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Dharmawan Y, Korfage IJ, Abqari U, Widjanarko B, Richardus JH. Measuring leprosy case detection delay and associated factors in Indonesia: a community-based study. BMC Infect Dis 2023; 23:555. [PMID: 37626291 PMCID: PMC10464084 DOI: 10.1186/s12879-023-08552-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Leprosy is a public health burden in Indonesia with a high number of new cases every year and a high proportion of disability among new cases. Case detection delay (CDD) can contribute to ongoing transmission and increased disability chances among leprosy patients. This study aimed to establish the CDD of leprosy and the factors associated with detection delay in Indonesia. METHOD Community-based study with a cross-sectional design. Data were collected through interviews about sociodemographic and behavioral factors, anticipated stigma, and duration of CDD. Leprosy classification and case detection methods were obtained from health service records. A random sample was taken of 126 leprosy patients registered between 1st October 2020 and 31st March 2022 in the Tegal regency in the Central Java Province. Data were analysed by descriptive and analytical statistics using multiple linear regression. RESULTS The mean CDD, patient delay, and health system delay were 13.0 months, 9.7 months, and 3.2 months, respectively. Factors associated with longer CDD are younger age (below 35 years), male, found through passive case detection, and not having a family member with leprosy. Factors associated with longer patient delay were being younger (below 35 years), being male, not having a family member with leprosy, and anticipated stigma of leprosy. It was not possible to reliably identify factors associated with health system delay. CONCLUSION CDD in leprosy should be reduced in Indonesia. The Indonesian National Leprosy Control Program (NLCP) is advised to adopt an integrated intervention programme combining active case detection with targeted health education to reduce CDD and thereby preventing disabilities in people affected by leprosy.
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Affiliation(s)
- Yudhy Dharmawan
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
- Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia.
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ulfah Abqari
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- NLR Indonesia, Jakarta, Indonesia
| | - Bagoes Widjanarko
- Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Li X, Jin G, Yang J, Li Y, Wei P, Zhang L. Epidemiological characteristics of leprosy during the period 2005-2020: A retrospective study based on the Chinese surveillance system. Front Public Health 2023; 10:991828. [PMID: 36711406 PMCID: PMC9874668 DOI: 10.3389/fpubh.2022.991828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Background Jiangsu Province is located in the Yangtze River Delta region, with a total area of 107,200 square kilometers. Since 1949, over 55,000 cases have been registered, with Taixing accounting for the highest number of patients. The proportion of new cases with MB and G2D was higher compared to other regions. As a result, Jiangsu has been considered a priority area for public health interventions in China. Methods This paper mainly described the population, time, and spatial distribution of the newly detected leprosy cases in Jiangsu Province between 2005 and 2020. In this study, all the data were entered into Microsoft Excel and SPSS for the descriptive analysis. ArcGIS was applied to create statistical maps, and Geoda was used to conduct spatial autocorrelation analysis with local Moran's I statistics (LISA). The epidemiological data were obtained from LEPMIS. In addition, population data were obtained from the Statistical Yearbook of Jiangsu Province. Results During the study period, 363 new cases were reported. Of these, 232 were men and 131 were women (1.77:1). The mean age at diagnosis was 60.56 years, and no adolescent cases were identified. Three hundred and twenty-seven (90.08%) were diagnosed with MB and 36 (9.92%) with PB. 31.68% (115/363) of the patients presented with G2D. Farmers accounted for 74.9%, and most cases were identified in skin clinics (248, 68.32%). We observed a decreasing trend in detection rate, with a higher concentration of new cases diagnosed between July and October. Spatial analysis showed that the new cases were primarily distributed in the northwest of Jiangsu province, and Suqian has the highest incidence of leprosy. Special attention should be paid to Wuzhong, a county with a potential risk of inter-provincial transmission. Furthermore, 55 new cases came from other Chinese provinces but lived in Jiangsu. Conclusion The NCDR of leprosy decreased, but the new cases showed disabilities, a sign of the late diagnosis. The results indicated that some regions were still suffering from the burden of leprosy. Thus, we recommend that the government should adopt effective strategies to promote leprosy control. The main priorities for eliminating new cases were to provide sustainable financial support, improve the quality of clinical services, strengthen preventive intervention and rehabilitation services for disabilities, provide health education among high-risk populations, and explore new approaches.
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Affiliation(s)
- Xiang Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Guangjie Jin
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jing Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yunhui Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Pingmin Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China,*Correspondence: Pingmin Wei ✉
| | - Lianhua Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China,Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China,Lianhua Zhang ✉
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Mulugeta SS, Maseresha BM, Wassihun SG, Moyehodie YA. Risk Factors for Disability Upgrading Among Leprosy Patients During Treatment: Multilevel Modeling Analysis. SAGE Open Nurs 2022; 8:23779608221129936. [PMID: 36238938 PMCID: PMC9551338 DOI: 10.1177/23779608221129936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background Leprosy not only brings about bodily incapacity but also creates a nasty image of affected individuals, triggering discrimination and social stigma. The purpose of this study was to evaluate the status of leprosy disability in patients registered at the All African TB and Leprosy Rehabilitation and Training Center. Methods The study consists of 205 leprosy patients who were undergoing treatment at the All African TB and Leprosy Rehabilitation and Training Center from January 2015 to December 2019. Regional states of the patients were used as a clustering effect in the multilevel logistic regression model. Results In total, 205 (66.3%) completed records revealed patients with leprosy were disabled. Among these, 64.88% of them were males. In multilevel binary logistic regression analysis, the individual-level variables, such as median age (AOR = 1.1; 95% CI: 1.043, 1.13) of patients, patients with duration of symptom [7-12 months (AOR = 2.26; 95% CI: 1.50, 3.39), 13-24 months (AOR = 2.13; 95% CI: 1.44, 3.15), and more than 24 months (AOR = 2.67; 95% CI: 1.8, 4.02)], the absence of sensory loss (AOR = 0.84; 95% CI: 0.72, 0.96), and patients with asymmetry lesion distribution (AOR = 0.74; 95% CI: 0.65, 0.85), were the most significant determinant factors of disability. The default leprosy patient (AOR = 15.53; 95% CI: 1.82, 134.96) and new leprosy patient (AOR = 0.51; 95% CI: 0.33, 1.68) were the significant determinant factors of disability due to leprosy patients. Conclusion An individual-level factor on the risk of disability was higher as age increased and for patients with a longer duration of symptoms. The risk of disability was lower for patients who do not lose their sensation and for patients whose lesion distribution is asymmetrical. The community-level factor, patient categories, was also a significant factor in disability due to leprosy. Furthermore, programs should emphasize raising community awareness, focusing on key messages and early case detection campaigns, such as active surveys, as well as the availability of leprosy care in a public health facility.
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Affiliation(s)
- Solomon Sisay Mulugeta
- Department of Statistics, College of Natural and Computational
Sciences, Debre Tabor
University, Debre Tabor, Amhara,
Ethiopia,Solomon Sisay Mulugeta, Department of
Statistics, College of Natural and Computational Sciences, Debre Tabor
university, P.O. BOX. 272, Debre Tabor, Amhara, Ethiopia. E.mail:
| | - Bezanesh Melese Maseresha
- Department of Statistics, College of Natural and Computational
Sciences, Debre Tabor
University, Debre Tabor, Amhara,
Ethiopia
| | - Selamawit Getachew Wassihun
- Department of Statistics, College of Natural and Computational
Sciences, Mekdela Amba University, Debre Tabor, Amhara, Ethiopia
| | - Yikeber Abebaw Moyehodie
- Department of Statistics, College of Natural and Computational
Sciences, Debre Tabor
University, Debre Tabor, Amhara,
Ethiopia
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Cisneros J, Ferreira JA, de Faria Grossi MA, de Filippis T, de Oliveira ALG, Lyon S, Fairley JK. Associations between occupation, leprosy disability and other sociodemographic factors in an endemic area of Brazil. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000276. [PMID: 36962742 PMCID: PMC10021318 DOI: 10.1371/journal.pgph.0000276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 08/16/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND In Brazil, new leprosy cases with grade-2 disability (G2D) have been increasing. Physical disability has been associated with experienced stigmatization, psychological distress, and social restriction. OBJECTIVES To identify factors associated with leprosy disability in an endemic area of Brazil focusing on occupational and other sociodemographic factors. METHODS Between July and December 2015, adult patients with multibacillary leprosy who attended a clinic in Belo Horizonte, Brazil were enrolled. Social, clinical, and demographic factors were collected from an administered questionnaire and medical charts. Occupations were categorized as manual vs non-manual. Descriptive statistics and multivariable logistic regression were performed to study associated factors with disability (Grade 1 disability (G1D) and G2D combined). FINDINGS Seventy-three patients were enrolled with 48 (65.8%) presenting with either G1D or G2D at the time of enrollment. Twenty-nine (39.7%) had G2D. About half of the patients (n = 36, 49%) reported a manual labor occupation and reactions were common (n = 53, 73%). On univariate analyses, older age (p = 0.048) and low education (p = 0.007) were associated with disability. On multivariable analyses, only low education (primary or less) was associated with disability (OR = 6.34, 95% CI 1.37, 29.26). Greater distance from clinic, income, smoking, marital status, and occupation were not associated. MAIN CONCLUSIONS Low education was associated with leprosy disability, consistent with prior studies, and therefore should be a focus for disability reduction programs. While the sample size of this study may have limited detection of associations between disability and social determinants tested, half of the patients reported a manual job, highlighting the need for more extensive studies on associations between occupation, disability, and related injuries.
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Affiliation(s)
- Juan Cisneros
- Emory University, Atlanta, Georgia, United States of America
| | | | | | | | | | - Sandra Lyon
- Faculdade da Saúde e Ecologia Humana, Vespasiano, MG, Brazil
- Eduardo de Menezes / FHEMIG, Belo Horizonte, MG, Brazil
| | - Jessica K Fairley
- Emory University School of Medicine, Atlanta, Georgia, United States of America
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Ganguly S, Shravani B, Shukla A, Chhabra N, Prabha N, Sachdev D, Khare S. Grade 2 disability among leprosy patients: A pilot study from an endemic area of Central India. J Family Med Prim Care 2022; 11:1416-1420. [PMID: 35516712 PMCID: PMC9067199 DOI: 10.4103/jfmpc.jfmpc_1375_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/04/2021] [Accepted: 12/07/2021] [Indexed: 11/09/2022] Open
Abstract
Background and Aim: Deformities and disabilities in leprosy lead to significant morbidity to the individual and financial burden to the family. As the prevalence of leprosy is higher in central India, this study was conducted to know the burden of deformity and disability among leprosy patients in central India and the factors associated with it. Materials and methods: This was a hospital-based, cross-sectional study, conducted on 50 new or on treatment or released from treatment leprosy patients, attending the Dermatology OPD of a tertiary care institute in Central India. Disability was graded as per the WHO criteria for disability grading of hands and feet. Results: Grade 2 disability was found among 32% of the patients with leprosy, whereas a total of 60% of our patients had either grade 1 or grade 2 disabilities. Trophic ulcer was found among 20% and claw hand among 14% of leprosy patients. We found significant associations of lepromatous leprosy with trophic ulcer (p = 0.004) and grade 2 disability (p = 0.012). All patients with claw hands and 80% of the patients with trophic ulcers presented to the healthcare facility at least 6 months after the onset of symptoms. Conclusions: We found very high rates of disability and deformity among leprosy patients indicating possible huge burden of morbidity among leprosy patients in central India. The significant association of lepromatous leprosy with trophic ulcer and grade 2 disability indicated delayed presentation and diagnosis of lepromatous leprosy patients. Our results underlined the need for large scale community-based studies on disability and deformity among leprosy patients in Central India. These results also call for better training of primary level healthcare workers for early detection and management of deformities and disabilities as well as better patient education for leprosy patients regarding hand and foot care.
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Dharmawan Y, Fuady A, Korfage I, Richardus JH. Individual and community factors determining delayed leprosy case detection: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009651. [PMID: 34383768 PMCID: PMC8360380 DOI: 10.1371/journal.pntd.0009651] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022] Open
Abstract
Background The number of new leprosy cases is declining globally, but the disability caused by leprosy remains an important disease burden. The chance of disability is increased by delayed case detection. This review focusses on the individual and community determinants of delayed leprosy case detection. Methods This study was conducted according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The study protocol is registered in PROSPERO (code: CRD42020189274). To identify determinants of delayed detection, data was collected from five electronic databases: Embase.com, Medline All Ovid, Web of Science, Cochrane CENTRAL, and the WHO Global Health Library. Results We included 27 papers from 4315 records assessed. They originated in twelve countries, had been published between January 1, 2000, and January 31, 2021, and described the factors related to delayed leprosy case detection, the duration of the delayed case, and the percentage of Grade 2 Disability (G2D). The median delay in detection ranged from 12 to 36 months, the mean delay ranged from 11.5 to 64.1 months, and the percentage of G2D ranged from 5.6 to 43.2%. Health-service-seeking behavior was the most common factor associated with delayed detection. The most common individual factors were older age, being male, having a lower disease-symptom perception, having multibacillary leprosy, and lack of knowledge. The most common socioeconomic factors were living in a rural area, performing agricultural labor, and being unemployed. Stigma was the most common social and community factor. Conclusions Delayed leprosy case detection is clearly correlated with increased disability and should therefore be a priority of leprosy programs. Interventions should focus on determinants of delayed case detection such as health-service-seeking behavior, and should consider relevant individual, socioeconomic, and community factors, including stigmatization. Further study is required of the health service-related factors contributing to delay. Leprosy remains an important public health problem with many new leprosy patients diagnosed with visible physical deformities, indicating a long delay in the detection of cases. For effective prevention programs, it is important to know the factors at the level of the individual and the community that contribute to the delay. We reviewed all published studies that reported individual and community factors related to delayed case detection in leprosy and included 27 studies in our analysis, published between January 1, 2000, and January 31, 2021. Health-service-seeking behavior was the most common factor associated with delay in case detection. The most common individual factors were older age, being male, having a lower disease-symptom perception, having multibacillary leprosy, and lack of knowledge about leprosy. The most common socioeconomic factors were living in a rural area, performing agricultural labor, and being unemployed. Stigma was the most common social and community factor associated with detection delay. The presence of physical disability in newly diagnosed leprosy patients is clearly related to the delay in detecting these patients. Leprosy control interventions should take factors related to detection delay into account more comprehensively. Also, there is a need to study health service-related factors that contribute to detection delay of leprosy patients.
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Affiliation(s)
- Yudhy Dharmawan
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
- * E-mail: , (YD)
| | - Ahmad Fuady
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ida Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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do Espírito Santo RB, Gonçalves DVC, Serafim RA, Loureiro RM, Sumi DV, de Mello RAF, Collin SM, Deps P. Evaluation of proposed cranial and maxillary bone alteration parameters in persons affected by Hansen's disease. PLoS Negl Trop Dis 2021; 15:e0009694. [PMID: 34432803 PMCID: PMC8386868 DOI: 10.1371/journal.pntd.0009694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/30/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Rachel Azevedo Serafim
- Department of Social Medicine, Postgraduate Programme in Infectious Diseases, Federal University of Espírito Santo, Vitória-ES, Brazil
| | | | | | | | - Simon M. Collin
- National Infection Service, Public Health England, London, United Kingdom
| | - Patrícia Deps
- Department of Social Medicine, Postgraduate Programme in Infectious Diseases, Federal University of Espírito Santo, Vitória-ES, Brazil
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Li YY, Shakya S, Long H, Shen LF, Kuang YQ. Factors Influencing Leprosy Incidence: A Comprehensive Analysis of Observations in Wenshan of China, Nepal, and Other Global Epidemic Areas. Front Public Health 2021; 9:666307. [PMID: 34136455 PMCID: PMC8200479 DOI: 10.3389/fpubh.2021.666307] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
Leprosy remains endemic in some regions and is a global health concern. However, the possible causes and risk factors of the disease remain unclear. Data in Wenshan, China were collected from the Wenshan Institute of Dermatology (1986-2015); data in Nepal were obtained from the Leprosy Control Division, Department of Health Services, Nepal (2011 to 2015); and data from Indonesia, India, and Brazil were collected from WHO records. We assessed the epidemiological trends of leprosy in Wenshan and compared the features of possible causes and risk factors with those of other countries. We then performed a descriptive and statistical analysis to make our study more purposeful and definitive. A total of 3,376 cases were detected in Wenshan from 1986 to 2015. The overall prevalence rate (PR) of leprosy presented a decreasing trend with a peak (4.9/10,000 population) in 1986. The detection of new leprosy cases was higher in males than in females. Visible deformity increased every year since 2005 with a disability of 34.8% in 2015 among new cases. In Nepal, 2,461 leprosy patients received multi-drug therapy (MDT) in 2015 which corresponded to the PR of 0.89/10,000 population. Geographic latitude and socio-economic situations appeared to be the main causes of leprosy, and the healthcare condition was an important factor associated with leprosy incidence. The introduction of MDT effectively reduced leprosy prevalence worldwide. Wenshan (China), Nepal, and other countries share similarities in various aspects with respect to socio-cultural features, geographical distribution, environmental factors, and economic situation, which may contribute to leprosy being endemic in these areas.
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Affiliation(s)
- Yu-Ye Li
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China.,NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
| | - Sunaula Shakya
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China.,NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
| | - Heng Long
- Wenshan Institute of Dermatology, Wenshan, China
| | - Lian-Fa Shen
- Wenshan Institute of Dermatology, Wenshan, China
| | - Yi-Qun Kuang
- NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China.,Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
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van Netten WJ, van Dorst M, Waltz M, Pandey B, Aley D, Choudhary R, van Brakel W. Mental wellbeing among people affected by leprosy in the Terai region, Nepal. LEPROSY REV 2021. [DOI: 10.47276/lr.92.1.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ferreira AF, Amorim de Sousa E, Soledad Márdero García G, da Silva Dos Reis A, Corona F, da Silveira Lima M, Silva Nascimento Andrade E, Ribeiro Filha C, Alves de Sena Neto S, Mendes Donato I, Novaes Ramos A. Leprosy in the North and Northeast regions of Brazil: an integrated spatiotemporal approach. Trop Med Int Health 2019; 25:193-208. [PMID: 31713982 DOI: 10.1111/tmi.13343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To analyse the spatiotemporal patterns of leprosy occurrence in the North and Northeast regions of Brazil from 2001 to 2017. METHODS Mixed population-based ecological study with spatial and temporal trend analysis of epidemiological indicators based on new cases reported to the Information System for Notifiable Diseases of the Ministry of Health occurring in individuals residing in North and Northeast states of Brazil. RESULTS A total of 396 987 new cases were analysed; 9.2% of these involved children <15 years of age, and 5.4% involved individuals with grade 2 disability (G2D). The Northeast region recorded 66.4% of the new cases. Most cases involved males between 15 and 59 years of age and of brown race/colour. The temporal trend showed a reduction in most of the indicators and study variables. The G2D rate did not have trends over time in the Northeast Region, in individuals 0-14 years of age, or in municipalities with 'very high' social vulnerability indexes. The spatial and spatiotemporal analysis showed the presence of hyperendemic foci with high detection risk involving municipalities in the states of Tocantins, Pará and Maranhão. CONCLUSION Leprosy in the North and Northeast regions of Brazil persists as a critical public health problem. Temporal and spatiotemporal patterns identified in this study confirm that leprosy remains epidemiologically relevant in vulnerable areas. Surveillance and control interventions are needed in municipalities with low detection in the general population, in children and in individuals with G2D, to reduce late diagnosis.
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Affiliation(s)
- Anderson Fuentes Ferreira
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Eliana Amorim de Sousa
- Multidisciplinary Health Institute, Federal University of Bahia - Anísio Teixeira Campus, Vitória da Conquista, Bahia, Brazil
| | | | - Adriana da Silva Dos Reis
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Francesco Corona
- Science Centre, Department of Computer Science, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Carmelita Ribeiro Filha
- General Coordination of Leprosy and Disappearing Diseases, Ministry of Health, Brasília, Federal District, Brazil
| | | | - Isaac Mendes Donato
- School of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Alberto Novaes Ramos
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
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Ruiz-Fuentes JL, Rumbaut Castillo R, Hurtado Gascón LDLC, Pastrana F. Leprosy in children: a Cuban experience on leprosy control. BMJ Paediatr Open 2019; 3:e000500. [PMID: 31799450 PMCID: PMC6863670 DOI: 10.1136/bmjpo-2019-000500] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Children are believed to be the most vulnerable group to leprosy. Childhood leprosy reflects disease transmission in the community as well as the efficiency of ongoing disease control programmes. In Cuba, leprosy is not a national health problem; however, new childhood leprosy cases are diagnosed every year. OBJECTIVE We summarise the experience of Cuba on childhood leprosy control over the past two decades. RESULTS Between 2000 and 2017, a total of 103 children in Cuba have been diagnosed with leprosy, showing that active transmission of cases remains in 13 of 15 provinces of Cuba. The majority of cases were multibacillary (66%), and 34% were paucibacillary cases. Clinically 60% of children have more than five lesions all over their body. Voluntary reporting was the principal method of case detection. The presence of familial and extrafamilial contact with leprosy cases may be a cause of concern, as it implies continuing transmission of the disease. Only four children had disabilities (one with grade 2 disabilities and three with grade 1 disabilities). A set of national investigations have been developed to intervene in a timely manner. Intervention strategies that combine clinical surveillance and laboratory test could be an option for early detection of childhood leprosy. CONCLUSIONS Early detection of cases due to effective health education campaigns, regular and complete treatment with MDT, and contact tracing may be important in reducing the burden of leprosy in the community.
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Factors Associated with Multibacillary Leprosy in a Priority Region for Disease Control in Northeastern Brazil: A Retrospective Observational Study. J Trop Med 2019; 2019:5738924. [PMID: 30911302 PMCID: PMC6397966 DOI: 10.1155/2019/5738924] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/09/2018] [Accepted: 01/17/2019] [Indexed: 01/09/2023] Open
Abstract
Background Leprosy is an infectious disease that can lead to physical disabilities and stigmatization. It remains an important public health problem, especially in Brazil. Objective To analyse sociodemographic and clinical factors associated with multibacillary leprosy in a hyperendemic region of the disease in northeastern Brazil. Method This is a retrospective observational study with secondary data acquired from 2012 to 2015, from a group of leprosy cases reported in a reference outpatient clinic for the treatment and followup of leprosy in the city of Imperatriz, Maranhao, in northeastern Brazil. Results From 905 new cases of leprosy studied, 656 (72.5%) were classified as multibacillary leprosy and 249 (27.5%) as paucibacillary leprosy. We observed that men were more likely to present 5 to 15 skin lesions (OR: 1.32; 95% CI: 1.18-1.49; p <0.0001) and >15 skin lesions (OR: 1.26; 95% CI: 1.09 -1.45; p = 0.005) and a lower chance of having <5 skin lesions (OR: 0.67; 95% CI: 0.59-0.76; p <0.0001). Women were more likely to have no affected nerves compared to men (OR: 1.46; 95% CI: 1.20-1.77; p <0.0001). The age range of 16 to 60 years showed a greater chance of having <5 skin lesions (OR: 1.01; 95% CI: 1.007-1.20; p = 0.03) and a lower chance of having 5 to 15 skin lesions (OR: 1.12, 95% CI: 1.03-1.23; p= 0.008) and a lower chance of being a grade I disability ( CI= 0.73-0.94; p=0.83) and II (OR: 0.82; 95% CI: 0.77-0.98; p=000.1). Conclusion Cases of multibacillary leprosy were associated with male gender, low educational level, and clinical variables such as number of skin lesions and grade I or II disability.
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Kolleri JJ, Sasidharanpillai S, Vadakkayil B, Chathoth AT. A 10-year Retrospective Descriptive Study on Pure Neuritic Leprosy from a Tertiary Referral Centre. Indian Dermatol Online J 2019; 10:13-18. [PMID: 30788282 PMCID: PMC6362753 DOI: 10.4103/idoj.idoj_118_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
CONTEXT Pure neuritic leprosy is a risk factor for grade 2 disability owing to the early nerve damage. AIMS To study the clinical patterns of neuritic leprosy, to determine the percentage of patients manifesting grade 2 disability at the time of diagnosis and to identify any risk factors for the same. SETTINGS AND DESIGN Retrospective descriptive study from previous case records of pure neuritic leprosy patients who attended a tertiary centre from 1st July 2007 to 30th June 2017. SUBJECTS AND METHODS Data on patients who satisfied the World Health Organization (WHO) cardinal criteria for diagnosis of leprosy, who had no skin lesion of leprosy and had acid-fast bacilli negative status on skin smears were collected using a pre-set proforma. STATISTICAL ANALYSIS USED The Chi-square test was used to assess statistical significance and logistic regression model was applied to avoid the effects of confounding factors. RESULTS A diagnostic delay of >1 year was observed in 44% patients. At the time of diagnosis, grade 2 disability was documented in 60 (80%) of patients. No statistically significant risk factor was identified for grade 2 disability. LIMITATIONS Retrospective nature and the study conducted in a tertiary care centre not reflecting the status in the community were the limitations. CONCLUSIONS Grade 2 disability noted in 80% of patients points to the inherent nature of disease to cause early nerve damage. Diagnostic delay of >1 year documented in 44% of patients underscores the diagnostic challenges in the absence of skin lesions.
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Affiliation(s)
- Jouhar Jabeen Kolleri
- Department of General Medicine, Government Medical College, Kozhikode, Kerala, India
| | - Sarita Sasidharanpillai
- Department of Dermatology and Venereology, Government Medical College, Kozhikode, Kerala, India
| | - Bindu Vadakkayil
- Department of Community Medicine, Government Medical College, Kozhikode, Kerala, India
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Marahatta SB, Amatya R, Adhikari S, Giri D, Lama S, Kaehler N, Rijal KR, Marahatta S, Adhikari B. Perceived stigma of leprosy among community members and health care providers in Lalitpur district of Nepal: A qualitative study. PLoS One 2018; 13:e0209676. [PMID: 30589875 PMCID: PMC6307718 DOI: 10.1371/journal.pone.0209676] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 12/07/2018] [Indexed: 02/06/2023] Open
Abstract
Background Leprosy remains a major stigmatizing condition. Stigma is a dynamic process resulting from the interaction between physical attributes caused by leprosy and the existing stereotypes in a community. Leprosy has pervasive impacts on all areas of life including psychosocial burden to an individual, social interaction, marriage, and employment. These impacts vary and are largely dependent on a particular culture and community. The main objective of this study was to explore the perceived stigma of leprosy amongst community members and health care providers in Lalitpur district of Nepal. Methods A total of six focused group discussions (FGDs) with 43 participants from a community living close to Anandaban Leprosy Hospital and ten semi structured interviews (SSIs) with health care providers were conducted between October and December 2016. An interview guide was used for the FGDs and SSIs. All qualitative data were transcribed and translated into English and were thematically analyzed using Atlas.ti software. Results Visible deformities due to leprosy was one of the major contributing factors for stigma. Stigma was further exacerbated by an attitude to conceal the disease due to perceived fear of potential discrimination. While over the years, stigma was felt to be decreasing, various aspects of life were still affected by leprosy stigma including marriage, employment and social interaction. This was largely attributed to leprosy and its consequences, specifically the disability and deformity caused by leprosy. Conclusion Leprosy was still perceived to be feared and concealed because of potential discrimination, even within the community that was close to a long established leprosy hospital. Various aspects such as marriage, employment and social interaction were still affected by the stigma which was strongly associated with visible deformities. In addition to ongoing rehabilitation and stigma reduction programs, integrating strategies such as community engagement wherein community and leprosy affected person jointly take a role in stigma reduction programs can be helpful.
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Affiliation(s)
| | - Rakchya Amatya
- Manmohan Memorial Institute of Health Sciences, Swayambhu, Kathmandu, Nepal
| | - Srijana Adhikari
- Manmohan Memorial Institute of Health Sciences, Swayambhu, Kathmandu, Nepal
| | - Deena Giri
- Manmohan Memorial Institute of Health Sciences, Swayambhu, Kathmandu, Nepal
| | - Sarina Lama
- Manmohan Memorial Institute of Health Sciences, Swayambhu, Kathmandu, Nepal
| | - Nils Kaehler
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | | | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- * E-mail:
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Katoch K, Aggarwal A, Yadav VS, Pandey A. National sample survey to assess the new case disease burden of leprosy in India. Indian J Med Res 2018; 146:585-605. [PMID: 29512601 PMCID: PMC5861470 DOI: 10.4103/ijmr.ijmr_1496_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A national sample survey of leprosy was undertaken in partnership with Indian Council of Medical Research (ICMR) institutions, National Leprosy Eradication Programme (NLEP), Panchayati Raj members, and treated leprosy patients to detect new cases of leprosy in India. The objectives of the survey were to estimate the new leprosy case load; record both Grade 1 and Grade 2 disabilities in the new cases; and to assess the magnitude of stigma and discrimination prevalent in the society. A cluster based, cross-sectional survey involving all States was used for the door-to-door survey using inverse sampling methodology. Rural and urban clusters were sampled separately. The population screened for detecting 28 new cases in rural and 30 in urban clusters was enumerated, recorded and analyzed. Data capture and analysis in different schedules were the main tools used. For quality control three tiers of experts were utilized for the confirmation of cases and disabilities. Self-stigma was assessed in more than half of the total new patients detected with disabilities by the approved questionnaire. A different questionnaire was used to assess the stigma in the community. A population of 14,725,525 (10,302,443 rural; 4,423,082 urban) was screened and 2161 new cases - 1300 paucibacillary (PB) and 861 multibacillary (MB) were detected. New case estimates for leprosy was 330,346 (95% Confidence limits, 287,445-380,851). Disabilities observed in these cases were 2.05/100,000 population and 13.9 per cent (302/2161) in new cases. Self-stigma in patients with disabilities was reduced, and the patients were well accepted by the spouse, neighbour, at workplace and in social functions.
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Affiliation(s)
- Kiran Katoch
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases (ICMR), Agra, India
| | - Abha Aggarwal
- ICMR-National Institute of Medical Statistics, New Delhi, India
| | - Virendra Singh Yadav
- ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases (ICMR), Agra, India
| | - Arvind Pandey
- ICMR-National Institute of Medical Statistics, New Delhi, India
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Pinto ACVD, Wachholz PA, Silva GVD, Masuda PY. Profile of leprosy in children under 15 years of age monitored in a Brazilian referral center (2004-2012). An Bras Dermatol 2017; 92:580-582. [PMID: 28954121 PMCID: PMC5595619 DOI: 10.1590/abd1806-4841.20175676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/29/2016] [Indexed: 11/22/2022] Open
Abstract
Leprosy in children under 15 years of age is a serious public health problem. In this retrospective case series conducted in a Brazilian reference center (2004-2012), we found 18 cases with a mean age of 10.0±3.6 years of age and 16.6% between 0-5 years of age. Almost 56% of the cases were female, with a median time between the first symptoms and diagnosis of 11 months (4-24); 77.8% reported household contact with leprosy patients. Upon hospital admission, 66.7% presented mostly skin symptoms, while 27.8% presented a degree 2 disability. Most were classified as multibacillary (66.7%). Half of the sample developed a reaction (predominantly type 1) during the follow-up period, while 22.2% developed a late disability.
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Affiliation(s)
| | - Patrick Alexander Wachholz
- Department of Public Health, Botucatu School of Medicine, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP) - Botucatu (SP), Brazil
| | | | - Paula Yoshiko Masuda
- Department of Dermatology, Instituto Lauro de Souza Lima (ILSL) - Bauru (SP), Brazil
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Odriozola EPD, Quintana AM, González V, Pasetto RA, Utgés ME, Bruzzone OA, Arnaiz MR. Towards leprosy elimination by 2020: forecasts of epidemiological indicators of leprosy in Corrientes, a province of northeastern Argentina that is a pioneer in leprosy elimination. Mem Inst Oswaldo Cruz 2017; 112:419-427. [PMID: 28591402 PMCID: PMC5446231 DOI: 10.1590/0074-02760160490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/04/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Corrientes, a province of northeastern Argentina with endemic leprosy, has improved its epidemiological indicators, however, a study of the dynamics over time is lacking. OBJECTIVES We analysed data of 1308 leprosy patients between 1991 to 2014, and the forecast for 2020. METHODS Descriptive statistics and stepwise Bayesian model selection were performed. Forecasts were made using the median of 100,000 projections using the parameters calculated via Monte Carlo methods. RESULTS We found a decreasing number of new leprosy cases (-2.04 cases/year); this decrease is expected to continue by an estimated 20.28 +/- 10.00 cases by 2020, evidenced by a sustained decline in detection rate (from 11 to 2.9/100,000 inhabitants). Age groups that were most affected were 15-44 (40.13%) and 45-64 (38.83%) year olds. Multibacillary forms (MB) predominated (70.35%) and while gradually declining, between 10 and 30% developed disability grade 2 (DG2) (0.175 (0.110 - 0.337) DG2/MB cases), with a time delay between 0 to 15 years (median = 0). The proportion of MB clinic forms and DG2 increased and will continuously increase in the short term (0.036 +/- 0.018 logit (MB/total of cases). MAIN CONCLUSIONS Corrientes is on the way to eliminating leprosy by 2020, however the increased proportion of MB clinical forms and DG2 signals a warning for disease control efforts.
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Affiliation(s)
| | | | - Victor González
- Programa Nacional para el Control de Tuberculosis y Lepra, Argentina
| | | | - María Eugenia Utgés
- Centro de Diagnóstico e Investigación en Endemo-Epidemias, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - María Rosa Arnaiz
- Centro de Diagnóstico e Investigación en Endemo-Epidemias, Ciudad Autónoma de Buenos Aires, Argentina
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Clinical Characteristics and Treatment of Leprosy. CURRENT TROPICAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40475-016-0095-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Freitas LRS, Duarte EC, Garcia LP. Trends of main indicators of leprosy in Brazilian municipalities with high risk of leprosy transmission, 2001-2012. BMC Infect Dis 2016; 16:472. [PMID: 27595751 PMCID: PMC5011946 DOI: 10.1186/s12879-016-1798-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 08/23/2016] [Indexed: 11/26/2022] Open
Abstract
Background Leprosy incidence has reduced in recent years in Brazil, although the disease still persists as a public health problem in some regions. To investigate the trends of selected leprosy indicators in Brazilian municipalities with high risk of transmission is essential to provide effective control of the disease, yet this area has not been investigated. Methods This is an ecological time-series study with multiple groups using Notifiable Diseases Information System (SINAN) data. All 692 municipalities of the states of Mato Grosso, Tocantins, Rondônia, Pará and Maranhão were included. The incidence rates of leprosy were calculated, as well as incidence rates in children under 15 years per 100,000 inhabitants and rates of new cases presenting grade-2 disabilities per 100,000 inhabitants. Joinpoint Regression was used to analyse the time trends of the different indicators studied. The spatial distribution of temporal variations of the indicators in the period was presented. Results Between 2001 and 2012, 176,929 leprosy cases were notified in the area studied, this being equivalent to 34.6 % of total cases in Brazil. In the aggregate of municipalities, there was a reduction in incidence rate of leprosy from 89.10 to 56.98 new cases per 100,000 inhabitants between 2001 and 2012, with a significant reduction between 2003 and 2012 (APC: − 6.2 %, 95 % CI: −7.2 % to −5.2 %). The incidence rate in <15 years also reduced significantly between 2003 and 2012 (APC: −5.6 %; 95 % CI: −7.2 % to −4.1 %). The rate of new cases with grade 2 disability remained stable between 2001 and 2012 (APC: −1.3 %; 95 % CI: −2.6 % to 0.1 %). Conclusion Despite the reduction in the leprosy incidence rate, strategies for controlling this disease need to be enhanced to enable early case detection, especially in hyperendemic municipalities, in order to prevent disability.
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Affiliation(s)
- Lucia R S Freitas
- Programa de Pós-Graduação em Medicina Tropical, Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil.
| | - Elisabeth C Duarte
- Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
| | - Leila P Garcia
- Instituto de Pesquisa Econômica Aplicada, Brasília, Brazil
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Maia FB, Teixeira ER, Silva GV, Gomes MK. The Use of Assistive Technology to Promote Care of the Self and Social Inclusion in Patients with Sequels of Leprosy. PLoS Negl Trop Dis 2016; 10:e0004644. [PMID: 27124408 PMCID: PMC4849766 DOI: 10.1371/journal.pntd.0004644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/30/2016] [Indexed: 11/21/2022] Open
Abstract
Background This study is about the contribution of occupational therapy inside a rehabilitation group, and we focus on the autonomy of patients with disabilities due to leprosy. There are few studies on the use of assistive technology by leprosy patients; to our knowledge, none of them aim to have a subjective approach of care. Our purpose was to analyze the repercussions of assistive technology on autonomy of care of the self in patients with sequels of leprosy. Methods A qualitative, descriptive exploratory study with a semi-structured interview and a field observation as a research method was conducted between November 2014 and February 2015 at a University Hospital in Rio de Janeiro. Findings Eight patients from the service of Occupational Therapy were interviewed, and 44 hours of observation were performed. Interviews followed a semi-structured script and a field journal was used to take notes. Analysis was conducted by the hermeneutic approach. Costs were obtained after a global cost analysis of the fixed and variable expenses and direct and indirect costs to the manufactured products with an amount of 100 dollars. Results were grouped according to the following categories: contribution of the adapted devices for the care of the self and feelings and sensations provoked by the use of self-help devices. The reports revealed feelings, perceptions and meaningful contents about the social, familiar and individual dimensions, also the stigma coupled with leprosy. However, forms of re-signification were elaborated. Conclusions Assistive technology empowers the subject to perform care of the self and promotes social inclusion. This study is about occupational therapy and we focus on the autonomy of patients with disabilities due to leprosy. Our purpose was to analyze the repercussions of assistive technology on the autonomy of care of the self in patients with sequels of leprosy We performed a qualitative, descriptive, exploratory study between November 2014 and February 2015 at a university hospital in Rio de Janeiro, and interviewed eight patients. Analysis was conducted by the hermeneutic approach. The following categories were studied: contribution of the adapted devices for the care of the self and feelings and sensations provoked by the use of self-help devices. The reports revealed feelings, perceptions and meaningful contents about the social, familiar and individual dimensions, also the stigma coupled with leprosy. Assistive technology is an approach with a powering potential that provides tools for the subject's care of the self and promotes social inclusion.
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Affiliation(s)
- Fátima Beatriz Maia
- Departamento de Terapia Ocupacional, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
| | - Enéas Rangel Teixeira
- Escola de Enfermagem Aurora de Afonso Costa, Universidade Federal Fluminense, Niteroi, Rio de Janeiro, Brazil
| | - Gislaine Valeria Silva
- Programa de Pós-Graduação em Clínica Médica, Hospital Universitário Clementino Fraga Filho e Departamento de Medicina de Família e Comunidade/Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Katia Gomes
- Programa de Pós-Graduação em Clínica Médica, Hospital Universitário Clementino Fraga Filho e Departamento de Medicina de Família e Comunidade/Faculdade de Medicina da Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Leon KE, Jacob JT, Franco-Paredes C, Kozarsky PE, Wu HM, Fairley JK. Delayed Diagnosis, Leprosy Reactions, and Nerve Injury Among Individuals With Hansen's Disease Seen at a United States Clinic. Open Forum Infect Dis 2016; 3:ofw063. [PMID: 27186586 PMCID: PMC4866574 DOI: 10.1093/ofid/ofw063] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/21/2016] [Indexed: 01/10/2023] Open
Abstract
Background. Hansen's disease (HD), or leprosy, is uncommon in the United States. We sought to describe the characteristics of patients with HD in a US clinic, including an assessment of delays in diagnosis and HD reactions, which have both been associated with nerve damage. Methods. A retrospective chart review was conducted on patients seen at an HD clinic in the southern United States between January 1, 2002 and January 31, 2014. Demographic and clinical characteristics were summarized, including delays in diagnosis, frequency of reactions, and other complications including peripheral neuropathy. Results. Thirty patients were seen during the study time period. The majority of patients were male (73%) and had multibacillary disease (70%). Brazil, Mexico, and the United States were the most frequent of the 14 countries of origin. Hansen's disease "reactions", severe inflammatory complications, were identified among 75% of patients, and nerve damage was present at diagnosis in 36% of patients. The median length of time between symptom onset and diagnosis was long at 12 months (range, 1-96), but no single factor was associated with a delay in diagnosis. Conclusions. The diagnosis of HD was frequently delayed among patients referred to our US clinic. The high frequency of reactions and neuropathy at diagnosis suggests that further efforts at timely diagnosis and management of this often unrecognized disease is needed to prevent the long-term sequelae associated with irreversible nerve damage.
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Affiliation(s)
| | - Jesse T Jacob
- Division of Infectious Diseases, Department of Medicine , Emory University School of Medicine
| | - Carlos Franco-Paredes
- Phoebe Putney Memorial Hospital, Albany, Georgia; Hospital Infantil de Mexico, Federico Gomez
| | - Phyllis E Kozarsky
- Division of Infectious Diseases, Department of Medicine , Emory University School of Medicine
| | - Henry M Wu
- Division of Infectious Diseases, Department of Medicine , Emory University School of Medicine
| | - Jessica K Fairley
- Division of Infectious Diseases, Department of Medicine , Emory University School of Medicine
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Brook CE, Beauclair R, Ngwenya O, Worden L, Ndeffo-Mbah M, Lietman TM, Satpathy SK, Galvani AP, Porco TC. Spatial heterogeneity in projected leprosy trends in India. Parasit Vectors 2015; 8:542. [PMID: 26490137 PMCID: PMC4618538 DOI: 10.1186/s13071-015-1124-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 09/30/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Leprosy is caused by infection with Mycobacterium leprae and is characterized by peripheral nerve damage and skin lesions. The disease is classified into paucibacillary (PB) and multibacillary (MB) leprosy. The 2012 London Declaration formulated the following targets for leprosy control: (1) global interruption of transmission or elimination by 2020, and (2) reduction of grade-2 disabilities in newly detected cases to below 1 per million population at a global level by 2020. Leprosy is treatable, but diagnosis, access to treatment and treatment adherence (all necessary to curtail transmission) represent major challenges. Globally, new case detection rates for leprosy have remained fairly stable in the past decade, with India responsible for more than half of cases reported annually. METHODS We analyzed publicly available data from the Indian Ministry of Health and Family Welfare, and fit linear mixed-effects regression models to leprosy case detection trends reported at the district level. We assessed correlation of the new district-level case detection rate for leprosy with several state-level regressors: TB incidence, BCG coverage, fraction of cases exhibiting grade 2 disability at diagnosis, fraction of cases in children, and fraction multibacillary. RESULTS Our analyses suggest an endemic disease in very slow decline, with substantial spatial heterogeneity at both district and state levels. Enhanced active case finding was associated with a higher case detection rate. CONCLUSIONS Trend analysis of reported new detection rates from India does not support a thesis of rapid progress in leprosy control.
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Affiliation(s)
- Cara E Brook
- Department of Ecology & Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - Roxanne Beauclair
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,The South African Department of Science and Technology/National Research Foundation (DST/NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Olina Ngwenya
- The South African Department of Science and Technology/National Research Foundation (DST/NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Lee Worden
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | | | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Sudhir K Satpathy
- School of Public Health, KIIT University, Bhubaneswar, Odisha, India
| | | | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA. .,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA. .,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
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Monteiro LD, Martins-Melo FR, Brito AL, Lima MDS, Alencar CH, Heukelbach J. Tendências da hanseníase no Tocantins, um estado hiperendêmico do Norte do Brasil, 2001-2012. CAD SAUDE PUBLICA 2015; 31:971-80. [DOI: 10.1590/0102-311x00075314] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 12/01/2014] [Indexed: 11/22/2022] Open
Abstract
A hanseníase é hiperendêmica no Estado do Tocantins, Brasil. O objetivo do estudo foi analisar as tendências dos indicadores da hanseníase no Tocantins em 2001-2012. Análise de dados advindos do Sistema de Informação de Agravos de Notificação (SINAN). Incluíram-se casos novos de residentes no Tocantins. Calcularam-se os indicadores da hanseníase e analisaram-se as tendências temporais por meio de regressão polinomial. Houve tendência significativa e decrescente para a detecção geral (R2 = 0,40; p < 0,05) e proporção de casos paucibacilares (R2 = 0,81). Foi estável a detecção em < 15 anos (R2 = 0,48; p > 0,05), detecção de casos com grau 2 de incapacidade física (R2 = 0,37; p > 0,05) e proporção de casos com grau 2 (R2 = 0,49; p > 0,05). Houve aumento significativo para a proporção de casos com grau 1 de incapacidade (R2 = 0,82; p < 0,05) e proporção de casos multibacilares (R2 = 0,81; p < 0,05). O Tocantins apresenta regiões com alta transmissão e diagnóstico tardio da hanseníase, apontando a expansão da doença de forma heterogênea na análise temporal.
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Affiliation(s)
- Lorena Dias Monteiro
- Secretaria de Estado da Saúde do Tocantins, Brasil; Universidade Federal do Ceará, Brasil
| | | | | | | | | | - Jorg Heukelbach
- Universidade Federal do Ceará, Brasil; James Cook University, Australia
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Duarte-Cunha M, Marcelo da Cunha G, Souza-Santos R. Geographical heterogeneity in the analysis of factors associated with leprosy in an endemic area of Brazil: are we eliminating the disease? BMC Infect Dis 2015; 15:196. [PMID: 25906984 PMCID: PMC4424884 DOI: 10.1186/s12879-015-0924-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/01/2015] [Indexed: 11/24/2022] Open
Abstract
Background The leprosy transmission chain is very complex and, in order to intervene in this transmission, more must be known about the factors linked to falling ill. There are doubts as to the influence of population size, population density and the disease’s magnitude in detection rate trends. This paper aimed to identify factors associated with detection of leprosy in an endemic municipality of Rio de Janeiro State, Brazil. Methods This ecological study in Duque de Caxias municipality, Rio de Janeiro State, Brazil, used neighbourhoods (bairros) as the unit of analysis. Selecting new cases of leprosy detected from 1998 to 2006, the analysis examined clinical, socioeconomic and service variables using a Poisson log-Normal model. Results In the municipality overall, 2572 new cases were detected, a rate of 3.70 cases/10,000 inhabitants. The results describe a heterogeneous distribution of cases and rates in the municipality. The final model displayed a significant association with indeterminate clinical form (β = 2.599), proportion of homes with running water (β = -2.334) and presence of a decentralised health care unit (β = 0.524). Conclusion Although the results indicate progress towards elimination of the disease in the municipality, high rates continue to be detected in municipal sub-regions. The following question can thus be posed: over how wide a geographical area could the disease be thoroughly eliminated, given this heterogeneity within a small municipality?
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Affiliation(s)
- Mônica Duarte-Cunha
- Department of Health Surveillance, Municipal Health Secretariat, Duque de Caxias, Rua James Franco, 3, Duque de Caxias, Rio de Janeiro, 25215-260, Brazil.
| | - Geraldo Marcelo da Cunha
- Department of Epidemiology, National School of Public Health Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Rio de Janeiro, Rio de Janeiro, 21041-210, Brazil.
| | - Reinaldo Souza-Santos
- Department of Endemic Diseases Samuel Pessoa, National School of Public Health Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Rio de Janeiro, Rio de Janeiro, 21041-210, Brazil.
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Abstract
BACKGROUND Leprosy in children is still a frequent but sometimes unrecognized public health problem and an important cause of disability. Establishing the risk factors that lead to the development of disability is important for the development of suitable prevention programs. We describe the incidence of leprosy and the prevalence and degree of associated disabilities in children<15 years of age at the time of first presentation to the health services in Aracaju, Sergipe, Northeast Brazil. METHODS A retrospective case series of 266 cases of leprosy in children under 15 years old of Aracaju from 2001 to 2012. Logistic regressions were performed to identify factors for disability. RESULTS The average detection rate was 16.5/100,000 children under 15 years old per year over the study period. Physical disability was associated with the presence of affected nerves and multibacillary leprosy. CONCLUSIONS The detection rate of leprosy in children is still high in Aracaju, Northeast Brazil. Having affected nerves and multibacillary leprosy are associated with the development of disability in children.
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Freitas LRS, Duarte EC, Garcia LP. Leprosy in Brazil and its association with characteristics of municipalities: ecological study, 2009-2011. Trop Med Int Health 2014; 19:1216-25. [PMID: 25040160 DOI: 10.1111/tmi.12362] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyse the ecological association between the demographic and socio-economic characteristics of the Brazilian municipalities and average leprosy incidence rate in the period 2009-2011. METHODS An ecological study taking the Brazilian municipalities as its units of analysis. The local empirical Bayes estimation method was used to obtain smoothed incidence rates (SIR) for leprosy. The mean, median, first quartile (Q1) and third quartile (Q3) of the SIR were calculated per 100 000 inhabitants. Hierarchical log-linear negative binomial regression models were used to estimate the incidence rate ratios (IRR). RESULTS In the period 2009-2011, the average SIR of leprosy in Brazil was 20.2 per 100 000 inhabitants, and the median incidence rate among municipalities was 9.1 per 100 000 inhabitants. Significantly higher adjusted IRR were identified for large municipalities (IRR = 1.67) compared to small municipalities, as well as in municipalities with higher illiteracy rates (IRR = 2.15), more urbanised municipalities (IRR = 1.53), those with greater social inequality as per the Gini index (IRR = 1.26), high percentage of households with inadequate sanitation (IRR = 1.63), higher average number of people per room (IRR = 1.41), high proportions of Family Health Programme coverage (IRR = 1.29), high percentage of household contacts investigated (IRR = 2.30) and those with percentage of cases with grade 2 disability considered to be the medium (IRR = 1.26). CONCLUSIONS In this study, SIR was significantly associated with municipalities with low socio-economic status. Disease control activities need to be focused on these municipalities, and investments need to be made in improving the population's living conditions.
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Affiliation(s)
- Lúcia R S Freitas
- Programa de Pós-Graduação em Medicina Tropical, Núcleo de Medicina Tropical, Faculdade de Medicina, Universidade de Brasília, Brasília, Brazil
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Richardus JH. Leprosy remains an important public health challenge in India. Indian J Med Res 2013; 137:878-9. [PMID: 23760371 PMCID: PMC3734677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040 3000 CA Rotterdam The Netherlands
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Lana FCF, Fabri ADCOC, Lopes FN, Carvalho APM, Lanza FM. Deformities due to Leprosy in Children under Fifteen Years Old as an Indicator of Quality of the Leprosy Control Programme in Brazilian Municipalities. J Trop Med 2013; 2013:812793. [PMID: 23577038 PMCID: PMC3614053 DOI: 10.1155/2013/812793] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 12/23/2012] [Accepted: 02/24/2013] [Indexed: 11/17/2022] Open
Abstract
The present study aims at analysing the degree of deformity in leprosy cases diagnosed in children under 15 years old and its relationship with operational and epidemiological factors. This epidemiological cross-sectional study was carried out at municipalities of three microregions in a Brazilian hyperendemic area. Data between 1998 and 2010 was collected from the Information System for Notifiable Diseases database. The average coefficient of detection was 32.96/100.000 inhabitants; 7.61% of new cases were diagnosed in children under 15 years old; 5% in this age group were grade 2 deformity at diagnosis. Prevalence of leprosy cases in children under 15 years old with deformity was higher in males (PR = 2.65;P = 0.032; CI 95%: 1.09-6.45) and in multibacillary patients (PR = 14.68;P < 0.001; CI 95%: 3.54-60.87) and lower when the detection mode was passive (PR = 0.73,P = 0.47, CI 95%: 0.31-1.73). Such context suggests high transmissibility and early exposure to Mycobacterium leprae since a lot of cases were diagnosed in children under fifteen years old and the incubation period of the leprosy bacillus varies from 02 to 07 years. This situation contributes to maintaining the chain of disease transmission in the area and indicates that health care services should intensify leprosy control.
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Affiliation(s)
- Francisco Carlos Félix Lana
- Nursing School, Federal University of Minas Gerais, Avenida Alfredo Balena, 190/402, Santa Efigênia, 30130-100 Belo Horizonte, MG, Brazil
| | | | - Fabiana Nascimento Lopes
- Nursing School, Federal University of Minas Gerais, Avenida Alfredo Balena, 190/402, Santa Efigênia, 30130-100 Belo Horizonte, MG, Brazil
| | - Ana Paula Mendes Carvalho
- Nursing School, Federal University of Minas Gerais, Avenida Alfredo Balena, 190/402, Santa Efigênia, 30130-100 Belo Horizonte, MG, Brazil
| | - Fernanda Moura Lanza
- Nursing School, Federal University of São João DelRei, Rua Sebastião Gonçalves Coelho, 400, Chanadour, 35501-293 Divinópolis, MG, Brazil
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Abstract
OBJECTIVES Leprosy is a chronic, non-fatal disease caused by Mycobacterium leprae. It can cause cutaneous lesions, peripheral nerve lesions and orofacial manifestations, including destruction of the alveolar premaxillary process associated with loss of the maxillary incisors. The aims of this study were to assess orofacial manifestations of disease in patients attending the Bombay Leprosy Project clinics and develop clinical guidelines for dentists. MATERIALS AND METHODS A cross-sectional questionnaire based study was administered to 43 diagnosed leprosy patients. This included questions on perceived oral health status and oral hygiene habits. An extra-oral and intra-oral examination was also performed. RESULTS Eighty-four per cent of patients were male with a mean age of 35.9 years. Forty-nine per cent had extra-oral cutaneous lesions. Twenty-eight per cent had intra-oral lesions including hyperpigmented patches. Twenty-one per cent had cranial nerve involvement and the trigeminal nerve was most commonly affected. CONCLUSIONS From this data a clinical dental pathway protocol for managing patients with leprosy was developed. It highlights dental issues when managing leprosy patients. Nerve involvement may mean patients are unable to give an accurate account of their symptoms. Special tests should include cranial nerve examination and swabs of intra-oral ulcers. Low rates of infectivity means that normal infection control measures can be taken when treating these patients.
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Affiliation(s)
- Bella Dave
- Centre for International Child Oral Health, King's College London, London, UK.
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Msyamboza KP, Mawaya LR, Kubwalo HW, Ng’oma D, Liabunya M, Manjolo S, Msiska PP, Somba WW. Burden of leprosy in Malawi: community camp-based cross-sectional study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2012; 12:12. [PMID: 22867526 PMCID: PMC3492035 DOI: 10.1186/1472-698x-12-12] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Accepted: 07/31/2012] [Indexed: 11/29/2022]
Abstract
UNLABELLED BACKGROUND Although leprosy was eliminated globally in 2000, the disease continues to be the significant cause of peripheral neuropathy, disability and disfigurement in some developing countries. However, recent population-based prevalence data are lacking to inform evidence-based renewed commitment for the final push for leprosy elimination at national and sub-national levels. METHODS Community camp-based cross-sectional descriptive study was conducted in four selected districts. World Health Organisation guidelines and tools for leprosy elimination monitoring were used to evaluate the Malawi National Leprosy Programme. RESULTS A total of 6,338 people (60% females, 35% children aged less than 15 years) were examined for leprosy and other skin diseases. Prevalence of skin diseases was 18%, the commonest being fungal (9%), eczema/dermatitis (3%) and leprosy (1%). Of the fungal skin conditions, pityriasis versicolor and Tinea capatis were the commonest (22% and 21% respectively) then Tinea corporis (9%), Tinea cruris (6%) and Tinea pedis (2%). A total of 66 leprosy cases were detected out of 6,338 people screened giving a prevalence of 104.1 per 10,000 population (range by district 67.1 to 194.1). Of the leprosy cases, 37 were new, 6 were defaulters and 23 were on treatment, 30 were females and 9 were children aged less than 15 years old. Of the 37 new leprosy cases, 9 (24.3%) were children, 25 (67.6%) had 1-5 leprosy lesions and 8 (21.6%) had grade 2 disability. The most frequent location of leprosy lesions was the head and neck (24.1%), arms (24.1%), chest (17.2%), legs (13.8%), back (13.8%) and abdomen (7.0%). Between 2006 and 2011, trends of leprosy prevalence and detection increased, prevalence/detection ratios were over 1 and cure rates by cohort analysis of 2009 multibacillary and 2010 paucibacillary cases were 33% and 63% respectively far below the expected 80% although the national prevalence remained at less than 1 case per 10,000 population. CONCLUSION Leprosy was still an important public health problem in Malawi. Improving knowledge and skills of health workers, registration and recording of data, contact tracing, decentralisation and integration of treatment to health centres and introduction of leprosy awareness days and community-based surveillance could help to improve early detection, treatment, case holding and prevention of disabilities.
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Affiliation(s)
- Kelias P Msyamboza
- World Health Organisation, Malawi Country Office, Lilongwe, Malawi
- World Health Organisation, Malawi Country Office, ADL House, 2nd Floor, City Centre, P.O. Box 30390, Lilongwe, 3, Malawi
| | | | - Hudson W Kubwalo
- World Health Organisation, Malawi Country Office, Lilongwe, Malawi
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Alencar CH, Ramos AN, dos Santos ES, Richter J, Heukelbach J. Clusters of leprosy transmission and of late diagnosis in a highly endemic area in Brazil: focus on different spatial analysis approaches. Trop Med Int Health 2012; 17:518-25. [PMID: 22248041 DOI: 10.1111/j.1365-3156.2011.02945.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The Brazilian National Hansen's Disease Control Program recently identified clusters with high disease transmission. Herein, we present different spatial analytical approaches to define highly vulnerable areas in one of these clusters. METHOD The study area included 373 municipalities in the four Brazilian states Maranhão, Pará, Tocantins and Piauí. Spatial analysis was based on municipalities as the observation unit, considering the following disease indicators: (i) rate of new cases/100,000 population, (ii) rate of cases <15 years/100,000 population, (iii) new cases with grade-2 disability/100,000 population and (iv) proportion of new cases with grade-2 disabilities. We performed descriptive spatial analysis, local empirical Bayesian analysis and spatial scan statistic. RESULTS A total of 254 (68.0%) municipalities were classified as hyperendemic (mean annual detection rates >40 cases/100,000 inhabitants). There was a concentration of municipalities with higher detection rates in Pará and in the center of Maranhão. Spatial scan statistic identified 23 likely clusters of new leprosy case detection rates, most of them localized in these two states. These clusters included only 32% of the total population, but 55.4% of new leprosy cases. We also identified 16 significant clusters for the detection rate <15 years and 11 likely clusters of new cases with grade-2. Several clusters of new cases with grade-2/population overlap with those of new cases detection and detection of children <15 years of age. The proportion of new cases with grade-2 did not reveal any significant clusters. CONCLUSIONS Several municipality clusters for high leprosy transmission and late diagnosis were identified in an endemic area using different statistical approaches. Spatial scan statistic is adequate to validate and confirm high-risk leprosy areas for transmission and late diagnosis, identified using descriptive spatial analysis and using local empirical Bayesian method. National and State leprosy control programs urgently need to intensify control actions in these highly vulnerable municipalities.
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Affiliation(s)
- Carlos H Alencar
- Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
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