Leprosy Control Programme Research Articles

Variations in the Clinical Management of Multibacillary Leprosy Patients in Selected Hospitals in Metro Manila

Introduction. This paper documents the variations in the diagnosis and management of multibacillary leprosy patients in three of the biggest case-holding hospitals in Metro Manila. Furthermore, we aimed to discuss the implications of these variations on the country’s leprosy control and elimination program.
 Methods. Focus group discussions (FGD) were conducted with 23 health professionals composed of doctors and nurses with at least a year of experience in managing leprosy patients. The topics included procedures on patient diagnosis and management such as treatment duration, patient follow-up and definitions of treatment completion and default. The FGD participants provided suggestions to improve treatment compliance of patients. Their responses were compared with World Health Organization (WHO) standards and/or the 2002 DOH Manual of Operating Procedures (MOP) for leprosy. Transcripts of the recordings of the FGDs were prepared and thematic analysis was then performed.
 Results. There were variations in the hospitals’ procedures to diagnose leprosy, in treatment duration, and in patient follow-up. Definitions for treatment completion and default differed not just between hospitals but also with the WHO guidelines and the 2002 MOP. Hospitals extended treatment up to 24 or even 36 months, despite the 12 months stipulated in the MOP. Two hospitals required slit skin smear and skin biopsy in diagnosis, despite the MOP and WHO provisions that these were not mandatory. One hospital defined default as three consecutive months without treatment, which was different from the MOP and WHO standards and from the other hospitals.
 Conclusion. Given the variations in patient management, we recommended that effectiveness of the standard treatment relative to other regimens being practiced by specialists be evaluated.

Leprosy in Colombia

Leprosy is a neglected chronic infectious disease produced by Mycobacterium leprae. Leprosy causes irreversible disabilities, poverty, social exclusion, stigma, and psychologic sequels. This review summarizes important facts occurred in leprosy epidemiology and clinical outcomes of patients from Colombia during the last 20 years. According to World Health Organization (WHO), leprosy in Colombia is not considered as a public health problem since 1997, when the prevalence achieves the goal of less than 1 case per 10,000 of inhabitants. Nevertheless, 350–500 new cases are reported every year, around 80% are classified multibacillary (MB), 30% with disability grade I or II. Additionally, 7% of new patients are children and adolescents. Clinical spectrum of leprosy is wide and initial stages are difficult to diagnose. Loss of clinical expertise, weakness of the Colombian leprosy control programs, endemic regions located far away from the urban areas, and lack of accessibility of medical resources, are some factors that influence late diagnosis and disabilities in Colombian patients. Leprosy in Colombia affects the poorest population. During 2014–2015, the prevalence of 13 regions was above the goal of 1 per 10,000, these are the following: Atlantico, Barranquilla, Bogota, Bolivar, Cartagena, Cesar, Huila, Magdalena, Santa Marta, Norte de Santander, Santander, Tolima, and Valle. The definition of leprosy elimination as a public health problem in Colombia should be reconsidered, as this country is classified as post elimination stage.

Treatment outcomes of tuberculosis patients under directly observed treatment short-course at Debre Tabor General Hospital, northwest Ethiopia: nine-years retrospective study

BackgroundData regarding tuberculosis (TB) treatment outcomes, proportion of TB/HIV co-infection and associated factors have been released at different TB treatment facilities in Ethiopia and elsewhere in the world as part of the auditing and surveillance service. However, these data are missing for the TB clinic offering directly observed treatment short-course (DOTs) at Debre Tabor General Hospital (DTGH).MethodsThe authors analysed the records of 985 TB patients registered at the DTGH from September 2008 to December 2016. Data on patients’ sex, age, type of TB, and treatment outcomes were extracted from the TB treatment registration logbook. The treatment outcome of patients was categorized according to the National TB and Leprosy Control Program guidelines: cured, treatment completed, treatment failed, died, and not evaluated (transferred out and unknown cases).ResultsAround half of the registered patients were males (516, 52.4%). In terms of TB types, 381 (38.7%), 241 (24.5%), and 363 (36.9%) patients had smear-negative pulmonary TB, smear-positive pulmonary TB, and extra pulmonary TB, respectively. Six hundred and seventy-two patients (90.1%) had successful treatment outcomes (cured and treatment completed), while 74 patients (9.9%) had unsuccessful treatment outcomes (death and treatment failure).TB treatment outcome was not associated with age, sex, type and history of TB, or co-infection with HIV (P > 0.05). The proportion of TB/HIV co-infection was at 24.2%, and these were found to be significantly associated with the age groups of 25–34, 35–44 and ≥65 years:(aOR: 0.44; 95% CI: 0.25–0.8), (aOR: 0.39; 95% CI: 0.20–0.70), (aOR: 4.2; 95% CI: 1.30–12.9), respectively.ConclusionsThe proportion of patients with successful treatment outcomes was above the World Health Organization target set for Millennium Development Goal of 85% and in line with that of the global milestone target set at > 90% for 2025. Relatively higher proportions of transfer-out cases were recorded in the present study. Similarly, the proportion of TB/HIV co-infection cases was much higher than the national average of 8%.Thus, the health facility under study should develop strategies to record the final treatment outcome of transfer-out cases. In addition, strategies to reduce the burden of TB/HIV co-infection should be strengthened.

Treatment outcome of tuberculosis among Human Immunodeficiency Virus positive patients in Eastern Ethiopia: a retrospective study.

IntroductionTuberculosis is the leading cause of morbidity and mortality among people living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome worldwide. Although Human Immunodeficiency Virus related tuberculosis is both treatable and preventable, incidence rates continue to climb in developing countries where both infections are endemic. The aim of this study was to assess the treatment outcome of tuberculosis among Human Immunodeficiency Virus positive patients attending in three hospitals of Eastern Ethiopia.MethodsA retrospective clinical record review was conducted for 627 Tuberculosis and Human immunodeficiency virus co-infected patients registered from January 2008 to January 2014 cards were reviewed in three hospitals of tuberculosis clinics of Eastern Ethiopia from December 2015 to February 2016. The three hospitals were selected based on their high patient load of TB-HIV co infection and the presence of ART and TB units. Data on patient's details and tuberculosis treatment outcome were collected using standardized report format of National Tuberculosis and Leprosy Control Programme (NTLCP). The collected data were analyzed by Statistical Package for Social Sciences (SPSS) software Version 16.ResultsThe overall treatment success rate was 78.3%. Of the total TB-HIV co infected study participants, 17.9% cured, 60.4% treatment completed, 8.6% died, 0.6% failure, 1.8% defaulter and 10.7% transferred out. Those participants in the age groups of less than or equals to 18 years old (Adjusted Odds Ratio = 1.990, 95% Confidence Interval: 1.01, 3.350), extra pulmonary tuberculosis (Adjusted Odds Ratio = 1.51, 95% Confidence Interval = 1.12, 3.42), on antiretro viral therapy (Adjusted Odds Ratio = 1.54, 95% Confidence Interval = 1.252, 3.910) were more likely to have higher treatment outcome than each of the above variables counter parts.ConclusionThe rate of treatment success in this study was lower than recommended rate by World Health Organization. Thus this study recommends improving counseling during tuberculosis treatment, providing home visits and motivation of patients, improving defaulter tracing and health information dissemination in order to reduce treatment interruption.

Childhood Leprosy: A Retrospective Descriptive Study from Delhi.

Background:Childhood leprosy is an important marker of the status of the ongoing leprosy control programme, as it is an indicator of active disease transmission in the community. Despite achievement of elimination status of leprosy in 2005, the reported prevalence of childhood cases continue to be high.Method:A retrospective analysis of 11 year records of leprosy patients aged less than 15 years in a tertiary care hospital of central Delhi was carried out from 2005-2015. Data were analysed using SPSS 22.0 system.Result:A total of 113 (7.6%) cases of childhood leprosy were reported during the 11 year period from 2005-2015. Multibacillary cases constituted a total of 57 (50.4%), while paucibacillary constituted 56 (49.6%) cases. The M:F ratio noted was 2.5:1. Signs of reaction were found in 15% cases, while deformity was noted in 24.7% cases.Conclusion:The rate of childhood leprosy continues to be high. Lack of proper access to health facilities, ignorance among the general population, high susceptibility due to immature immune system etc make this population highly vulnerable.Limitations:Limited data of 11 years from an urban center were analyzed.

Drugs Supply and Laboratory Services in Dots System of Kaduna State: A Health Care Worker Perspective

A study was conducted in Kaduna State Nigeria to ascertain the impact of Drug Supply and laboratory services towards effective functioning of DOTS system. Six DOTS providing centres were identified for the study and in each centre, three respondents were selected based on their profession, the Medical Officer, the Pharmacist and the Laboratory Technician totaling 18. The officers were interviewed for the purpose of the research. Semi structured Interviews were conducted in this research as a means of obtaining Health workers perspective. The Interview which was conducted in their respective work station was open ended and all questions are same for all respondents. During the course of the study, all respondents agreed that the sources of drugs supply to their respective centres was the Kaduna State Tuberculosis and leprosy control Program office from the state capital and that drugs are been supplied quarterly and are adequate with slight interruption due to Logistic while for Laboratory services the respondents were of the view that there is the need to improve on it as there are cases of shortage of reagents and erratic supply of Electricity for effective Laboratory functioning.

Evaluation of the leprosy control programme surveillance system in Kwara State, Nigeria, 2010 - 2014

Objective: Leprosy is a chronic, infectious disease complicated with blindness and loss of fingers/toes in some cases. Though the disease is targeted for eradication in Nigeria, the country had the 6th highest prevalence globally in 2013. This study was conducted to evaluate the leprosy surveillance system in Kwara State, assessing its operations, attributes and determining its usefulness. Method: The 2001 updated guidelines for evaluating public health systems of Centers for Disease Control and Prevention was used. Key informant interviews were done with the State Tuberculosis and Leprosy (TBL) Control Officer, and the State Epidemiologists to assess the importance of the public health, purpose and operation of the surveillance system, resources used to operate it as well as the attributes of the system. Questionnaires were administered to Local Government Area TBL supervisors to assess the attributes of the surveillance system. Surveillance data from 2010 to 2014 was analyzed and data quality determined. Results: Incidence of leprosy over the five year period 2010 – 2014 was 62.0%, 59.0%, 54.0%, 67.0%, and 42.0% respectively, with occurrence of the multi-bacillary type in 83.1% to 90.7% newly detected cases. The system was found to be 51.0% sensitive(most hospitals do not have treatment forms for health workers use, community awareness programmes was done in 53.0% of local government areas in last 3 months, contact tracing was however always done), 90.0% simple, 93.0% acceptable and 95.0% timely. Data system was both paper and electronics, based on collection, collation, analysis and reporting done quarterly in a year. The surveillance system is donor-driven and fully integrated with that of tuberculosis and buruli ulcer. Annual surveillance expenditure was about $2 500. Conclusion: Kwara State Leprosy Surveillance System has a low sensitivity with delayed case detection. Training of health workers on early case detection, provision of treatment forms and more community awareness will improve the surveillance system’s sensitivity.

High occurrence of disabilities caused by leprosy: census from a hyperendemic area in Brazil’s savannah region

Objectives: To describe leprosy-related disabilities, we performed a census including people affected by leprosy in 78 municipalities of Tocantins state in northern Brazil. The study consisted of a review of patient charts, structured questionnaires, and clinical examinations for disabilities of eyes, hands, and feet (August–December 2009), according to WHO standards. Results: A total of 910 individuals diagnosed from 2006 to 2008 were included (clinical examination and application of questionnaires), but information from patient charts was not available in all cases, resulting in different denominators. The majority (783/858; 91.3%) had completed multidrug therapy. The most common clinical findings included: enlarged/painful peripheral nerves (412/910, 45.3%), namely of ulnar (207; 22.7%), posterior tibial (196; 21.6%), peroneal (186; 20.5%), and radial cutaneous nerves (166; 18.2%); reduction/loss of sensibility 201/907 (22.2%) and reduced motor function (185/906, 20.4%). At diagnosis, 142/629 (22.6%) had Grade 1 disability (G1D), and 28/629 (4.5%) had Grade 2 disability (G2D). At the time of the study, 178/910 (19.6%) presented with G1D, and 84/910 (9.2%) with G2D. Disability grading was significantly higher in males (P < 0.01). Subjects with G2D showed claw hands (26; 2.9%), followed by plantar ulcers (23; 2.5%), abrasion/excoriation on the foot (12; 1.3%), claw foot (7; 0.7%), and drop foot (7; 0.7%). Conclusions: Leprosy-related disabilities were common in a highly endemic area. Prevention and rehabilitation measures, especially after release from treatment, should be intensified by the primary health care system. Policy makers need to be aware of an ongoing demand for leprosy control programmes, even in a world of constantly reducing leprosy detection.

Assessment of the implementation of the Leprosy Control Program in Camaragibe, Pernambuco State, Brazil.

to assess the implementation of the actions of the Leprosy Control Program in Camaragibe, Pernambuco State, Brazil. evaluative research with 'implementation analysis', based on criteria, indicators and parameters guided from the construction of the Logic Model; four components were assessed - management, health care, epidemiological surveillance, health education and communication -; direct observation/questionnaire was used, as well as data from the Information System for Notifiable Diseases. the implementation of the program was incipient (58.3%); the estimate for the components varied from 'not implemented' (health education and communication, 48.0%), 'incipient' (management, 53.3%; health care, 57.2%) to 'partially implemented' (epidemiological surveillance, 73.0%); in 2012, it was observed low proportion of examined contacts (28.4%), treatment dropout (34.1%), limited standardization of patient care flow, and poor resolution of problems by managers. the level of implementation found was related to the organization of services, with negative repercussions regarding the result indicators.

Introducing leprosy post-exposure prophylaxis into the health systems of India, Nepal and Indonesia: a case study

BackgroundLeprosy has a wide range of clinical and socio-economic consequences. India, Indonesia and Nepal contribute significantly to the global leprosy burden. After integration, the health systems are pivotal in leprosy service delivery. The Leprosy Post Exposure Prophylaxis (LPEP) program is ongoing to investigate the feasibility of providing single dose rifampicin (SDR) as post-exposure prophylaxis (PEP) to the contacts of leprosy cases in various health systems. We aim to compare national leprosy control programs, and adapted LPEP strategies in India, Nepal and Indonesia. The purpose is to establish a baseline of the health system’s situation and document the subsequent adjustment of LPEP, which will provide the context for interpreting the LPEP results in future.MethodsThe study followed the multiple-case study design with single units of analysis. The data collection methods were direct observation, in-depth interviews and desk review. The study was divided into two phases, i.e. review of national leprosy programs and description of the LPEP program. The comparative analysis was performed using the WHO health system frameworks (2007).ResultsIn all countries leprosy services including contact tracing is integrated into the health systems. The LPEP program is fully integrated into the established national leprosy programs, with SDR and increased documentation, which need major additions to standard procedures. PEP administration was widely perceived as well manageable, but the additional LPEP data collection was reported to increase workload in the first year.ConclusionsThe findings of our study led to the recommendation that field-based leprosy research programs should keep health systems in focus. The national leprosy programs are diverse in terms of organizational hierarchy, human resource quantity and capacity. We conclude that PEP can be integrated into different health systems without major structural and personal changes, but provisions are necessary for the additional monitoring requirements.

Leprosy disease burden, active transmission and late presentation at the lowest administrative level in Nigeria: A spatial approach

Background: Leprosy is one of the neglected tropical diseases on the global watch of the WHO, with a commitment to globally eliminate the disease by 2020. This study utilises spatial analytics to identify areas of high leprosy burden, active transmission and delayed presentation at the lowest administrative level in Nigeria. Methods: presentation at the lowest administrative level in Nigeria. Methods: The study is an ecological study of secondary data of newly diagnosed leprosy cases reported to the Nigerian National TB and Leprosy Control Programme in 2016. The 774 LGAs were used as the unit of geographical analysis. The global Moran’s I and Local Moran’s I (LISA) test were used to measure spatial autocorrelation for annual leprosy case detection, childhood case detection and Grade 2 disability. Results: A total of 2835 new leprosy cases were notified in 2016. Majorities were male (60.5%) and multi-bacillary 2026 (71.5%). A total of 200 (7.1%) were children aged 0–14 years and 286 (10.1%) had Grade 2 disability. The leprosy case detection rate for 2016 was 1.7 per 100,000 population, while the annual case detection rate in children 0–14 years was 0.12 per 100,000 population; the Grade 2 disability rate was 0.17 per 100,000. Significant clustering was observed for annual leprosy case detection, recent transmission and for delayed presentation. Conclusion: A significant clustering of leprosy case detection, active transmission and delayed diagnosis was observed in the country. The identification of these hot spot LGAs will provide valuable information to programme managers in the implementation of targeted activities for the elimination of the disease in Nigeria.

Trends and patterns in leprosy in nine states of the Republic of the Sudan 7 years after the introduction of routine contact screening.

This paper analyzes the trends of key indicators reflecting the epidemiological situation of leprosy in nine different states of the Republic of the Sudan after the introduction of a systematic contact screening in 2010. The routinely assessed data from the leprosy control program from 2010 to 2016 were analyzed. Despite, intense contact screening, the overall number of new cases detected showed a decreasing trend. The female:male ratio among new cases was constantly low. The overall average number of contacts needed to screen in order to detect a new case among contacts was 64. However, this number varied significantly in the nine states under investigation, with the best yield being observed in the state with the lowest case detection rate. The total number of new cases of leprosy in nine states of the Republic of the Sudan has shown declining tendencies since 2010. Our data are not suggestive of a significant impact of contact screening on the trends of leprosy key indicators. Overall, contact screening proved to be efficient in most states, including those that exhibited very low annual new case detection rates (ANCDRs). Sensitization of personnel undergoing training and measures improving access of females to leprosy services are urgently needed.

Trend of tuberculosis case notification and treatment outcome in Lagos State, Nigeria: a 5-year retrospective study.

This study assessed trends of tuberculosis (TB) case notification rate (CNR) and treatment outcomes between 2011 and 2015 in Lagos State, Nigeria. A retrospective review of TB notification data to the Lagos State Tuberculosis and Leprosy Control Programme (LSTBLCP) between 1 January 2011 and 31 December 2015 was conducted. A total of 44 516 TB cases were notified during the study period, representing 9.4% of the national figure. The male:female ratio was 1.3:1. About 53%, 44.1% and 2.7% of patients were smear positive, smear negative and extrapulmonary TB cases, respectively. TB notification increased by 12.2% between 2011 and 2013 and subsequently declined by 7.2% in 2015 relative to 2013. The TB CNR declined from 82.9 per 100 000 in 2013 to 72.1 per 100 000 in 2015. However, directly observed treatment short course (DOTS) and microscopy site expansion increased from 0.3 to 0.64 per 25 000 population and from 0.16 to 0.4 per 50 000 population, respectively, from 2011 to 2015. Similarly, there was a slight increase in treatment success rate, from 80.1% in 2011 to 82% in 2015. The CNR declined in Lagos State despite an increasing trend in DOTS and microscopy site expansions between 2013 and 2015. The LSTBLCPs need to re-engineer current strategies of active TB case findings in order to improve case notification in the state.

Influence of Ebola on tuberculosis case finding and treatment outcomes in Liberia.

Setting: National Leprosy and Tuberculosis (TB) Control Programme, Liberia. Objectives: To assess TB case finding, including human immunodeficiency virus (HIV) associated interventions and treatment outcomes, before (January 2013-March 2014), during (April 2014-June 2015) and after (July-December 2015) the Ebola virus disease outbreak. Design: A cross-sectional study and retrospective cohort analysis of outcomes. Results: The mean quarterly numbers of individuals with presumptive TB and the proportion diagnosed as smear-positive were: pre-Ebola (n = 7032, 12%), Ebola (n = 6147, 10%) and post-Ebola (n = 6795, 8%). For all forms of TB, stratified by category and age group, there was a non-significant decrease in the number of cases from the pre-Ebola to the Ebola and post-Ebola periods. There were significant decreases in numbers of cases with smear-positive pulmonary TB (PTB) from the pre-Ebola period (n = 855), to the Ebola (n = 640, P < 0.001) and post-Ebola (n = 568, P < 0.001) periods. The proportions of patients tested for HIV, found to be HIV-positive and started on antiretroviral therapy decreased as follows: pre-Ebola (respectively 72%, 15% and 34%), Ebola (69%, 14% and 30%) and post-Ebola (68%, 12% and 26%). Treatment success rates among TB patients were: 80% pre-Ebola, 69% Ebola (P < 0.001) and 73% post-Ebola (P < 0.001). Loss to follow-up was the main contributing adverse outcome. Conclusion: The principal negative effects of Ebola were the significant decreases in diagnoses of smear-positive PTB, the declines in HIV testing and antiretroviral therapy uptake and poor treatment success. Ways to prevent these adverse effects from recurring in the event of another Ebola outbreak need to be found.

Trends in leprosy case detection in Rwanda, 1995-2011: analysis of 17 years of laboratory data.

BackgroundLeprosy, or Hansen’s disease, is a chronic, infectious disease caused by Mycobacterium leprae. It remains one of the leading causes of deformity and physical disability.ObjectiveWe analysed laboratory records to assess trends in prevalence rates and case detection rates (CDRs) in Rwanda.MethodsA retrospective review of detected leprosy cases from the records of the Rwanda National Reference Laboratory over a 17-year period (1995–2011) was conducted. Skin biopsy samples were analysed microscopically using Ziehl-Neelsen staining technique to identify M. leprae.ResultsCumulatively, 266 suspected cases were reported between 1995 and 2011. Of the suspected cases, 77 (28.9%) were laboratory confirmed as having leprosy. Among detected cases, 59 (76.6%) were men and 18 (23.4%) women. The male:female ratio was 3:1. There were 77 registered leprosy cases over the 17-year period of the study, and the prevalence rate was 0.005 per 10 000 population. A gradual decrease in the prevalence rate was observed from 0.015 per 10 000 population in 2003 to 0.003 per 10 000 population in 2010. From 1995 to 2011, the CDR did not exceed one per 10 000 population.ConclusionThis laboratory review demonstrates a declining trend in prevalence rates and CDR during the period of the study. Early case detection and a sustainable leprosy control programme remain the cornerstones of reducing the physical and socio-economic burden of leprosy in Rwanda.

Evaluation of outcomes of tuberculosis management in private for profit and private-not-for profit directly observed treatment short course facilities in Lagos State, Nigeria.

Background:The engagement of private practitioners in the public-private mix of tuberculosis (TB) management started in 2007 in Lagos State Nigeria. This study compared the treatment outcomes of patients managed at private for profit (PFP) and private not for profit (PNFP) directly observed treatment short course (DOTS) facilities.Methods:A retrospective review of treatment cards of TB patients managed between January 1, 2012, and June 30, 2012, in seven PFP and four PNFP DOTS facilities that served as treatment and microscopy center under the Lagos State TB and Leprosy Control Programme (LSTBLCP) at least 2 years before data collection was conducted.Results:A total of 372 treatment cards of TB patients were reviewed, of which 132 (35.5%) and 240 (64.5%) were from PFP and PNFP DOTS facilities, respectively. Treatment success rate was higher among patients managed at PFP (89.4%) DOTS facilities than PNFP (81.3%) DOTS facilities (P = 0.04). The proportion of patients lost to follow-up (12.5% vs. 8.3%), dead (3.3% vs. 1.5%) and treatment failure (2.5% vs. 0.8%) was higher among patients managed at PNFP DOTS facilities (P > 0.05). The odds that patients treated at PFP DOTS facilities had treatment success were about four times higher than PNFP DOTS facilities when other variables have been controlled for (P < 0.05).Conclusion:There is need by the LSTBLCP to engage more private practitioners to increase case detection and improve treatment outcomes of TB patients.

Historical Overview of Leprosy Control in Cuba.

INTRODUCTION Leprosy, an infectious disease caused by Mycobacterium leprae, affects the nervous system, skin, internal organs, extremities and mucous membranes. Biological, social and environmental factors influence its occurrence and transmission. The first effective treatments appeared in 1930 with the development of dapsone, a sulfone. The main components of a control and elimination strategy are early case detection and timely administration of multidrug therapy. OBJECTIVES Review the history of leprosy control in Cuba, emphasizing particularly results of the National Leprosy Control Program, its modifications and influence on leprosy control. EVIDENCE ACQUISITION The historiological method was applied using document review, complemented by interviews with experts on leprosy and its control. Archived documents, medical records, disease prevalence censuses conducted since 1942, and incidence and prevalence statistics for 1960-2015 from the Ministry of Public Health's National Statistics Division were reviewed. Reports and scientific literature published on the Program and the history of leprosy in Cuba were also reviewed. DEVELOPMENT Leprosy has been documented in Cuba since 1613. In 1938, the Leprosy Foundation was created with ten dispensaries nationwide for diagnosis and treatment. The first National Leprosy Control Program was established in 1962, implemented in 1963 and revised five times. In 1972, leper colonies were closed and treatment became ambulatory. In 1977, rifampicin was introduced. In 1988, the Program instituted controlled, decentralized, community-based multidrug treatment and established the criteria for considering a patient cured. In 2003, it included actions aimed at early diagnosis and prophylactic treatment of contacts. Since 2008, it prioritizes actions directed toward the population at risk, maintaining five-year followup with dermatological and neurological examination. Primary health care carries out diagnostic and treatment activities. The lowest leprosy incidence of 1.6 per 100,000 population was achieved in 2006. Since 2002, prevalence has remained steady at 0.2 per 10,000 population. Leprosy ceased to be considered a public health problem in Cuba as of 1993. In 1990-2015, 1.6% of new leprosy patients were aged <15 years. At present, late diagnosis of cases exceeds 20%, which leads to a high percentage of grade 2 disability in such patients. Spontaneous physician visits by already symptomatic patients surpassed 70% of cases diagnosed in 2010-2015. CONCLUSIONS Actions undertaken after initial detection of leprosy in Cuba failed to control it. Effective control began in 1963, with the implementation of the National Leprosy Control Program, whose systematic actions have had an impact on trends in leprosy, reflected in WHO's 1993 declaration that leprosy was no longer a public health problem in Cuba. KEYWORDS Leprosy, Mycobacterium leprae, history of medicine, epidemiology, communicable disease control, Cuba.

Spatial distribution of leprosy in Nigeria

Despite achieving the WHO elimination target of less than 1/10,000 population in 1998 at the national level, there are still pockets of relative high endemicity of leprosy in Nigeria. This study used spatial analytic techniques to determine the spatial distribution of leprosy in Nigeria. The study is an ecological study of secondary data of new leprosy cases reported to the National TB and Leprosy Control Programme (NTBLCP) in Nigeria, 2010–2014. The 36 states and Federal Capital Territory were used as the unit of geographical analysis. The global Moran’s I and Local Moran’s I (LISA) test were used to measure spatial autocorrelation and significant levels were taken at P < , 0·05. A total of 17,356 new leprosy cases were notified over 5 years (2010–2014) in Nigeria. A majority of the cases were multi-bacillary 16,037 (92·4%) while 1319 (7·6%) were pauci-bacillary. A total of 1569 (9%) children were reported with leprosy. The leprosy case detection rate increased slightly from 2·21/100,000 in 2010 to 2·24/100,000 in 2012 and declined to 1·66/100,000 population in 2014. Significant clustering of average annual leprosy case detection rate was observed in Kebbi state only, while childhood leprosy was significantly clustered in four states namely Sokoto, Kebbi, Rivers and Zamfara states. The study observed a significant clustering of leprosy case detection rate in Nigeria. The findings can serve as a useful guide to the national leprosy control programme for efficient use of scarce resources to target interventions to priority states for the elimination of leprosy in the country.

The Burden of Leprosy in Cameroon: Fifteen Years into the Post-elimination Era.

BackgroundCameroon achieved the elimination target of leprosy in 2000, and has maintained this status ever since. However, a number of health districts in the country continue to report significant numbers of leprosy cases. The aim of this study was to assess the burden of leprosy in Cameroon from 2000 to 2014.MethodsWe obtained and analysed using the new leprosy burden concept of analysis, leprosy surveillance data collected between 2000 and 2014 from the National Leprosy Control Programme.Principal findingsCameroon achieved leprosy elimination in 2000, registering a prevalence rate of 0.94/10,000 population. The prevalence rate dropped further to reach 0.20/10,000 population (78% reduction) in 2014. Similarly, the new case detection rate dropped from 4.88/100,000 population in 2000 to 1.46/100,000 population (85.3% reduction) in 2014. All 10 regions of the country achieved leprosy elimination between 2000 and 2014; however, 10 health districts were still to do so by 2014. The number of high-leprosy-burden regions decreased from 8 in 2000 to 1 in 2014. Seven and two regions were respectively medium and low-burdened at the end of 2014. At the health districts level, 18 remained at the high-leprosy-burdened level in 2014.ConclusionThe leprosy prevalence and detection rates as well as the overall leprosy burden in Cameroon have dropped significantly between 2000 and 2014. However, a good number of health districts remain high-leprosy-burdened. The National Leprosy Control Programme should focus efforts on these health districts in the next coming years in order to further reduce the burden of leprosy in the country.

Health information system model for monitoring treatment and surveillance for leprosy patients in indonesia (case study in Pekalongan District, Central Java, Indonesia).

After India and Brazil, Indonesia has the third highest incidence/prevalence of leprosy in the world. Every year thousands of new cases and case with grade-2 disability are reported and, while the recovery rate lingers only 80-90 %. Therefore, more than 10 % of leprosy patients drop out of treatment and can be a source of new infections in the community. Our research was aimed at determining apparent difficulties in the leprosy control program as well as how a health information system (HIS) could assist the Indonesian leprosy control program. We used qualitative method with deep interview and observation of document. One of the difficulties which the Indonesian leprosy control program faces is discontinuity of patient's data due to rotating staff as well as the treatment monitoring and queries patients which should be monitored after treatment has ceased. Technology implementation is feasible through short message service (sms) reminders and web base applications. The leprosy control program urgently needs to implement continuous monitoring and recording of patients because of the particular characteristics of this contagious disease.