone to illness | 13.3 | 0.0 | 0.0 | 0.13 | 13.9 | 4.8 | 0.6 | 0.20 | |
Insect bites | 13.3 | 0.0 | 0.0 | 0.13 | 7.2 | 2.4 | 0.6 | 0.11 | |
Scratches on skin | 13.3 | 0.0 | 0.0 | 0.13 | 14.5 | 7.2 | 1.8 | 0.27 | |
Weakness of blood | 20.0 | 0.0 | 0.0 | 0.20 | 38.6 | 24.1 | 6.0 | 0.81 | |
Environmental
|
40.0
|
6.7
|
0.0
|
0.47
|
34.3
|
15.7
|
4.2
|
0.63
| |
Poor sanitation | 40.0 | 0.0 | 0.0 | 0.40 | 27.7 | 10.2 | 1.2 | 0.42 | |
Poor personal hygiene | 26.7 | 0.0 | 0.0 | 0.27 | 21.1 | 5.4 | 2.4 | 0.34 | |
Exposure to sand | 20.0 | 6.7 | 0.0 | 0.27 | 23.5 | 7.8 | 0.6 | 0.33 | |
Behaviour
|
60.0
|
40.0
|
53.3
|
2.60
|
48.2
|
28.9
|
18.1
|
1.31
| |
Swimming in ponds and rivers | 60.0 | 40.0 | 53.3 | 2.60 | 43.4 | 25.9 | 18.1 | 1.23 | * |
Contact with animals | 6.7 | 6.7 | 0.0 | 0.13 | 9.0 | 3.0 | 0.0 | 0.12 | |
Spiritual
|
20.0
|
6.7
|
0.0
|
0.27
|
64.5
|
51.2
|
39.7
|
2.35
| ** |
Witchcraft | 20.0 | 6.7 | 0.0 | 0.27 | 64.5 | 51.2 | 39.7 | 2.35 | ** |
Miscellaneous
|
46.7
|
46.7
|
40.0
|
2.13
|
31.9
|
31.9
|
24.7
|
1.38
| |
Cuts, abrasions, unexplained swelling of limbs | 13.3 | 13.3 | 13.3 | 0.67 | 8.4 | 8.4 | 6.6 | 0.37 | |
Cannot say/ uncertain | 33.3 | 33.3 | 26.7 | 1.47 | 24.1 | 24.1 | 18.1 | 1.02 |
Discussions
Study limitations and implications
Background characteristics of respondent | Narrative | Procedure adopted |
---|---|---|
Father of 12-year-old female child | A herbalist cut the boil open and placed a herbal dressing on it. | Nodule was cut |
Father of 4-year-old male child | We took him (son) to see his grandfather who cut the boil and it became a sore. His grandfather has been cutting other people’s boils that is why we took him to see him. | Nodule was cut |
Father of 4- year-old male child | The boil became big and we cut it open and placed some herbal preparations on it. | Nodule was cut |
A 13-year-old male respondent | My uncle used a sharp object to cut the boil so that the blood could come out. Then he applied some black powder and put some in alcohol for me to drink. | Nodule was cut |
A 26-year-old female respondent | I burst the boil because I did not know what it was and then I cleaned the sore everyday with hot water. | Nodule was cut |
A 48-year-old adult male respondent | My father put some herbs on the boil to open it up. | Herbs applied to the boil to open it up |
An 18-year-old female respondent | My grandmother ground herbs mixed with salt and placed it on the boil so that it could burst. | Herbs applied to the boil to open it up |
A 43-year-old female respondent | I had a swelling on my ankle for one week. My husband slit it and then it gradually became a big sore. | Oedema cut open |