Leprosy in an endemic focus in the Sudan

Abstract

Objectives: The objectives of this study were active case detection, provision of multidrug treatment in primary health care settings and evaluation of the accuracy of the clinical system of classification that was adopted by the Leprosy Control Program of Sudan. Design: The whole population of two villages in a remote area in eastern Sudan were examined initially and then followed up for three years in this prospective study. Patients from the surrounding villages, who were self reporting were also included in the study. Setting: The study was conducted in a primary health care setting, which was the only available form of health care facility in the study area. Subjects: Communal consent was obtained following explanation and discussion with the Sheikhs. The population of the two villages were interviewed and examined clinically with particular reference to skin lesions. Informed consents to participate in the study were obtained from individuals with skin lesions. Interventions: Skin biopsies were taken under local anaesthesia and aseptic conditions from suspicious lesions. Multi-drug therapy regimen (MDT) was given to those with proven disease. Out come measures: Response was measured by improvement in skin lesions and sensations every six months. Results: Compliance was around 90 %. According to the clinical classification 68.4% and 31.6% of the patients were multi-bacillary and pauci-bacillary respectively. There was 100 % agreement between the clinical classification and Ridley & Jopling classification where all Tuberculoid (TT) patients were correctly diagnosed as pauci-bacillary and borderline Lepromatous (BL) and Lepromatous (LL) patients were correctly diagnosed as multibacillary. Seventy BT patients were misclassified as multi-bacillary disease. Conclusions: The clinical classification is adequate for the diagnosis and treatment of leprosy patients in remote areas of eastern Sudan. Sudanese Journal of Dermatology Vol. 3(2) 2005: 73-79