Management Of Leprosy Research Articles

Towards a Leprosy-Free Country — China, 2011−2018

What is already known about this topic? Leprosy is a chronic infectious disease that is endemic in several countries. Control of leprosy has had targets set by World Health Organization’s (WHO) Global Strategy 2016–2020 and by China through a national leprosy-control plan (2011–2020). What is added by this report? Data from the Leprosy Management Information System in China was analyzed and showed a national prevalence of 0.178 per 100,000 and detection rate of 0.037 per 100,000 residents in 2018. In addition, all the main targets for 2020 have been met by 2018 except for the proportion of counties or cities to reach a prevalence of less than 1/100,000 and the proportion of children cases with grade 2 disability (G2D). What are the implications for public health practice? There are still challenges remaining to close the gaps between current progress and the targets set forth by the WHO and China. However, lessons learned in China in developing and implementing the national program may be invaluable for future plans to achieve and sustain elimination of leprosy at global and country level.

Karakteristik Penderita Kusta Multi Basiller (MB) dengan Reaksi Erythema Nodosum Leprosum (ENL) di Poliklinik Kulit dan Kelamin RSUP Sanglah selama Tahun 2016-2018

Introduction: Leprosy is still a burden on endemic countries such as Indonesia. As well as leprosy reaction is a problem associated with the cessation of treatment from leprosy patients. The purpose of this study was to do a description of the characteristics of leprosy patients with ENL reactions in the Skin and Sex Polyclinic of Sanglah Hospital Denpasar.Method: This study used a descriptive design with a retrospective approach conducted at the Skin and Sex Polyclinic of Sanglah General Hospital. A search related to the characteristics of leprosy patients who experienced an ENL reaction, then the data was presented in descriptive form.Results: Female gender tend to have more severe leprosy reactions (50%) compared to men. High income (50%), non-endemic area origin (44.8%), elementary school education level (44.4%), and active working (31.0%) tended to experience more severe leprosy reactions. And in this study more severe leprosy reactions were found in the multi-bacillary leprosy group (65.7%), whereas mild leprosy reactions were higher in the pauci-bacillary leprosy group (34.2%).Conclusion: The high rate of severe leprosy reaction requires special attention from both the government and health practitioners, so that there is an integrated management of leprosy, so that the population in Indonesia becomes healthier.

PERILAKU SEHAT PENDERITA KUSTA DENGAN KEPATUHAN KONSUMSI MDT DI PUSKESMAS LIMO KOTA DEPOK JAWA BARAT

Leprosy is a disease caused by the bacterium Mycobacterium leprae, will attack the skin and peripheral nerves, and is transmitted through the upper respiratory tract. Management of leprosy requires patient patience in treatment, because it takes a long time. Patient compliance in the treatment process determines the success of treatment. Healthy behavior in the management of leprosy treatment requires discipline in taking leprosy medication. Poor treatment management can have permanent damage to the limbs of the patient, which is the occurrence of disability. The purpose of this study was to determine the main factor dimensions of healthy behavior that affect leprosy compliance in consuming Multi Drug Therafi (MDT) of leprosy. The research design used cross sectional descriptive, the sampling technique used was a total sampling of 15 people. The research instrument used a questionnaire containing statements of compliance and healthy behavior consisting of dimensions of knowledge, attitudes and psychomotor, and analyzed using multiple linear regression. The results obtained that the factors of knowledge, attitudes, and psychomotor have a positive and significant effect on patient compliance consuming MDT (p value

Setia Sampai Terbukti: A Triadic Intervention in Persons With Leprosy to Improve Wellbeing and Reduce Stigma

Persons with leprosy suffer physically, psychologically and socially. They feel punished, condemned, discarded and ostracized as the result of their stigma. We argued that leprosy management and complete healing better be done simultaneously on physiological, psychological, sociological and religious faith-spiritual levels, using triadic approach intervention. This study conducted in 2017 in Lembata District, Nusa Tenggara Timur, Indonesia. 42 leprosy cases were screened through laboratory examination conducted at Damian hospital. 28 leprosy patients agreed to receive the treatment in addition to leprosy medical treatment. 14 patients refused to participate. The Leprosy intervention model successfully enhances the improvements of 24 patients’ health. Spiritual/religious values can be used as a base of a positive view on leprosy management, empowering the family and community capacity on treating leprosy. Social integration is needed to improve the wellbeing of patients both physically and psychologically. This support helps patients to cope with negative feelings and reintegrating them into communities.

Leprosy Statistics in China, 2017

Objective To describe the epidemiologic characteristics of leprosy in China and to provide evidence for making specific strategies in the leprosy control programme. Methods We used a descriptive analysis method to analyse the leprosy data from 2017 provided by the Leprosy Management Information System in China (LEPMIS) covering all the provinces of China excluding Hong Kong, Macao, and Taiwan. Results In 2017, 634 newly detected cases of leprosy were reported, with a case detection rate of 0.046 per 100,000 individuals. The proportions of cases in children under 15, multi-bacillary cases, and cases with grade 2 disability were 1.4%, 91.8%, and 20.0%, respectively. A total of 52 relapse cases, among which 28 cases occurred after multi-drug therapy, were reported. By the end of 2017, the total number of registered cases was 2,697, with a prevalence rate of 0.194 per 100,000 individuals. Conclusion In China, the overall leprosy prevalence is still at a low level, but its distribution is unbalanced, with higher incidence in Yunnan, Sichuan, Guizhou, Guangdong. To continue making progress toward eliminating leprosy, control efforts must be sustained over the coming years. Key words: Leprosy; Incidence; Morbidity; China

Causes and Treatment of Indeterminate Leprosy-A Study

Leprosy is one of the oldest human bacterial disease recognized by a Norwegian scientist Armauer Hansen working in Bergen in 1873. Leprosy is still one of the infectious diseases and major health problem of developing countries. Leprosy is not a single entity but rather a spectral disease with varied clinico-pathological presentations. It is generally agreed that multibacillary cases (lapromatous and borderline lepromatous cases) are the most infectious for the community. This study has been taken to show the symptoms of leprosy and detection and management of indeterminate cases of leprosy

Suggested protocol for the management of leprosy by primary health-care clinicians

The new WHO guideline for the management of leprosy may not address all the grass roots realities of treating and preventing leprosy effectively in India. I suggest the addition of supervised doses of ROM as a part of addressing these problems.

Worsening of the disability grade during leprosy treatment: prevalence and its determinants in Southern Nigeria.

In Nigeria, little is known about the development of new or additional physical disability during leprosy treatment. The objective of this study was to determine the prevalence and evaluate factors associated with worsening of physical disability during leprosy treatment in Nigeria. This was a retrospective cohort study conducted among leprosy patients treated in six referral facilities in six States in Nigeria between January 2011 and December 2015. Multivariable logistic regression analysis was used to identify predictors of worsening disability after treatment. Of 984 leprosy patients who completed treatment, the mean age of the patients was 39.8±17.6 years and 57.4% (565/984) of them were male. Also, 51.6% (508/984) of the patients had either grade 1 or 2 disability at diagnosis, but this declined to 30.8% (303/984) following treatment (p<0.001). Overall, 4.7% (46/984) of the cases developed new or additional disability (or worsening disability) during treatment. The cases with the greatest odds for developing worsening physical disability were patients from the southwest (adjusted odds ratio [aOR] 15.9; 95% CI 3.8-67.4) and southeast zones (aOR 4.7; 95% CI 1.1-19.2), and patients who had a leprosy reaction requiring additional corticosteroid therapy (aOR 11.7; 95% CI 4.4-31.2). Sustained capacity building for health professionals on better monitoring and management of leprosy and its complications is strongly recommended in Nigeria.

A study on gender differences in newly detected leprosy cases in Sichuan, China, 2000-2015.

Many researches on gender differences in leprosy found that female patients were detected with the disease later and had more serious disabilities than male patients. We analyzed the gender differences related to epidemiological characteristics of new leprosy cases detected from 2000 to 2015 in Sichuan Province, China. A retrospective study was undertaken to analyze the gender differences with respect to age, delay in disease detection, the main modes of detection, and disability grade. The chi-squared test and t test were applied for the comparison using Epi Info 7.2 with a significance level of a = 0.05. The data were collected from the Leprosy Management Information System in China. A total of 2900 new leprosy cases were detected from 2000 to 2015, of whom 2075 (71.6%) were male and 825 (28.4%) were female with a gender ratio of 2.5. The gender ratio of patients aged 15-30 was significantly lower than that of patients aged 31-45 and 46-60. Male cases were older than female cases when they were detected. The proportion of Grade 2 Disability (G2D) among men (20.6%) was significantly higher than that among women (17.3%). The average period of delay in detection among male cases was similar with that among females cases. Gender-related differences existed among the leprosy cases detected from 2000 to 2015. Female patients were younger than male patients. The detection of leprosy in women was not later than in the case of men. The disability situation in men was more serious than in women.

Molecular, immunological and neurophysiological evaluations for early diagnosis of neural impairment in seropositive leprosy household contacts.

BackgroundHousehold contacts constitute the highest risk group for leprosy development, and despite significant progress in the disease control, early diagnosis remains the primary goals for leprosy management programs.MethodsWe have recruited 175 seropositive and 35 seronegative household contacts from 2014 to 2016, who were subjected to an extensive protocol that included clinical, molecular (peripheral blood qPCR, slit-skin smear qPCR, skin biopsy qPCR) and electroneuromyographic evaluations.Results/Principal findingsThe positivity of peripheral blood qPCR of seropositive contacts was 40.6% (71/175) whereas only 8.6% (3/35) were qPCR positive in seronegative contacts (p = 0.0003). For the slit-skin smear, only 4% (7/175) of seropositive contacts presented positive bacilloscopy, whereas the qPCR detected 47.4% (83/175) positivity in this group compared with only 17.1% (6/35) in seronegative contacts (p = 0.0009). In the ENMG evaluation of contacts, 31.4% (55/175) of seropositives presented some neural impairment, and 13.3% (4/35) in seronegatives (p = 0.0163). The presence of neural thickening conferred a 2.94-fold higher chance of ENMG abnormality (p = 0.0031). Seropositive contacts presented a 4.04-fold higher chance of neural impairment (p = 0.0206). The peripheral blood qPCR positivity presented odds 2.08-fold higher towards neural impairment (OR, 2.08; p = 0.028). Contrarily, the presence of at least one BCG vaccine scar demonstrated 2.44-fold greater protection against neural impairment (OR = 0.41; p = 0.044).Conclusions/SignificanceELISA anti-PGL-I is the most important test in determining the increased chance of neural impairment in asymptomatic leprosy household contacts. The combination of the two assays (ELISA anti-PGL-I and peripheral blood qPCR) and the presence of BCG scar may identify individuals with higher chances of developing leprosy neuropathy, corroborating with the early diagnosis and treatment.

Innate Immune Responses in Leprosy.

Leprosy is an infectious disease that may present different clinical forms depending on host immune response to Mycobacterium leprae. Several studies have clarified the role of various T cell populations in leprosy; however, recent evidences suggest that local innate immune mechanisms are key determinants in driving the disease to its different clinical manifestations. Leprosy is an ideal model to study the immunoregulatory role of innate immune molecules and its interaction with nervous system, which can affect homeostasis and contribute to the development of inflammatory episodes during the course of the disease. Macrophages, dendritic cells, neutrophils, and keratinocytes are the major cell populations studied and the comprehension of the complex networking created by cytokine release, lipid and iron metabolism, as well as antimicrobial effector pathways might provide data that will help in the development of new strategies for leprosy management.

Evaluation of safety tool for ambulatory leprosy patients at risk of adverse outcome

BackgroundLeprosy is a potentially debilitating disease of the skin and nerves that requires a complex management approach consisting of laboratory monitoring, screening for factors that will adversely affect outcome with corticosteroids, engagement of allied health services, and prolonged follow-up. Given the complexities of leprosy management, a safety tool was developed and implemented in the Tropical Disease Unit at Toronto General Hospital. Our objective was to evaluate the utility of the tool using a retrospective chart review.MethodsWe reviewed the charts of patients with leprosy treated over a 3.5-year period: up to 3 years prior to tool implementation, and 6-months following implementation. Pre-determined outcomes of interest included: loss to follow-up; monitoring of laboratory parameters; allied health services engagement; baseline ophthalmologic assessment; and risk mitigation interventions.ResultsOf 17 patients enrolled, 8 were treated pre-implementation, and 9 post-implementation. Five (29.4%) pre-implementation patients were lost to follow-up compared to none post-implementation (p = 0.009). One (12.5%) pre-implementation patient was sent for baseline ophthalmologic assessment versus 8 (88.9%) post-implementation (p = 0.0034). Only post-implementation patients received referrals for occupational therapy and social work, with 77.8% (n = 7) receiving occupational therapy (p = 0.0023) and 33.3% (n = 3) social work (p = 0.2059). Laboratory parameters such as hemoglobin, hepatic transaminases, and methemoglobin were routinely monitored for patients on dapsone irrespective of tool implementation.ConclusionsImplementation of a leprosy-specific safety tool has established a user-friendly method for systemizing all elements of care, and ensuring the involvement of allied health services necessary for optimizing health outcomes.

Distribution Of CD4+RORg-T Th17 And CD25+ FOXP3+ Treg In Leprosy Patient With Reversal Reaction

Background: One of the most common difficulties found in leprosy management is how to manage leprosy reaction, even though MDT has proven to be effective for the patients. Reversal reaction is associated with cell mediated immunity (CMI), consists of T-helper (Th) 1 and Th2 activities. Moreover, subset of CD4+ Th17 and CD25+ FOXP3 Treg were known to have an important role in leprosy’s natural history. Prior study showed a decreasing number of CD25+ FOXP3 Treg and increasing number of CD4+ Th17 in type II reversal reaction (ENL). However, the distribution of Th17 and Treg in type I reversal reaction (RR) has not yet been identified.Objective: To compare the distribution of CD4+ Th17 and CD25+ FOXP3 Treg between RR and ENL patient groups.Method: A total of 50 samples, consisted of 27 samples of reversal reaction (RR) and 23 samples of ENL, were collected. Observation of CD4+ RORg-T Th17 and CD25+ FOXP3 Treg were conducted with immunohistochemistry staining technique using anti FOX-P3 and anti RORg-T. Expression of CD4+ ROR-g Th17 and CD25+ FOXP3 Treg in percentage were analyzed using T-test.Result: There is a significant difference in mean CD4+ ROR-g Th17 and IL17 cell distribution for RR patient group (14.96% and 10.72%) compared with ENL (9.12% and 4.28%). No significant difference were found between mean CD25+ FOXP3 Treg and TGF-β cell distribution in RR patient group (6.12% and 5.44%) compared with ENL group (6.16% and 5.96%).Conclusion: There is a significant increment od CD+RORg-T Th17 and IL17 in RR patients group compared with ENL patients group. however, the distribution of CD25+ FOXP3+ Treg and TGF beta in RR has no significant difference campared with ENL.

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.

Leprosy in Children.

This manuscript aims to review the cutting-edge developments regarding to the diagnosis, management, and prevention of leprosy in children. Leprosy transmission still occurs continuously in some endemic areas in the world. Leprosy in children below 15years old is a robust indicator of active source of infection in the community where they live. A special focus on children to reduce disabilities and reduce transmission is one of the core areas of interventions of the global leprosy strategy 2016-2020. Ongoing research is trying to develop better diagnostic tests and to advance chemoprophylaxis and immunoprophylaxis approaches. Early diagnosis in children can be hard because of the wide range of clinical aspects of the skin lesions and mainly due to the difficulty of performing the clinical peripheral nerve evaluation. We must maintain leprosy expertise and improve the health professionals training for leprosy diagnosis, since we still have a long journey to reach leprosy elimination.

The involvement of endothelial mediators in leprosy.

Leprosy is a chronic infectious disease that requires better understanding since it continues to be a significant health problem in many parts of the world. Leprosy reactions are acute inflammatory episodes regarded as the central etiology of nerve damage in the disease. The activation of endothelium is a relevant phenomenon to be investigated in leprosy reactions. The present study evaluated the expression of endothelial factors in skin lesions and serum samples of leprosy patients. Immunohistochemical analysis of skin samples and serum measurements of VCAM-1, VEGF, tissue factor and thrombomodulin were performed in 77 leprosy patients and 12 controls. We observed significant increase of VCAM-1 circulating levels in non-reactional leprosy (p = 0.0009). The immunostaining of VEGF and tissue factor was higher in endothelium of non-reactional leprosy (p = 0.02 for both) than healthy controls. Patients with type 1 reaction presented increased thrombomodulin serum levels, compared with non-reactional leprosy (p = 0.02). In type 2 reaction, no significant modifications were observed for the endothelial factors investigated. The anti-inflammatory and antimicrobial activities of the endotfhelial factors may play key-roles in the pathogenesis of leprosy and should be enrolled in studies focusing on alternative targets to improve the management of leprosy and its reactions.

Performance of general health workers in leprosy control activities at public health facilities in Amhara and Oromia States, Ethiopia.

BackgroundLeprosy is a chronic infectious disease of public health importance and one of the leading causes of permanent physical disability. Nevertheless, the drop in prevalence following multidrug therapy has resulted in the neglect of leprosy. The annual incidence of leprosy has remained the same in Ethiopia since decades with more than 76 % of the reported new cases coming from Oromia and Amhara Regional States. This study was aimed to assess the knowledge, attitude and skill of general health workers in leprosy control activities at public health facilities in Oromia and Amhara Regional States.MethodsA cross-sectional study was conducted from September 2011 to February 2012 at different public health facilities in selected eight zones in Oromia and Amhara Regional States. A multistage sampling method was used to obtain representative samples. High and low endemic zones for leprosy were included in the study in both regional states. Data were collected from general health workers through a structured self-administered questionnaire and at on-site assessment of their performance. Baseline socio-demographic data, health workers’ attitude towards leprosy and their knowledge and skill in the management of leprosy were assessed. Bloom’s cut off point was used to describe the knowledge and practical skills of the respondents while Likert’s scale was used for attitude assessment.ResultA total of 601 general health workers responsible for leprosy control activities at public health facilities were included in knowledge and attitude assessment and 83 of them were subjected to practical evaluation, with on-site observation of how they handle leprosy patients. These included medical doctors (4 %), health officers and nurses with Bachelor degree in Science (27 %), clinical nurses with diploma (66 %) and health assistants (2.8 %). The median age of the respondents was 26.0 years and females made up of 45 %. Generally the knowledge and skills of the respondents were found to be poor while attitude towards leprosy was positive for the majority of the respondents. The result showed that 519 (86.3 %) had poor knowledge. Overall 155 (25.8 %) of the respondents had positive attitude towards leprosy while 205 (34.1 %) had intermediate (mixed) attitude and 241 (40.1 %) had negative attitude to the disease. Among 83 respondents assessed for diagnosis of leprosy only 15(18.0 %) diagnosed leprosy correctly. Variation in knowledge and attitude indicated a significant difference (p < 0.05) among different health institutions, professions, gender, in-service training and years of experience.ConclusionThe current finding underlines that although leprosy control activities are integrated to the general health services in the country, the knowledge and skills of leprosy diagnosis, treatment and management by health workers was unsatisfactory. Hence, attention should be given to develop training strategies that can improve health worker knowledge and promote better leprosy management at public health facilities. This could be achieved through pre-service and in-service training and giving adequate emphasis to leprosy related practical work and continuous follow- up.

Integrative literature review of the reported uses of serological tests in leprosy management.

An integrative literature review was conducted to synthesize available publications regarding the potential use of serological tests in leprosy programs. We searched the databases Literatura Latino-Americana e do Caribe em Ciências da Saúde, Índice Bibliográfico Espanhol em Ciências da Saúde, Acervo da Biblioteca da Organização Pan-Americana da Saúde, Medical Literature Analysis and Retrieval System Online, Hanseníase, National Library of Medicine, Scopus, Ovid, Cinahl, and Web of Science for articles investigating the use of serological tests for antibodies against phenolic glycolipid-I (PGL-I), ML0405, ML2331, leprosy IDRI diagnostic-1 (LID-1), and natural disaccharide octyl-leprosy IDRI diagnostic-1 (NDO-LID). From an initial pool of 3.514 articles, 40 full-length articles fulfilled our inclusion criteria. Based on these papers, we concluded that these antibodies can be used to assist in diagnosing leprosy, detecting neuritis, monitoring therapeutic efficacy, and monitoring household contacts or at-risk populations in leprosy-endemic areas. Thus, available data suggest that serological tests could contribute substantially to leprosy management.

Pain and quality of life in leprosy patients in an endemic area of Northeast Brazil: a cross-sectional study.

BackgroundPain emerges as a challenge in the treatment of leprosy patients. In this study, we describe the prevalence and type of pain in patients with leprosy, and its effect on patients’ quality of life in an endemic area of Northeast Brazil.FindingsA cross-sectional survey of 260 patients attending leprosy reference centres in Sergipe, Northeast Brazil was conducted. Individuals were assessed for the presence and type of pain, skin sensory loss, peripheral nerve enlargement, touch and pinprick sensations, mechanical allodynia and nerve palpation. Participants completed the Douleur Neuropathique 4 questionnaire, and we also used the Brief Pain Inventory scale and the World Health Organization Quality of Life-BREF instrument to arrive at our results. One hundred and ninety-five (75 %) patients reported pain, mostly of the neuropathic type. Pain was moderate in 84 (43.1 %) and severe in 94 (48.2 %) participants. The presence of pain was associated with disability (p = 0.001), leprosy reactions (p = 0.004) and lower quality of life. Most patients with neuropathic pain were treated with steroids, despite their low efficacy for this type of pain.ConclusionPain is highly prevalent among leprosy patients and is associated with low quality of life. Leprosy management should include a systematic assessment of the type of pain a patient experiences in order to provide adequate treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0113-1) contains supplementary material, which is available to authorized users.

How to improve early case detection in low endemic areas with pockets of leprosy: a study of newly detected leprosy patients in Guizhou Province, People’s Republic of China

Although leprosy in China is controlled at a low endemic level, the number of new cases in Guizhou province has shown no significant decrease over the past 20 years. Guizhou remains the province with the second highest prevalence in China. The authors conducted a study in which the characteristics of newly detected leprosy cases, found between 2008 and 2012 in Guizhou, were analysed. These cases represented people from pocket areas of leprosy in a generally low endemic environment. The purpose of the study was to understand characters of newly detected cases, strong points and weakness of routine detection approaches for improving the effectiveness of early case detection in the future. The analysis considered data that was collected from a 'Leprosy Management Information' report system and also from annual statistical reports of leprosy that reflect the situation throughout the province. 1274 new patients were detected in Guizhou from 2008 to 2012. That number included 58 (4.6%) children (0-14 years old). The average age of patients at diagnosis was 42.6 ± 16.5 years. The proportion of people with WHO Grade 2 disability (WHO DG2) among new patients was 35.7% and the proportion of people with Grade 1 disability (DG1) constituted 10.1%. The average delay before diagnosis after the onset of symptoms of leprosy was 41.7 ± 49.8 months. Suspect survey was a major method by which most cases were detected. Trough this method 790 (62.0%) new patients were detected. It was also in this group that the highest proportion of people with WHO DG2 359 of 790 (45.4%) was reported. Self- reporting, diagnosis at a general skin clinic, household contact examination, and spot surveys accounted for 13.0%, 11.8%, 11.5% and 1.7% of other cases detected respectively. It was generally found that cases detected through household contact examinations were earlier cases (delay to diagnosis < 24 months = 70.7%). It was also recorded that fewer of these had WHO DG2 (12.9%). The proportion of men with WHO DG2 was higher than that of females (38.2% compared with 28.8%). The proportion of Han Chinese new cases with WHO DG2 was significantly higher than that of the main minority group (41.5% compared with 29.2%). The proportion of new cases among the main minority group who self-reported (50%) was significantly higher than those detected through other detection approaches. Detecting leprosy early in low endemic situations where pockets persist was difficult to achieve. The authors suggest that if more early patients are to be detected earlier, the quality of suspect surveys and household contact examination should be improved. Professional training and supervision might affect that result. Greater emphasis should be given to the role of general skin clinics as surveillance sites and advocacy for new health policy that will enhance the detection leprosy should be sustained.