Leprosy Control Research Articles

Active case-finding and enhanced data collection to identify neglected tropical diseases

ObjectiveTo strengthen public health surveillance to monitor neglected tropical diseases (NTDs) like leprosy as a control measure to avert disabilities in the Kingdom of Swaziland.IntroductionLeprosy is a chronic infectious disease caused by Mycobacterium leprae. It is a contagious disease that affects the skin, mucous membrane, and nerves causing discoloration and lumps on the skin and in severe cases disfigurement and deformities. The mode of transmission remains uncertain, but is believed that M.leprae is spread from person to person primarily as a nasal droplet infection. The incubation period for a bacterial disease generally is 5 – 7 years. Progress in the fight against leprosy has been one of the greatest public health success and in the country, was eliminated in the mid-1990s. However on the 22nd August 2017 a confirmed leprosy cases was reported by the National Referral Hospital.MethodsFollowing the confirmed case an investigation was conducted to fully understand the possible source of the case and identify further cases. The assessment was done in three parts that is, hospital visit to follow up on the index case; conducting home visits to collect data for leprosy and their contact and a file review of all clients who were once diagnosed as having leprosy.ResultsThe index case was identified and his condition is improving as he has been initiated on MDT which he will be taking for a minimum of six months. Eleven clients were visited in their homes. Their age range was 31 to 91 years but the majority were above 60 years with a median age of 70 years. There were 7 females and 4 males. . The clients presented with permanent nerve damage either from the face, upper or lower limbs. The common disabilities and deformities post treatment were sagging of face, nasal collapse, blindness and clawing of fingers and feet. Other patients had plantar-palmar ulcers and abscesses from trauma, injuries or burns sustained due to nerve damage and inadequate protection. They reported to be experiencing stigma and are being discriminated. None of the clients presented with clinical signs and symptoms suggestive of leprosy. There were 18 files that were reviewed out of 58 who are known to exist. Six of the 18 files belonged to clients who were seen during home visits. One of the clients was epidemiologically linked to the index case as they used to live together in 1994.ConclusionsThe country seem to be experiencing the re-emerging of leprosy. Since the index case is epidemiologically linked to one of the old cases this therefore confirms the incubation period of leprosy being from 15 to 20 years. There is need to strengthen leprosy prevention and control measures as well as strengthening of leprosy surveillance in the context of IDSR. There is an urgent need to raise public awareness and provide clients with protective clothing. Furthermore, there is need to strengthen the Bilharzia and Worms Control Program to incorporate leprosy as it is one of the NTDs targeted for elimination in Swaziland.

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.

A Study of Reversal Reactions in Leprosy

Reversal reactions (RRs) are the leading cause of deformities and disabilities in leprosy. A comprehensive data on the magnitude of RR is crucial in implementing and evaluating the leprosy control strategy. Therefore, we had undertaken this study to find out the rate of reversal reaction (RR) and the key features associated with it, so that a comprehensive strategy could be adopted for their early detection and management. In this prospective study, all untreated newly diagnosed cases of leprosy that attended a tertiary level urban hospital from April 2012–March 2017, were examined for RR at the time of diagnoses as well as during the course of their treatment. RR was recorded in 13.61% (84/617) of patients, of these 73.80% (62/84) presented in RR at the time of the first visit (at the time of diagnoses) to the hospital, while the remaining 26.20% (22/84) developed it during the course of multidrug therapy (MDT). Majority of RR were seen in multi-bacillary (MB) cases (78/84, 92.85%), in comparison to pauci-bacillary (PB), where it was seen only in 7.15% (6/84). Another important finding was the declining trend of RR, from 21.15% (22/104) in 2012-13 to 2.34% (3/128) in 2016-17. MB cases and MDT were found to be the two key features associated with reversal reactions. Although a significant declining trend of RR was recorded in the study, yet they are still prevalent, particularly in the MB cases, and most of them were detected at the time of the patient’s first visit. Therefore, a strategy to further augment the public awareness program regarding the features of RR, as well as explaining these features to patients before starting treatment should be emphasized.

Primary health care in leprosy, assessed by users and professionals

Objective: Evaluate the performance of primary health care in control of leprosy in Teresina, Brazil from the perspective of users and professionals.
 Methods: This cross-sectional, descriptive study involved 25 healthcare users with leprosy and 34 professionals (physicians and nurses) working in 13 municipal health units within the urban area of Teresina. The data were collected from January to June, 2017, using the Instrument for Assessing the Performance of Primary Care in Leprosy Control Actions, a document based on the Primary Care Assessment Tool/PCATool Brasil which measures the presence and extension of essential and derived attributes from primary health care.
 Results: The mean scores obtained for the essential, derived and global attributes, through the perception of the users, were lower than 6.6, indicating that the primary health services in Teresina are not sufficiently oriented to carry out leprosy control actions, mainly in terms of access, integrality of services provided, family orientation and community orientation. The professionals showed a contrasting view, with averages exceeding 6.6 for all attributes and scores. The difference in perception between the groups was significant for all attributes except for coordination (Mann-Whitney U test, p = 0.479).The overall evaluation of quality was not influenced by the user’s clinical or socioeconomic variables, but rather by the organization/provision of services.
 Conclusions: The municipal health units within the urban area of Teresina must be strongly guided by primary health care attributes in order to reach higher levels of user satisfaction.

Minimal essential data to document contact tracing and single dose rifampicin (SDR) for leprosy control in routine settings: a practical guide

In leprosy control there is a renewed interest in active case finding, which is increasingly being combined with chemoprophylactic interventions to try and reduce M. leprae transmission. The Leprosy Post-Exposure Prophylaxis (LPEP) programme, currently ongoing in eight endemic countries, pilots the provision of single-dose rifampicin (SDR) to eligible contacts of leprosy patients. LPEP has developed a surveillance system including data collection, reporting and regular monitoring for every participating country. This system is still largely programme- specific to LPEP. To facilitate continuity after completion of the project phase and start-up in other interested countries, we aim at identifying the minimal set of data required to appropriately document contact tracing activities and SDR administration for leprosy control in a routine setting. We describe four indicators for the index case (plus four already routinely collected) and seven indicators for household/neighbour screening, and community surveys. We propose two generic forms to capture all relevant information required at field and district level to follow-up on individuals or data if needed, provide guidance on the sequence of tasks, provide quality control by listing key questions to assess SDR eligibility, and facilitate reporting. These generic forms have to be adapted to local requirements in terms of layout, language, and additional operational indicators.

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.

Control Actions on Leprosy in Primary Health Care in a Brazilian Capital: Profile of Professionals and Users

Objective: analyze profile of users of primary health care services affected by leprosy, as well as the medical professionals and nurses responsible for the follow - up of these patients. 
 Methods: This is a field study that surveyed the socioeconomic and clinical profile of 26 patients affected by leprosy, attended at the municipal health units of the urban area of ​​Teresina-PI, as well as the professional profile and clinical practices of 15 physicians and 19 nurses responsible for the follow-up of these patients.
 Results: It was observed a profile of people affected by leprosy, characterized by: individuals aged 50 years or more; predominantly male; with low schooling and income. The clinical characteristics reveal a high prevalence of multibacillary cases of leprosy and with a significant diagnosis of some degree of physical disability. Regarding the profile of the professionals and their clinical behaviors, it was verified that the majority had post-graduation and a long time of experience in primary health care and leprosy control actions, however, it has been shown that they do not always put into practice all actions necessary for the diagnosis and treatment of the disease.
 Conclusions: The profile of patients with leprosy treated at the municipal health units in the urban area of Teresina was similar to that found in other Brazilian territories, thus evidencing the need to implement public social support policies and more effective diagnostic and therapeutic follow-up practices by reduce the high rates of endemicity of the disease.

Programmatic vulnerability in leprosy control: gender-related patterns in Bahia State, Brazil

The aim of this study was to analyze operational indicators and time trends in leprosy control from a gender perspective in Bahia State, Brazil, from 2001 to 2014. This was a time series study based on epidemiological data on leprosy from the Brazilian National System of Diseases of Notification, using joinpoint Poisson and polynomial regression. Of the 40,054 new cases of leprosy, 47.1% of the recorded contacts were not examined, with a significant upward trend, especially in women (average annual percentage change - AAPC = 5.6; 95%CI: 3.5; 7.7) when compared to men (AAPC = 3.0; 95%CI: 0.5; 5.6). The proportion of cure in the 2003-2014 cohort was 85%, with a downward trend, especially in men (AAPC = -0.5; 95%CI: -0.9; 0.0), compared to women (AAPC = -0.4; 95%CI: -0.7; -0.1). Treatment dropout rate was 5.5%, with a more significant downward trend in women (AAPC = -4.9; 95%CI: -8.7; -1.1) than in men (AAPC = -2.7; 95%CI: -4.4; -1.0). Relapse was recorded in 3.8% of all the entries during the same period; women showed a significant downward trend (AAPC = -2.2; 95%CI: -3.3; -1.0) and men a significant upward trend (AAPC = 4.9; 95%CI: 2.9; 6.8). Polynomial regression analysis was consistent with joinpoint regression. Leprosy in Bahia State shows operational indicators with significant magnitude and time trends, especially in the male population. Health services' insufficient performance in conducting contact surveillance and longitudinal care reveal various dimensions of vulnerability.

Leprosy trends following implementation of an intervention project in a state capital in the North of Brazil, 2002-2016

The project Palmas Free of Leprosy was implemented to improve indicators and deal with the disease, since the capital of Tocantins State is the most hyperendemic state capital in Brazil. This study measures the impact of the project's intervention through trend analysis of the priority indicators in Palmas, from 2002 to 2016. The study was based on an analysis of data from the Brazilian Information System for Notifiable Diseases (SINAN) and reports of applied training courses with problem-solving methodology. The indicators for new leprosy cases in Palmas residents were investigated, and the trends were identified by joinpoint regression analysis to assess the results. In the year the intervention project was implemented (2016), the detection rate for new cases in the overall population was 236.3/100,000 inhabitants, and this indicator showed a significant decrease of -7.5% from 2002 to 2014. From 2014 to 2016, there was a significant increase of 104.6% in overall detection. The detection rate in individuals under 15 years of age also showed a reduction of -4.6%, but in the years 2014, 2015, and 2016 there was an increase of 111.1%, together with detection rates for grades 0, 1, and 2, with 59.3%, 225.2%, and 121.7%, respectively. The proportion of cases detected by contact assessment showed a significant increase of 201.1% from 2014 to 2016. The data proved the effectiveness and potentiality of the project's intervention strategy for the diagnosis and control of leprosy in Palmas. The study provided evidence that timely diagnosis by primary care services results in indicators that reflect the real incidence of cases.

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.

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.

Epidemiologic study of leprosy in Brazil: reflections on elimination goalsEstudio epidemiológico de la lepra en el Brasil: reflexión sobre las metas de eliminación

RESUMOObjetivosDescrever o perfil epidemiológico da hanseníase no Brasil no período de 2005 a 2015 e verificar como os indicadores brasileiros estão se comportando em relação às metas estipuladas pela Organização Mundial da Saúde (OMS) para eliminação dessa doença.MétodosA pesquisa foi realizada a partir dos dados disponíveis nos sites do Ministério da Saúde. Foram avaliados os indicadores: dados de prevalência, coeficientes de detecção geral e conforme grupo etário (< 15 anos ou ≥ 15 anos), porcentagem de cura e grau 2 de incapacidade.ResultadosNo período do estudo, o coeficiente de prevalência dos casos de hanseníase manteve-se em patamar médio (de 1,00 a 4,99/10 000 habitantes), com tendência nacional decrescente. Entretanto, esse comportamento não foi observado nas regiões Nordeste, Norte e Centro-Oeste. O coeficiente de casos novos em indivíduos com menos de 15 anos apresentou diminuição entre 2005 e 2015 em todas as regiões. O coeficiente de detecção de casos novos diagnosticados com grau 2 de incapacidade teve redução significativa, principalmente nas regiões Sul e Sudeste; o Norte do país foi a única região com aumento desse coeficiente. O percentual de cura de hanseníase no Brasil, independentemente da faixa etária, não sofreu alteração desde 2005, sendo considerado regular (75% a 90%).ConclusãoOs principais indicadores de hanseníase apresentaram redução no período do estudo. Embora o Brasil não tenha erradicado a hanseníase, essa meta deverá ser alcançada em 2020 caso sejam mantidos os parâmetros. Recomenda-se adaptar a política de atenção à hanseníase à realidade de cada região brasileira, visto que a prevalência da doença apresenta distribuição heterogênea.

Statistical Analysis of Tuberculosis in Jigawa State, North-Western Nigeria

Studies on Tuberculosis (TB) in Jigawa, a Northwestern state in Nigeria, is very scarce as Tuberculosis and Leprosy Control Center in the state started functioning properly only recently in 2009. Since then, there has been a hike in the number of TB patients visiting the center. This study is conducted to analyze the incidence of Tuberculosis in the state. Data used is obtained from Tuberculosis and Leprosy Control Center, Ministry of Health, Jigawa State, Nigeria. Questioners are used for the collection of the available data for the period of six years (2009–2014). Linear regression is used to analyze the trend of the disease from the same period. Trends within various age groups were recorded. HIV co–infection is analyzed and its trend is also recorded over the years. Gender parity is also analyzed using a t-test. There is an increase in the number of patients from 2009 to 2014. Out of the 9590 patients seen in the period, 6538 (68.18 %) are males and3052 (31.82%) are females. At-test is used to show the significance in the difference between the number of males and females. It is also found that, there is an increase in the number of HIV co-infection over the said years. The study shows the prevalence of TB is highest among the age group of 25 – 34 (30.15%). The commonest type of TB in the population was smear positive pulmonary TB, with 5853 patients (61.03%). TB in Jigawa state was found to be significantly increasing. Out of all the 9590 patients seen at the center, 6538 (68.18 %) are males and3052 (31.82%) are females. HIV co - infection with Tuberculosis occurred in 9.94% of the patients considered. This study shows a high percentage of infection: 30.14% between the age group of 25-34.In general, Pulmonary TB has a higher prevalence of 95.69% compared to Extra Pulmonary TB that has 4.31%.

Retrospective active case finding in Cambodia: An innovative approach to leprosy control in a low-endemic country

Currently, leprosy control relies on the clinical diagnosis of leprosy and the subsequent administration of multidrug therapy (MDT). However, many health workers are not familiar with the cardinal signs of leprosy, particularly in low-endemic settings including Cambodia. In response, a new approach to early diagnosis was developed in the country, namely retrospective active case finding (RACF) through small mobile teams. In the frame of RACF, previously diagnosed leprosy patients are traced and their contacts screened through “drives”.According to the available records, 984 of the 1,463 (67.3%) index patients diagnosed between 2001 and 2010 and registered in the national leprosy database were successfully traced in the period 2012–2015. Migration (8.4%), death (6.7%), operational issues (1.6%) and unidentified other issues (16.0%) were the main reasons for non-traceability. A total of 17,134 contacts of traced index patients (average: 2.2 household members and 15.2 neighbors) and another 7,469 contacts of the untraced index patients could be screened. Among them, 264 new leprosy patients were diagnosed. In the same period, 1,097 patients were diagnosed through the routine passive case detection system. No change was observed in the relation between the rate at which new patients were identified and the number of years since the diagnosis of the index patient. Similar to leprosy patients diagnosed through passive case detection, the leprosy patients detected through RACF were predominantly adult males. However, the fraction of PB leprosy patients was higher among the patients diagnosed through RACF, suggesting relatively earlier diagnosis.It appears that RACF is a feasible option and effective in detecting new leprosy patients among contacts of previously registered patients. However, a well-maintained national leprosy database is essential for successful contact tracing. Hence, passive case detection in the frame of routine leprosy surveillance is a precondition for efficient RACF as the two systems are mutually enhancing. Together, the two approaches may offer an interesting option for countries with low numbers of leprosy patients but evidence of ongoing transmission. The impact on leprosy transmission could be further increased by the administration of single dose rifampicin as post-exposure prophylaxis to eligible contacts.

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.

Evaluation of the economic burden of leprosy among migrant and resident patients in Guangdong Province, China

BackgroundA lot of time and money was needed during the diagnosis and treatment process of leprosy, the delayed leprosy would also impair the labor capability of patients as well, and these put a heavy burden for the leprosy patients. The migrant leprosy patient is a special group and need more concern. Our goal was to assess the economic burden of leprosy on migrant and resident patient populations in Guangdong province, China.MethodsWe conducted a population-based cross-sectional survey from February to July of 2016. A self-designed questionnaire was administered to leprosy patients who: (1) had registered in Leprosy Management Information System in China (LEPMIS) by the end of February 2016, (2) had received multiple drug treatment (MDT) drugs at a local leprosy control institution for three consecutive months or had had at least one physical check in the past half year, and (3) were willing to take part in the investigation and give informed written consent. Demographic characteristics, Financial and disease information, and costs before and after leprosy diagnosis were collected and compared using t-test and χ2 test.ResultsA total of 254 participants completed the questionnaires, including 168 males and 86 females. Migrants and residents accounted for 33.9% and 66.1% of patients, respectively. Among migrant patients, the median cost before diagnosis was $131.6 (39.2–450.9), the median yearly cost of leprosy treatment after diagnosis was $300.6 (158.4–868.5), and the median yearly cost of leprosy complications was $69.5 (11–178.4). In comparison, among residents the median yearly costs were $152.4 (30.7–770.9) pre-diagnosis, $309.7 (103.2–1016.7) after diagnosis, and $91.9 (32.6–303.1) for leprosy complications. Base on this, we determined that the median yearly total expense after diagnosis amounted to 15% of migrant and 38% of resident patients’ annual income.ConclusionLeprosy places a heavy economic burden on both migrant and resident leprosy patients and governmental policies and programs could substantially alleviate this. Measures to implement more active surveillance and early diagnosis would benefit both populations, while labor protection and medical insurance are urgently needed for migrant patients and easier access to medical services and social aids could substantially decrease the burden of leprosy for resident patients.

Cleansing Western Samoa: Leprosy Control during New Zealand Administration, 1914–1922

ABSTRACT When New Zealand military forces occupied Sāmoa in 1914, there were 12 recorded leprosy sufferers isolated in a leprosy station established by the Imperial German government in the village of Falefa. By 1918, the leprosy sufferers had been relocated to the island of Nu‘utele, off the east coast of Upolu. Four years later in 1922, the patients were transferred to the Fiji leprosy colony on the island of Makogai. Drawing largely on archival, song and oral records, this paper focuses on the years from 1918 to 1922 and examines the network of authorities involved in the care of leprosy sufferers and the policies of the New Zealand administration to keep Sāmoa ‘clean’ of the disease. This care and these policies led to the ‘Makogai solution’, which, as fragments of songs and oral histories indicate, was for decades to haunt those left behind in Sāmoa.

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.