Detection Rate Of New Cases Research Articles

Leprosy and social deprivation: Definition of priority areas in an endemic state Northeastern Brazil.

Leprosy is a disease that reserves close relation with social and economic conditions. Brazil is the only country that has not yet reached the goal of eliminating the disease as a public health problem. This study aimed to analyze social deprivation in the municipalities of Bahia and its relation with the detection of new cases of leprosy in the population. It is an ecological study conducted in the state of Bahia, from 2001 to 2015. Variables analyzed: detection rate of new cases, social deprivation index (SDI) and Hansen's disease in children under 15 years of age. The SDI was built on four variables: socioeconomic performance index, per capita income, proportion of extremely poor, and household density. For spatial analysis, local empirical bayesian modeling and global and local Moran statistics were used. Statistical analysis used multivariate, spatial and logistic regression, odds ratio calculation and analysis of variance. Leprosy showed heterogeneous distribution in the state, with concentration in the north-west and south axis. 60.4% (n = 252) of the municipalities presented very low life conditions. An association was observed between living conditions and the detection of leprosy, with higher coefficients in the municipality group with better living conditions (p < 0.001). It was concluded that the worst conditions acted as an impediment to the diagnosis, while increasing the risk of illness. Good conditions have the opposite effect.

Factors associated with leprosy in a municipality of the Pre-Amazon region, state of Maranhão, Brazil.

The Integrated Program of Leprosy Control was initiated in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy in 2003. It aims at assessing the clinical and epidemiological characteristics of the disease to reduce the detection rate of new cases until 2015. Here, we present the evolution of the indicators of leprosy within the period from 2003 to 2015. We conducted a descriptive analytical study based on the active search for and voluntary referral of cases of leprosy. The detection rate of new cases was analyzed over time. We included individuals diagnosed with leprosy between January 2003 and December 2015. The association between categorical variables was assessed using the chi-square test of independence, considering a level of significance of 5%. When the association was significant, the detection rate (with a confidence interval of 95%) was calculated. Overall, 879 new leprosy cases were detected; the majority of the affected individuals were men (65.9%). Multibacillary leprosy was the most common type of the disease, according to the operational classification (55.5%); it showed the strongest association with an age ≥60 years. We also detected an association between the male sex and both, lepromatous and multibacillary leprosy. The detection rate reduced from 211.09/100,000 population in 2003 to 50.26/100,000 population in 2015. We found an improvement in leprosy control, with a reduction in the detection rate and the absolute number of cases. Strengthening of disease control measures should be prioritized to eliminate leprosy as a public health concern in this municipality.

High detection rate of new cases of multibacillary leprosy in Mato Grosso do Sul, Brazil: an observational study from 2001-2015.

ABSTRACTLeprosy remains a public health problem in Brazil, and the Mato Grosso do Sul State (MS) had the seventh highest rate of detection of new cases in the country in 2015 (26.59 per 100,000 inhabitants) which was classified as very high. This work aimed to determine the epidemiological characteristics of leprosy in MS. Descriptive statistics were performed with data from the Information System on Diseases of Compulsory Declaration (SINAN) between 2001 and 2015, with all patients included in the system serving as the sample. Clinical forms of multibacillary (MB) leprosy predominated in MS during the study period, with a clear positive trend from 2009 to 2015 and a peak in the detection rate of new cases (NCDR) in 2014 corresponding to 40.39 per 100,000 population (p<0.001). The most affected groups were men (56.7%) aged 20–59 years (70.52%), an economically active population. We observed that Northern MS had the highest overall NCDR in the State. In cities bordering other countries, NCDRs were significantly lower than in those of other analyzed cities. There was no dependency ratio correlating NCDRs in cities with higher or lower indexes with basic care coverage (p=0.799) and human development index (p=0.887). In conclusion, the large number of patients with MB leprosy indicates that the diagnosis of leprosy is delayed in MS, perhaps due to difficulties related to diagnostic methods. This situation contributes to the continuing prevalence of leprosy in MS.

Spatial study of leprosy in Bahia, Brazil, 2001-2012: an approach based on the local empirical Bayesian model.

to compare the temporal evolution and spatial distribution of epidemiological indicators of leprosy, both crude and also corrected using the empirical Bayesian model, Bahia, Brazil, 2001-2012. this was an ecological study using data from the Notifiable Diseases Information System; all 417 municipalities in Bahia were included and the following indicators per 100,000 inhabitants were analyzed - detection rate of new cases in the general population, in those <15 years old, and in those with grade 2 physical disability -; the local empirical Bayesian model was used to smoothen the indicators, and Student's t-test was used to compare means. indicators estimated by the model were higher than crude indicators; estimated detection rates in the general population and in those <15 years old were higher than crude rates in 253 (60.7%) and 209 (50.1%) municipalities, respectively; areas of greatest risk were concentrated in the northwestern and southern regions of the state. spatial distribution of the disease was heterogeneous and there was possible underreporting of cases.

Minimum requirements and optimal testing strategies of a diagnostic test for leprosy as a tool towards zero transmission: A modeling study.

BackgroundThe availability of a diagnostic test to detect subclinical leprosy cases is crucial to interrupt the transmission of M. leprae. In this study we assessed the minimum sensitivity level of such a (hypothetical) diagnostic test and the optimal testing strategy in order to effectively reduce the new case detection rate (NCDR) of leprosy.Methods and findingsWe used the individual-based model SIMCOLEP, and based it on previous quantification using COLEP data, a cohort study of leprosy cases in Bangladesh. The baseline consisted of treatment with Multidrug therapy of clinically diagnosed leprosy cases, passive case detection and household contact tracing. We examined the use of a leprosy diagnostic test for subclinical leprosy in four strategies: testing in 1) household contacts, 2) household contacts with a 3-year follow-up, 3) a population survey with coverage 50%, and 4) a population survey (100%). For each strategy, we varied the test sensitivity between 50% and 100%. All analyses were conducted for a high, medium, and low (i.e. 25, 5 and 1 per 100,000) endemic setting over a period of 50 years.In all strategies, the use of a diagnostic test further reduces the NCDR of leprosy compared to the no test strategy. A substantial reduction could already be achieved at a test sensitivity as low as 50%. In a high endemic setting, a NCDR of 10 per 100,000 could be reached within 8–10 years in household contact testing, and 2–6 years in a population testing. Testing in a population survey could also yield the highest number of prevented new cases, but requires a large number needed to test and treat. In contrast, household contact testing has a smaller impact on the NCDR but requires a substantially lower number needed to test and treat.ConclusionsA diagnostic test for subclinical leprosy with a sensitivity of at least 50% could substantially reduce M. leprae transmission. To effectively reduce NCDR in the short run, a population survey is preferred over household contact tracing. However, this is only favorable in high endemic settings.

Chemoprophylaxis of leprosy with rifampicin in contacts of multibacillary patients: study protocol for a randomized controlled trial

BackgroundThe annual new-case detection rate for leprosy, while generally stable over the last decade, shows that transmission rates have remained stagnant despite the successful worldwide administration of multidrug therapy since the 1980s. As such, novel control strategies are urgently needed. Focusing on managing leprosy patient contacts, the most susceptible to contracting the disease, has been seen as a potential strategy in limiting the spread of leprosy as shown by a number of recent epidemiological studies. Immunoprophylaxis with Bacillus Calmette-Guérin (BCG) has been seen as an effective preventive measure due to its ability to stimulate the development of cellular immunity which is essential in controlling the disease, especially in its multibacillary (MB) forms. The association of immunoprophylaxis with chemoprophylaxis in a single dose of rifampicin has been shown to be a promising preventive strategy, although a variety of studies have found instances of early case detection just a few months after BCG vaccination.Methods/designThe present study is a phase IV chemoprophylactic clinical trial consisting of administration of a single dose of rifampicin in MB leprosy patient contacts under care at the Souza Araújo Outpatient Clinic/FIOCRUZ as part of a randomized (2:1), double-blind, placebo-controlled study. It is comprised of two groups: 1) rifampicin + BCG; and 2) placebo + BCG.DiscussionThe aim is to evaluate whether the use of chemoprophylaxis with a single dose of rifampicin in MB leprosy patient contacts prior to the BCG vaccine would be able to prevent the onset of leprosy in those cases that may occur just a few months after vaccination. Contact subclinical infections (polymerase chain reaction) and the immunological parameters (anti-PGL-1, anti-LID-1, and IFN-γ) will be evaluated and the results will be compared after 12 months of follow-up.Trial registrationThe Brazilian Registry of Clinical Trials (ReBEC), RBR-69QK5P. Retrospectively registered on 1 June 2017.

ЭФФЕКТИВНОСТЬ ВНЕДРЕНИЯ АКТИВНОГО СКРИНИНГА И БЫСТРЫХ МЕТОДОВ ВЫЯВЛЕНИЯ СЛУЧАЕВ ТУБЕРКУЛЁЗА В РЕСПУБЛИКЕ ТАДЖИКИСТАН

Objective: To study the effectiveness of using active screening in identifying people with suspected tuberculosis, as well as express methods for diagnosing patients with tuberculosis in the Republic of Tajikistan. Methods: This study included persons who applied for medical institutions to primary health care (PHC) facilities for the period from 2011 to 2015 years in Dushanbe, Tursunzade, Khujand, Kanibadam and the regions of Gonchi, Mastchoh and Rudaki, which were screened for complaints and anamnestic data. All persons suspected of having tuberculosis underwent a complete clinical, x-ray examination and sputum research by two quick methods (microscopically and on the GeneXpert device), as well as sowing culture with subsequent determination of drug resistance on the Bactec MGIT apparatus. Results: Under our observations, there were 214,434 persons with suspicion of tuberculosis, from among which it was revealed 22,349 patients with different clinical forms of tuberculosis, which amounted to 10.4%. In the observed group of men there were 13887 (62.1%), women – 8462 (37.9%). Of the total number of patients, most (n=14100) included in the age group 19-44 years (63.1%) and 8249 people (36.9%) were from the age group of 45-69 years. Of the 22,349 tuberculosis patients, 65.5% suffered pulmonary tuberculosis with bacterial excretion, 25.1% – pulmonary tuberculosis without bacterial excretion and 9.4% – extrapulmonary tuberculosis. In 7.3% of cases, multiple drug resistance was detected, and in 92 patients (0.41%) – a combination of the active form of tuberculosis with HIV infection. Comparative study of the detection rate of new cases of tuberculosis over the same period in the study regions exceeded this indicator in other representative control regions twice. The beginning of the treatment after verification of the diagnosis was 3 days. Conclusion: The introduction of active screening in institutions of PHC facilities promotes a more effective integration of the phthisiatric services with the network of institutions of PHC facilities. In the implementation of active screening in 10.4% of cases, varifies different clinical forms of the disease. Keywords: Tuberculosis, screening, express methods, PHC, integration.

Evidence of hidden leprosy in a supposedly low endemic area of Brazil

OBJECTIVESShow that hidden endemic leprosy exists in a municipality of inner São Paulo state (Brazil) with active surveillance actions based on clinical and immunological evaluations.METHODSThe study sample was composed by people randomly selected by a dermatologist during medical care in the public emergency department and by active surveillance carried out during two days at a mobile clinic. All subjects received a dermato-neurological examination and blood sampling to determine anti-PGL-I antibody titers by enzyme-linked immunosorbent assay (ELISA).RESULTSFrom July to December 2015, 24 new cases of leprosy were diagnosed; all were classified as multibacillary (MB) leprosy, one with severe Lucio's phenomenon. Seventeen (75%) were found with grade-1 or 2 disability at the moment of diagnosis. Anti-PGL-I titer was positive in 31/133 (23.3%) individuals, only 6/24 (25%) were positive in newly diagnosed leprosy cases.CONCLUSIONSDuring the last ten years before this study, the average new case detection rate (NCDR) in this town was 2.62/100,000 population. After our work, the NCDR was raised to 42.8/100,000. These results indicate a very high number of hidden leprosy cases in this supposedly low endemic area of Brazil.

Forecasting the new case detection rate of leprosy in four states of Brazil: A comparison of modelling approaches

BackgroundBrazil has the second highest annual number of new leprosy cases. The aim of this study is to formally compare predictions of future new case detection rate (NCDR) trends and the annual probability of NCDR falling below 10/100,000 of four different modelling approaches in four states of Brazil: Rio Grande do Norte, Amazonas, Ceará, Tocantins. MethodsA linear mixed model, a back-calculation approach, a deterministic compartmental model and an individual-based model were used. All models were fitted to leprosy data obtained from the Brazilian national database (SINAN). First, models were fitted to the data up to 2011, and predictions were made for NCDR for 2012–2014. Second, data up to 2014 were considered and forecasts of NCDR were generated for each year from 2015 to 2040. The resulting distributions of NCDR and the probability of NCDR being below 10/100,000 of the population for each year were then compared between approaches. ResultsEach model performed well in model fitting and the short-term forecasting of future NCDR. Long-term forecasting of NCDR and the probability of NCDR falling below 10/100,000 differed between models. All agree that the trend of NCDR will continue to decrease in all states until 2040. Reaching a NCDR of less than 10/100,000 by 2020 was only likely in Rio Grande do Norte. Prediction until 2040 showed that the target was also achieved in Amazonas, while in Ceará and Tocantins the NCDR most likely remain (far) above 10/100,000. ConclusionsAll models agree that, while incidence is likely to decline, achieving a NCDR below 10/100,000 by 2020 is unlikely in some states. Long-term prediction showed a downward trend with more variation between models, but highlights the need for further control measures to reduce the incidence of new infections if leprosy is to be eliminated.

Leprosy New Case Detection Trends and the Future Effect of Preventive Interventions in Pará State, Brazil: A Modelling Study.

BackgroundLeprosy remains a public health problem in Brazil. Although the overall number of new cases is declining, there are still areas with a high disease burden, such as Pará State in the north of the country. We aim to predict future trends in new case detection rate (NCDR) and explore the potential impact of contact tracing and chemoprophylaxis on NCDR in Pará State.MethodsWe used SIMCOLEP, an existing individual-based model for the transmission and control of M. leprae, in a population structured by households. The model was quantified to simulate the population and observed NCDR of leprosy in Pará State for the period 1990 to 2014. The baseline scenario was the current control program, consisting of multidrug therapy, passive case detection, and active case detection from 2003 onwards. Future projections of the NCDR were made until 2050 given the continuation of the current control program (i.e. baseline). We further investigated the potential impact of two scenarios for future control of leprosy: 1) discontinuation of contact tracing; and 2) continuation of current control in combination with chemoprophylaxis. Both scenarios started in 2015 and were projected until 2050.ResultsThe modelled NCDR in Pará State after 2014 shows a continuous downward trend, reaching the official elimination target of 10 cases per 100,000 population by 2030. The cessation of systematic contact tracing would not result in a higher NCDR in the long run. Systematic contact tracing in combination with chemoprophylaxis for contacts would reduce the NCDR by 40% and bring attainment of the elimination target two years forward to 2028.ConclusionThe NCDR of leprosy continues to decrease in Pará State. Elimination of leprosy as a public health problem could possibly be achieved around 2030, if the current control program is maintained. Providing chemoprophylaxis would decrease the NCDR further and would bring elimination forward by two years.

Evaluation of National Leprosy Eradication Program after Integration into General Health System in Rajkot District, Gujarat from 2003 to 2014.

Background:National Leprosy Eradication Program (NLEP) was launched in 1983 with the goal of elimination of leprosy as a public health problem.Aim:To evaluate the NLEP performance after integration into general health system from April 2003 to March 2014.Material and Methods:A retrospective record based study was conducted by obtaining data from Rajkot district leprosy center. Prevalence rate (PR), new case detection rate (NCDR), proportion of female cases, child cases, multibacillary (MB) cases, Grade II disability among new cases and release from treatment (RFT) cases were evaluated from April 2003 to March 2014 and analyzed by using Chi-square for trend analysis test.Results:The PR of leprosy per 10,000 populations was significantly declined (P < 0.001) from 0.44 in 2003–2004 to 0.15 during March 2014. Reduction in NCDR trend was statistically significant (P < 0.001). The proportion of female cases among newly detected cases showed fluctuation from 36.23% in 2003–2004 to 37.10% in 2013–2014 (P > 0.05). The proportion of child cases also showed significantly declining trend from 12.08% in 2003–2004 to 6.70% in 2013–2014 (P < 0.05). Significant number of MB cases decreased from 122 (2003–2004) to 69 (2013–2014) (P < 0.001). Grade II disability proportion was 1.45% in the year 2003–2004, increased to 5.2% in 2009–2010 and then again decreased to 3.4% in 2013–2014 (P > 0.05). Proportion of patients RFT showed fluctuation from 66.66% (2003–2004) to 45.68% (2009–2010) and then 64.66% (2013–2014) (P < 0.001).Conclusion:The NLEP is having a favorable impact on the problem of leprosy by maintaining the elimination level of leprosy in Rajkot district over a decade.

Epidemiological analysis of leprosy in an endemic state of northeastern Brazil

To characterise the trend of leprosy according to epidemiological and operational indicators in the state of Paraíba in the period of 2001-2011 with projections for the years 2012-2014. An epidemiological, retrospective, documentary study of a temporal sequence conducted with 10,476 reported cases of leprosy diagnosed in adults between 2001 and 2011 in 223 municipalities in the state of Paraiba, Brazil. The results were composed and analysed using two epidemiological indicators, an operational indicator and statistical software. The annual detection rate of new cases showed an upward slope between 2001 and 2005 and a declining trend from 2006. Disability showed a cyclic variation with a downward tendency and a medium level of efficiency. The results show that the disease continues to be a problem in the state and reveal the need for shorter assessments that focus on health programmes and strategies that are used to fight leprosy.

Mowat–Wilson syndrome detected by using high resolution microarray

Individuals with Mowat–Wilson syndrome (MWS; OMIM#235730) have characteristic facial features, a variety of congenital anomalies such as Hirschsprung disease, and intellectual disabilities caused by mutation or deletion of ZEB2 gene. This deletion or cytogenetic abnormality has been reported primarily from Europe, Australia and the United States, but not in Korea. Here we report a patient with characteristic facial features of MWS, developmental delay and spasticity. High resolution microarray analysis revealed 0.9Mb deletion of 2q22.3 involving two genes: ZEB2 and GTDC1. This case shows the important role of high resolution microarray in patients with unexplained psychomotor retardation and/or facial dysmorphism. Knowledge about the most striking clinical signs and implementation of effective molecular tests like microarray could significantly increase the detection rate of new cases of MWS in Korea. This is the first reported case of MWS in Korea.

Analysis of newly detected leprosy in Sohag Governorate, Upper Egypt, 2004–2008

Leprosy is a chronic and complex infectious illness; the new-case detection rate is better than prevalence as an indicator of disease trends. This study presents an analysis of pattern of new cases of leprosy detected annually from 2004 to 2008 in Sohag Governorate, Upper Egypt. Data about patients with newly diagnosed leprosy were collected from Sohag leprosy hospital, the main referral centre in the governorate. Case detection rates (CDR) were calculated for each year by dividing the newly diagnosed cases by mid-year populations for the same year. 587 patients were newly diagnosed between 2004 and 2008. The mean age of patients at diagnosis was 34 years, 62% were males, and 11% were children below 15 years of age. The overall leprosy case detection rate was 3-1/100,000 population and it decreased from 3.4/100,000 population in 2004 to 2.8/100,000 population in 2008. Ninety three percent were classified as multibacillary, and 20.4% had Grade 2 disability at diagnosis. Leprosy remains a health problem in Sohag Governorate. It is possible that new cases are being detected late owing to inadequate community awareness of the disease. Leprosy control activities should be provided in primary health care units in order to detect new cases, and continued surveillance is required to detect relapses and to ensure good patient compliance with treatment.

Cystic echinococcosis in the human population of a western Romanian county, 2004–2010

This report aims to assess the epidemiological characteristics of cystic echinococcosis (CE) in the largest Romanian county (Timis County). Our study group included 182 patients diagnosed with this condition during 2004–2010. The yearly detection rate of new cases was 3.8 cases per 100 000 inhabitants. People over 40 years old accounted for 52.7% of cases. The incidence was higher in women and in rural inhabitants. No statistically significant decline in the number and incidence of CE cases was observed throughout the study period (R2 = 0.24, p 0.3). Consequently, more efficient implementation of correct public health measures is required to fully prevent and eradicate CE in this region.

Perfil epidemiológico da hanseníase no município de Teresina, no período de 2001-2008

Leprosy is an infectious disease that can lead to functional and physical disability. It is a major public health problem in some regions, requiring knowledge of its epidemiological variations so that strategies for disease control can be subsidized. To describe the epidemiological profile of the city of Teresina from 2001 to 2008. Data on leprosy in the city of Teresina from 2001 to 2008, which were present on the official database of the Information System for Notifiable Diseases of the City Health Foundation, were analyzed. The data show an average detection rate of new cases of 96.21 cases per 100,000 inhabitants. Among those younger than 15, there was a peak of 40 cases per 100,000 inhabitants in 2003. Grade 2 disability evaluated at diagnosis ranged from 5 to 7% and at discharge from 2.77 to 0.14%. Prevalence is high, varying from 8 to 11 cases per 10,000 inhabitants. Regarding clinical form, there is a predominance of forms I with 30% of the cases and D with 28% of the cases at the end of the series; and in relation to operational classification, the average is 62% of paucibacillary cases and 37.86% of multibacillary cases. Among the reported cases, there is a slight predominance of females at the end of the series. Leprosy is hyperendemic in Teresina and it can lead people at working age to inactivity.

Evaluation of the French national plan to promote screening and early management of viral hepatitis C, between 1997 and 2003: a comparative cross-sectional study in Poitou-Charentes region

The aim of this repeated cross-sectional survey was to document trends in screening practices, to analyze the evolution of the epidemiological characteristics of patients with newly diagnosed hepatitis C virus (HCV) infection, and to evaluate the implementation of hepatitis C management guidelines. Medical laboratories in Poitou-Charentes region were surveyed on serological tests for HCV infection prescribed during two 2-month periods in 1997 and 2000, and a 4-month period in 2003. An epidemiological questionnaire and a 12-month follow-up questionnaire were addressed to physicians who prescribed tests that were positive. The annual screening coverage rate increased by 40% during the study period, whereas the number of positive tests fell by 53%. The estimated detection rate of new cases decreased from 43 to 26 per 100 000 inhabitants between 1997 and 2003. In 2003, 56% of serological tests were prescribed to patients who already knew that they were HCV-seropositive. The frequencies of the two main risk factors (transfusion and intravenous drug use) slightly decreased. Management of newly diagnosed patients was inappropriate in 42% of cases in 1997, 33% in 2000, and 34% in 2003; 26% of the participants at the three periods declined follow-up. Among drug users, the proportion of treated patients remained stable (17%). One-third of the drug users were lost to follow-up by their family doctor. Campaigns to encourage HCV screening have been effective, but the number of newly diagnosed cases has fallen markedly. National campaigns targeting the general public and healthcare professionals seem to have had no impact on patient management: in particular, drug users still do not receive adequate follow-up.

Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial

Objectives To assess whether screening improves the detection of atrial fibrillation (cluster randomisation) and to compare systematic and opportunistic screening.Design Multicentred cluster randomised controlled trial, with subsidiary trial embedded within...

Epidemiological shift in leprosy in a rural district of central India following introduction of multi-drug therapy (April 1986 to March 1992 and April 1992 to March 2002)

This study compares the epidemiological pattern of leprosy in pre- (April 1986 to March 1992) and post- (April 1992 to March 2002) multi-drug therapy (MDT) periods by retrospective analysis of 3274 registered leprosy cases in the rural field area of Regional Leprosy Training & Research Institute (RLTRI), situated in Raipur district of Chattisgarh province of Central India. The area has high endemicity for leprosy. In the post-MDT period, prevalence rate (PR) came down to less than 1 in 10, while New Case Detection Rate (NCDR) remained almost static during the two periods. Of the total new registered cases, 30.1% were registered during the pre-MDT period and the remaining 69.9% during the post-MDT period. Comparison of key leprosy variables among new registered cases showed a 2-fold rise in the proportion of MB cases (14.8 versus 27.6%), 3.0% increase in proportion of child cases (15.3 versus 18.6%) and cases with deformity grade II (3.1 versus 5.9%) and 4.0% increase in female proportion (41.4 versus 45.7%) during the post-MDT period. A decline was noted in mean age of registration for both MB (6.4 years) and PB (5.7 years) groups in the post-MDT period. While comparing treatment and outcome related variables, a marked fall of 25.8 months was recorded in treatment duration in the post-MDT period. The defaulter rate came down by 45.0% and relapse rate by more than 12.0% during the same period. The study shows that MDT is effective operationally, but continued ongoing transmission of infection and delayed diagnosis needs corrective action.

Multi-drug Regimen in Leprosy and its impact on Prevalence of the Disease.

Multi-drug Regimen in Leprosy and its impact on Prevalence of the Disease.