The Impact of Leprosy and Physical Disability on Marital and Sexual Relationships of Married Nepali Men

Maartje J Meis; Anna Tiny van 't Noordende; Liesbeth F Mieras; Nand Lal Banstola; Krishna P Dhakal; Dirk R Essink; Wim H van Brakel

doi:10.47985/dcidj.523

Maartje J Meis ⁽¹⁾, Anna Tiny van 't Noordende ⁽²⁾, Liesbeth F Mieras ⁽³⁾, Nand Lal Banstola ⁽⁴⁾, Krishna P Dhakal ⁽⁵⁾, Dirk R Essink ⁽⁶⁾, Wim H van Brakel ⁽⁷⁾

(1) NLR, Netherlands,

(2) NLR, Netherlands,

(3) NLR, Netherlands,

(4) NLR, Nepal, Nepal,

(5) NLR Nepal, Nepal,

(6) VU University Amsterdam, Netherlands,

(7) NLR, Netherlands

https://doi.org/10.47985/dcidj.523

Issue
Vol. 33 No. 1: (Spring) - 2022

Submitted
August 20, 2021

Published
May 15, 2022

Keywords:

Marriage, sex education, physical limitations, identity, friction, qualitative

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Abstract

Purpose: Both leprosy and disability can have a negative impact on a person’s relationships. This study aimed to gain insight into the impact of leprosy and disability on marital and sexual relationships of married Nepali men.

Method: The study used a cross-sectional design with a qualitative approach. Thirty participants were selected using purposive sampling and put in 3 groups (10 to a group):

(1) men with impairments due to leprosy, (2) men without leprosy but with physical disabilities, and (3) men without leprosy or disabilities (control group). Data was collected during semi-structured interviews and two focus group discussions, and analysed with the software programme NVivo using structured coding.

Results: The majority of the men indicated they were satisfied with their marital and sexual relationships. However, some leprosy-affected men and some men with disabilities experienced friction in their marital relationships. Fighting between husband and wife was reported by half of the men affected by leprosy. Leprosy and disability had a negative influence on the sexual relationships of some of the men, because of physical limitations, pain, or decreased sex drive. Furthermore, many participants appeared to lack knowledge about the cause of leprosy and about sexual health.

Conclusion and Implications: Men affected by leprosy or disabilities seemed to face more problems in their marital relationships than men from the control group. This was primarily related to physical limitations which resulted in the inability to work; this threatened their personal and social identity. Findings show that there may be a problem in accessibility or availability of sex education. In addition, some marital problems could be related to lack of knowledge of leprosy. These point to the importance of providing education on leprosy and sexual health at the time of diagnosis.

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Authors

Maartje J Meis

NLR

Anna Tiny van 't Noordende

NLR

https://orcid.org/0000-0002-6415-1057

a.vt.noordende@nlrinternational.org (Primary Contact)

Liesbeth F Mieras

NLR

Nand Lal Banstola

NLR, Nepal

Krishna P Dhakal

NLR Nepal

Dirk R Essink

VU University Amsterdam

Wim H van Brakel

NLR

Author Biographies

Maartje J Meis, NLR

Maartje Meis has a Bachelor's degree in Health Sciences and has specialized in International Public Health as part of her Master's. She has worked in the healthcare sector, focusing on the IT part of Health facilities. This includes implementing new IT solutions in health facilities and the development of new solutions to support healthcare professionals.

Anna Tiny van 't Noordende, NLR

Anna van ’t Noordende is a Researcher and Technical Advisor for NLR (until No Leprosy Remains). She holds a M.Sc. degree in International Public Health and a Ph.D. in Social Sciences. Her Ph.D. focused on the social and psychological impact of leprosy and leprosy-related stigma and interventions to reduce this impact at individual, family, and community levels. She has worked on several mixed-methods research projects, most of which focus on promoting inclusion and participation of persons affected by neglected tropical diseases.

Liesbeth F Mieras, NLR

Liesbeth Mieras is a medical doctor, Head Technical Department of NLR, with 20 year's experience working in public health. Working as medical doctor/medical advisor in Mozambique and Indonesia provided valuable experience in translating science into practice in the field of communicable diseases, including leprosy. She has been involved in leprosy related research projects in several endemic countries, including some large multi-country (research) projects focusing on the implementation of single-dose-rifampicin as post-exposure prophylaxis (PEP) for leprosy.

Nand Lal Banstola, NLR, Nepal

Nand Lal Banstola holds a Master’s degree, an MBA Specialization in Project Management & Public Relations Management. He has worked with NLR Nepal in leprosy control, disability inclusive development and research. Mr. Banstola is the Deputy Director of NLR Nepal. He is working towards a world free of leprosy through prevention of leprosy and disabilities, stigma reduction, mental wellbeing and social inclusion of all persons affected by Leprosy. He is also the promoter of right-based approaches and human rights perspectives.

Krishna P Dhakal, NLR Nepal

Krishna Prasad Dhakal is a Doctor of Medicine (MD), a Diploma in Dermatology and also has a Master's degree in Public Health. He started his professional journey as a general practitioner and after attaining specialization, he has devoted his life to Leprosy control including leprosy case management, as well as, programme management and research for over 30 years. After completing his work in NLR for about 20 years, he is currently working as a Consultant Dermatologist-Leprologist in one of the largest leprosy hospitals in Nepal, the Lalgad Leprosy Hospital and Services Center (LLHSC).

Dirk R Essink, VU University Amsterdam

Dr. Dirk Essink is an Assistant Professor, Global health and transdisciplinarity, at the Athena Institute, Vrije Universiteit Amsterdam, and Deputy Director of the Amsterdam Centre for World Food Studies at the same university. His background is in international public health sciences (Master degree, cum laude) and he obtained his Ph.D. in 2012 on sustainable health system innovation. Dirk has been principal investigator in many studies related to reproductive health and nutrition in various LMICs. His primary research interest lies with the integration and translation of knowledge for public health policy and strategies for scaling up intervention that are at odds with dominant system structures. His research focusses on so-called evidence informed public health policy (e.g. working out methodologies for policy dialogues aiming at integration and translation of research evidence, the development of the national research agenda for Lao PDR, and developing a framework for scaling up nutrition sensitive agriculture).

Wim H van Brakel, NLR

Wim van Brakel holds a medical degree, an M.Sc. in Infectious Disease Epidemiology and a Ph.D. in leprosy. He has worked in Nepal and India in leprosy control and research. Dr. van Brakel is a Medical Director of NLR and chairs the ILEP Technical Commission and is immediate-past chair of the NNN DMDI Cross-Cutting Group. Dr van Brakel is passionate about working towards a world free of leprosy through prevention of leprosy and disabilities, stigma reduction, mental wellbeing and social inclusion of all persons affected by NTDs.

1.

Meis MJ, van ’t Noordende AT, Mieras LF, Banstola NL, Dhakal KP, Essink DR, van Brakel WH. The Impact of Leprosy and Physical Disability on Marital and Sexual Relationships of Married Nepali Men. DCIDJ [Internet]. 2022 May 15 [cited 2024 Dec. 21];33(1):69-88. Available from: https://dcidj.uog.edu.et/index.php/up-j-dcbrid/article/view/523

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