03059nas a2200361   4500000000100000008004100001260001200042653001100054653001700065653000900082653002200091100001200113700001100125700001300136700001200149700001300161700001400174700001400188700001200202700001300214700001800227700001300245700001300258700001500271700001300286700002000299245010500319856009900424300000900523490000700532520214400539022001402683       2024                            d  c04/202410aStigma10aBuruli ulcer10aYaws10acoping-strategies1 aTuwor R1 aMtuy T1 aAmoako Y1 aOwusu L1 aOppong M1 aAgbanyo A1 aAgbavor B1 aMarks M1 aWalker S1 aYeboah-Manu D1 aPullan R1 aDapaah J1 aPhillips R1 aPalmer J1 acollaboration S00aStigma experiences, effects and coping among individuals affected by Buruli ulcer and yaws in Ghana.  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0012093&type=printable  a1-190 v183 a<p><strong>Background: </strong>Stigma related to skin neglected tropical diseases like Buruli ulcer (BU) and yaws has remained underexplored and existing studies are limited to individual diseases despite the WHO call for integration in disease management. Within two districts in central Ghana, we explored stigma associated with BU and yaws to understand overlaps and disease-specific nuances to help guide integrated interventions.</p>

<p><strong>Methodology/Principal Findings: </strong>In-depth interviews were conducted with 31 current or formerly affected individuals to assess the experiences, effects and coping strategies adopted to manage disease related stigma. Data were analysed along broad themes based on the sociological construct of macro and micro interaction and Goffman's treatise on stigma. Disapproving community labels fueled by misconceptions were noted among BU participants which contributed to macro stigma experiences, including exclusion, discrimination and avoidance. In contrast, a high level of social acceptance was reported among yaws participants although some micro-level stigma (anticipated, felt and self-stigma) were noted by individuals with both diseases. While younger participants experienced name-calling and use of derogatory words to address affected body parts, older participants and caregivers discussed the pain of public staring. Stigma experiences had negative consequences on psychosocial well-being, schooling, and social relations, particularly for BU affected people. Problem-focused strategies including confrontation, selective disclosure and concealment as well as emotion-focused strategies (religious coping and self-isolation) were noted.</p>

<p><strong>Conclusions and Significance: </strong>The types and levels of stigma varied for BU and yaws. Stigma experiences also differed for adults and children in this setting and these differences should be accounted for in integrated interventions for these skin NTDs. School health programs need to prioritize educating school teachers about skin NTDs and the negative impact of stigma on the wellbeing of children.</p>
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