Strengthening access to people-centred mental healthcare for people affected by skin neglected tropical diseases in Nigeria: a pilot study.
Neglected tropical diseases (NTDs) contribute to the global burden of mental health conditions, largely mediated through mechanisms of stigma and social exclusion. Within this group, skin NTDs are particularly prominent, as visible deformities often drive stigma reinforced by cultural myths, fear of contagion, social isolation, and associated poverty. The WHO recommends a collaborative cross-sectoral approach in its NTD Road Map 2021-30, integrating care for people with NTDs. This study was conducted as a pilot to assess the feasibility, acceptability, and impact of a person-centred intervention care package on mental health outcomes and stigma among people with skin NTDs in Nigeria.
This quasi-experimental mixed-methods study, with a before-and-after design, was conducted from August 2023 to June 2025 in five local government areas in Nigeria among people with skin NTDs (leprosy, lymphatic filariasis, and Buruli ulcer) using a convenience sampling technique. Depression, anxiety, and well-being were assessed before and after implementation of a package of person-centred care interventions. In addition, 10 focus group discussions were conducted among people with skin NTDs, along with 21 key informant interviews with healthcare workers and relevant stakeholders to explore the feasibility of scaling up interventions.
At baseline, 456 people with skin NTDs were enrolled [37.9% female; median age 45 (IQR 25-80) years], of whom 315 were followed up at endline providing paired data. The proportion screening positive for depression decreased from 213/315 (67.6%) to 88/315 (27.9%), and anxiety from 201/315 (63.8%) to 56/315 (17.8%). Well-being improved, with 156/315 (49.5%) reporting good well-being at baseline compared with 193/315 (61.3%) at endline. Additionally, a package of interventions-including capacity building for health workers, referral systems, peer support groups, livelihood support activities, and anti-stigma campaigns-was feasible, acceptable, and well integrated into existing contexts, with perceived improvements in mental health outcomes and stigma.
This pilot study suggests that the person-centred care package is feasible and acceptable in this low-resourced setting in Nigeria and is associated with improvements in mental health outcomes and stigma among people with skin NTDs in Nigeria.
This quasi-experimental mixed-methods study, with a before-and-after design, was conducted from August 2023 to June 2025 in five local government areas in Nigeria among people with skin NTDs (leprosy, lymphatic filariasis, and Buruli ulcer) using a convenience sampling technique. Depression, anxiety, and well-being were assessed before and after implementation of a package of person-centred care interventions. In addition, 10 focus group discussions were conducted among people with skin NTDs, along with 21 key informant interviews with healthcare workers and relevant stakeholders to explore the feasibility of scaling up interventions.
At baseline, 456 people with skin NTDs were enrolled [37.9% female; median age 45 (IQR 25-80) years], of whom 315 were followed up at endline providing paired data. The proportion screening positive for depression decreased from 213/315 (67.6%) to 88/315 (27.9%), and anxiety from 201/315 (63.8%) to 56/315 (17.8%). Well-being improved, with 156/315 (49.5%) reporting good well-being at baseline compared with 193/315 (61.3%) at endline. Additionally, a package of interventions-including capacity building for health workers, referral systems, peer support groups, livelihood support activities, and anti-stigma campaigns-was feasible, acceptable, and well integrated into existing contexts, with perceived improvements in mental health outcomes and stigma.
This pilot study suggests that the person-centred care package is feasible and acceptable in this low-resourced setting in Nigeria and is associated with improvements in mental health outcomes and stigma among people with skin NTDs in Nigeria.
Authors
Afolaranmi Afolaranmi, Dogo Dogo, Akinnusi Akinnusi, Gofung Gofung, Ojo Ojo, Afolayan Afolayan, Pali Pali, Danfulani Danfulani, Ugwu Ugwu, Nwafor Nwafor, Bestman Bestman, Emma-Joseph Emma-Joseph, Ogbu Ogbu, Ibrahim Ibrahim, Ode Ode, Musa Musa, Cleobas Cleobas, Unam Unam, Ogunleye Ogunleye, Duru Duru, Abu Abu, Jimenez Jimenez, Giné-March Giné-March, Pozzati Pozzati, Iorkighir Iorkighir, Kumaga Kumaga, Onyima Onyima, Obindo Obindo, Eaton Eaton
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