02444nas a2200325   4500000000100000008004100001260001200042653002500054653001800079653002000097653001400117653002700131653002300158653001500181653001400196653001200210653001100222100001400233700001700247700001600264700001500280700001800295700001100313245013700324856013300461300000900594490000600603520149500609022001402104       2024                            d  bMDPI AG10aLymphatic filariasis10aMental Health10aMental distress10aSelf-care10aLymphoedema management10aDisease Management10aDisability10aInclusion10aPoverty10aGender1 aBarrett C1 aChiphwanya J1 aMatipula DE1 aDouglass J1 aKelly-Hope LA1 aDean L00aAddressing the Syndemic Relationship between Lymphatic Filariasis and Mental Distress in Malawi: The Potential of Enhanced Self-Care  uhttps://mdpi-res.com/d_attachment/tropicalmed/tropicalmed-09-00172/article_deploy/tropicalmed-09-00172-v2.pdf?version=1722491792  a1-230 v93 a<jats:p>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.</jats:p>  a2414-6366