Stigma is seen in several NTDs, particularly Buruli ulcer, Chagas disease, leprosy, lymphatic filariasis, onchocerciasis, and podoconiosis. Three types of stigma can be distinguished in the literature. These include enacted (i.e. actual experience of discrimination by the affected person), anticipated (ie anticipation on the actual, enacted stigma), and internalized stigma (ie acceptance of the societal discrimination by the affected person, self-stigmatization). Reasons for stigmatization are appearance, inability to fulfill gender role, fear of contagion, being a (financial) burden to family and society, promiscuity, believed heredity aspect and cursed or witchcraft.
To overcome the NTD-related stigmatization, health education for both patients and the community, and disease management focusing on the psychological impact of NTDs are successful measures against stigmatization. Personal support (ie rehabilitation, counseling and support groups) is effectively used in relation to leprosy and lymphatic filariasis only. Since much work has been done on reducing leprosy-related stigmatization, including personal support in the approach to reduce NTD-related stigma will result in improved self-esteem and increased participation and community acceptance/support.
Assessing the nature of stigma is vital to prevent disabilities and reduce stigma. Instruments to measure stigma can be used to assess the magnitude of NTD-related stigma in a community and identify which manifestations of stigma are most profound. The podoconiosis stigma scale is the first standardized measures of podoconiosis stigma. However, further research is needed to validate the scale in other contexts.