Reducing stigma and discrimination associated with COVID-19: early stage pandemic rapid review and practical recommendations.

AIMS: To develop recommendations for strategies and interventions to reduce stigma and discrimination related to coronavirus disease 2019 (COVID-19), through reviewing and synthesising evidence in relation to COVID-19 and other disease outbreaks and infectious/stigmatised conditions from systematic reviews and primary studies and recommendations from additional materials. METHODS: Rapid review, drawing on the World Health Organization's (WHO) methodology for developing interim guidelines during health emergencies. PubMed/MEDLINE, PsycINFO, Cochrane Central and Campbell Collaboration searched up to mid-April 2020. Searches were supplemented by reference-searching and expert recommendations. Searches were designed to identify: (1) systematic reviews (<10 years), or (2) primary intervention studies (no date limit) reporting evidence on anti-stigma interventions (in relation to COVID-19 or other infectious/stigmatised conditions) or (3) additional relevant materials. Data were extracted on population, intervention, outcome and results. These data were compiled into evidence summary tables and narrative overviews. Recommendations on strategies for COVID-19 stigma-reduction were developed using the WHO 'Evidence to Decision' framework approach. The review protocol was registered with PROSPERO (registration ID: CRD42020177677). RESULTS: The searches identified a total of 4150 potentially relevant records, from which 12 systematic reviews and 29 additional articles were included. Overarching considerations and specific recommendations focus on: (1) language/words used in relation to COVID-19 and affected people; (2) media/journalistic practices; (3) public health interventions; (4) targeted public health interventions for key groups and (5) involving communities and key stakeholders. CONCLUSIONS: These recommendations represent the first consolidated evidence-based guidance on stigma and discrimination reduction in relation to COVID-19. Mitigating the impact of stigma is critical in reducing distress and negative experiences, and strengthening communities' resolve to work together during exceptional circumstances. Ultimately, reducing stigma helps addressing structural inequalities that drive marginalisation and exacerbate both health risks and the impact of stigma. Administrations and decision makers are urged to consider integrating these recommendations into the ongoing COVID-19 response.

Treatment outcome and impact of leprosy elimination campaign in Sokoto and Zamfara states, Nigeria.

A Leprosy Elimination Campaign (LEC) was implemented in 37 districts of Sokoto and Zamfara states, Nigeria from 13 August to 30 November 1998. The campaign utilized intensive community mobilization and training of local health personnel to detect hidden leprosy cases. During 8 weeks of case finding, 160,127 persons were screened; 353 new cases of leprosy were detected and placed on MDT; 236 (67%) of new cases detected were classified as MB, 64 cases (18%) suffered visible deformities and 24 patients (6.8%) were children. Follow-up in December 1999 of patients placed on MDT revealed 97% PB and 96% MB cure rates, respectively. Detection of cases in communities led some community leaders to ask for repeat surveys in their communities. Repeat surveys continue to yield new cases. The authors recommend that LECs be maintained for 3 years to accelerate leprosy elimination in the region. The cost effectiveness and impact of LEC in Sokoto-Zamfara are discussed.

Results of a 1 year Special Action Project for the Elimination of Leprosy (SAPEL) in poorly accessible areas of Akwa Ibom State, Nigeria.

This article reports the outcome of a Special Action Project for the Elimination of Leprosy (SAPEL), including the implementation of multidrug therapy (MDT) in difficult situations in Akwa Ibom State in Nigeria. Twenty-two fishing villages and five communities in areas of gully erosion participated in the project from August 1996 to September 1997. Seven new cases were detected and treated with MDT. Twenty-one out of 22 defaulters examined resided in the mainland part of the project area and not in the fishing villages. Considerable difficulties were encountered with regard to the exorbitant cost of transport, physical attacks on the teams and the lack of reliable information on population figures for the project area. The discussion includes attention to the cost-effectiveness of the SAPEL approach under the conditions described and the need to develop better monitoring of treatment and community participation in poorly accessible areas.

Seizures following chloroquine treatment of type II lepra reaction: a case report.

A case of tonic-clonic seizures following chloroquine treatment for leprosy reactions in a Nigerian male is reported. Seizures were controlled with phenytoin sodium capsules. A casual relationship between the seizures and chloroquine is suggested. There have been no previous reports of this adverse reaction in leprosy patients receiving chloroquine for treatment of reactions. The author recommends that chloroquine be used with caution especially in patients with seizures.