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At least 19 recordsLinked to original sources
PubMed1994

Integrating leprosy control into primary health care: the experience in Ghana.

Integration of leprosy control into primary health care is the most comprehensive and permanent system of delivering care to leprosy patients. But so far only a few countries have adopted this approach, largely on account of a fear of failure. Over the past decade Ghana has developed a model approach towards the transition from a vertical to an integrated programme. The highlights of our approach included the development of the leprosy service as part of the overall development of the health service, increasing capacity building for leprosy control at the district and subdistrict levels as well as the establishment of a regular and effective monitoring to identify and correct operational problems early. This paper describes the principles behind the integration, the strategies adopted and how they were implemented. It also includes the achievements made as well as the problems that were encountered and how they were solved.

Ghana↗
PubMed1997

Dermatologists combat leprosy in Yemen.

BACKGROUND: Leprosy has been prevalent in Yemen for many years. The ostracization and stigmatization of leprosy patients are well documented in the yemeni literature. No control activities were carried out until 1980. AIM: To document the development of leprosy control activities in the Republic of Yemen during the period from 1982 to 1996. MATERIALS AND METHODS: The dermatologists in Yemen used various methods, including the media, to fight the stigma of leprosy and thus to mobilize the community for the reintegration of leprosy patients. They sought support from international non-governmental organizations (NGOs) to start mobile teams all over the country. RESULTS: The support of the German Leprosy Relief Association (GLRA) and the World Health Organization (WHO) enabled the National Leprosy Control Program (NLCP) to reach people in remote areas. The prevalence of leprosy has declined from 1.9 per 10,000 population in 1989 to 0.5 per 10,000 population in 1996. CONCLUSIONS: The stigma associated with leprosy also extends to other skin diseases. To combat this stigma, various methods, such as health education, training of medical personnel, and mass treatment for skin diseases, have been used.

Communicable Disease Control↗
PubMed1998

Evaluation of a sustained 7-year health education campaign on leprosy in Rufiji District, Tanzania.

To assess the impact of a 7-year intensive health education campaign about leprosy delivered by workers of the Kindwitwi Leprosy Trust to schoolchildren and general public in Rufiji District. Knowledge, attitude and beliefs towards leprosy were measured in Rufiji and compared to neighbouring Kisarawe District as control. Lessons learned from this analysis may be useful for the planning and evaluating of health education campaigns. Interview of schoolchildren, general public, community leaders, traditional healers and medical staff in both districts. A stratified randomized sampling scheme was used, with stratification for urban and rural settings. A representative sample of schoolchildren, general public, community leaders, traditional healers and medical staff in Rufiji District and in the control area of Kisarawe District was interviewed. The interviews were partly structured and partly open. The results of the interviews were analysed in the context of epidemiological leprosy data from 1985 till 1995, and demographic data of both districts. Data entry and statistical analysis was done using FileMaker Pro, Stata and Excel computer packages. We did not observe positive effects of the health education campaign on the indicators regarding early diagnosis of leprosy with less disability. Leprosy case detection was declining in both districts. We found that the campaign had a favourable impact on the knowledge and the attitude of schoolchildren in Rufiji District. We could demonstrate a relationship between increased knowledge of leprosy and a positive, less stigmatizing attitude. Knowledge of leprosy was better in Rufiji as compared to Kisarawe, but only among schoolchildren. We found indications that low level of education, rural residence, older age, female gender and Moslem religion were associated with stigmatizing attitudes and beliefs towards leprosy. Knowledge about leprosy reactions among medical staff interviewed was not optimal. The exact outcome of the sustained campaign in Rufiji District was difficult to assess because no comparison could be made with the situation prior to the campaign. However, the health education campaign was associated with increased knowledge and diminished tendency to stigmatize leprosy among schoolchildren. Health education campaigns have to be sustained and have to cover a broad sector of the society in order to induce behavioural changes in the community. The focus of health education should be rural communities and schools, and pay special attention to women, religious leaders and traditional healers. Awareness of diagnosis and treatment of leprosy reactions among medical staff should be improved.

Adolescent↗
PubMed1995

Elimination of leprosy as a public health problem: progress and prospects.

Leprosy is still an important problem in about 80 countries of Asia, Africa and Latin America, some 2.4 million persons being estimated to have the disease in 1994. The WHO-recommended standard multidrug therapy (MDT) was introduced in the 1980s and has been shown to be effective in combating the disease. Experiences based on many thousands of patients treated with MDT over the past decade indicate extremely low relapse rates (cumulative relapse rates around 1%). By the end of 1993, some 5.6 million patients had been cured, and the global cumulative MDT coverage of registered patients had reached 89%. The number of registered cases fell from 5.4 million in 1985 to 1.7 million in 1994. The significant progress made in leprosy control enabled the World Health Assembly in 1991 to set a goal for eliminating leprosy as a public health problem by the year 2000. One important epidemiological factor is that leprosy is very unevenly distributed: 80% of the problem is confined to only five countries and 92% to just 25 countries. The elimination strategy envisages identifying and treating with MDT a total of about 5 million cases from 1994 to the year 2000. The cost of dealing with these cases has been estimated at US$ 420 million, including US$ 150 million for the drugs.

Africa↗
PubMed1997

A practical method of active case finding and epidemiological assessment: its origin and application in the leprosy control project in Indonesia.

Random sample surveys in the past have revealed high estimated against low registered prevalences for leprosy in several parts of Indonesia. A pilot project showed that the problem of cases that had not yet been detected could not be solved without the active participation of the local authorities, who proved able to overcome the stigma and to convince potential patients to go for examination and treatment. The pilot project was based on the principle of what are called exploration surveys, which were introduced by Sitanala in Indonesia in 1931. The Indonesian government decided to reintroduce these surveys in 1977 under the name of chase or trace surveys. They are carried out within the framework of the leprosy workers' routine duties and no additional expenses are incurred. Since then, thousands of patients of all types and with long case histories have been detected and brought under treatment. Without this "push" it is fair to assume that many would never have sought treatment voluntarily. In view of the experience in Indonesia, one wonders whether leprosy can be eliminated without emphasizing the importance of active case finding, especially in areas in which the disease is still highly endemic. Chase surveys also provide rough information about the local leprosy situation. Although of great value, they are not, in high-endemic regions, an alternative to random sample surveys which reveal, besides a wealth of additional information, the possible unknown sources of infection.

Communicable Disease Control↗
PubMed1979

Acedapsone in the prevention of leprosy: field trial in three high prevalence villages in Micronesia.

The 1,659 non-leprous people in a Micronesian population experiencing an annual leprosy incidence rate of about 7/1,000 were offered 15 acedapsone (DADDS) injections during 1967--1970 for leprosy prevention purposes. Subsequent annual surveillance showed an initial cessation of new cases during the 3-year DADDS campaign, followed by a resumption of cases thereafter at a yearly level of about 2/1,000 with a longer pause and slower rise among those who received the full regimen. A secondary wave of cases that has occurred since 1973 among children born after 1968 shows that post-campaign transmission occurred, probably principally from relapsing multibacillary cases with onset before the campaign. Recommendations are made for a balanced, long-term control program with DADDS preventive treatment limited to contacts of multibacillary cases.

Acedapsone↗
PubMedDate not supplied

Cross-reactivity of Mycobacterium leprae and M. tuberculosis and the implications for assessment of in vitro T cell function in leprosy patients.

The cross-reactivity in vitro between Mycobacterium leprae and M. tuberculosis was studied in 41 Aboriginal Australians with leprosy, 78 uninfected contacts of leprosy patients and 38 control individuals. A vigorous T cell response to epitopes cross-reactive between these two mycobacteria was found for healthy uninfected contacts or non-contacts (controls) of leprosy patients, but not for the patients themselves. The data suggest that a vaccine based on antigen shared between M. leprae and other mycobacteria is unlikely to be useful in preventing leprosy. Further studies of responses in vitro to purified T cell-reactive antigens would be useful in designing newer vaccines for more widespread field studies of leprosy prevention.

Cell Migration Inhibition↗
PubMed1995

Harnessing the strengths of the leprosy programme to control tuberculosis.

Tuberculosis remains a leading cause of death in Ethiopia but there is no effective national tuberculosis control programme. By contrast, the leprosy control programme has been very successful, with a 10-fold reduction in the number of leprosy cases requiring antibacterial treatment, though patients with nerve damage require continuing care. The paradox of rising numbers of tuberculosis cases and declining numbers of leprosy cases may be solved by joint leprosy-tuberculosis clinics. The strengths of leprosy fieldworkers in control management, case holding, and compliance can be harnessed in developing an effective tuberculosis control programme. Implementing a joint programme in Ethiopia may be beneficial not only for tuberculosis patients but also for leprosy patients, who are thus brought closer to general medical services.

Ethiopia↗
PubMed1992

[The progress of National Leprosarium].

Leprosy Prevention Law was proclaimed in 1907 in Japan. According to the regulation, Leprosy Control Policy has got under way by the Government. In 1909, five leprosaria were established in the leprosy endemic areas by local government to admit vagrant leprosy patients who were estimated as one thousand and two hundred. The vagabonds had many troubles, especially, they often escaped from leprosaria. Dr. Kensuke Mitsuda who was one of the directors of leprosaria suggested the Government to establish the National Leprosarium in small island to admit them. In 1930, the Government had Ten-year Program to eradicate leprosy and decided to set up ten thousand beds in existing leprosaria and newly-established National Leprosarium. The plan has been almost completed by the construction of five National Leprosaria by 1940. The number of in-patients was 9,125, including 4,389 in five national institutions. In 1941, five local leprosaria were transferred their superintendence to the Central Government, after then, in 1943 and 1944, two National Leprosaria were established. The total number of National Leprosarium in Japan came to thirteen in 1945.

History, 20th Century↗
PubMed1994

Evaluation of a multidrug therapy programme of leprosy control.

MDT programmes for leprosy control have two objectives, controlling leprosy in populations and controlling leprosy in individuals. Evaluation of such programmes needs to address both objectives and this can be done by a review of the trends in key indicators and by site visits. Site visits are more expensive and should be done less frequently, but they can reveal issues not apparent in routinely produced statistics. Evaluation on an annual basis is the responsibility of programme managers and programme funders. Evaluation by programme staff themselves should be encouraged and supported. Evaluation of an MDT programme's effectiveness in controlling leprosy in a population should be by analysis of case detection as a proxy for incidence. Prevalence rates will continue to be monitored because of the WHO elimination goal, but these do not reflect disease transmission. Case detection is a proxy measure of incidence and depends on consistency in case detection activities. Case detection data by age, gender, mode of detection, disability ratio and lepromatous (MB) rate need to be analysed over at least 5 years and preferably 10 years to give an indication of trends in incidence. Caution is needed, however, as the pattern seen when case detection deteriorates may resemble the pattern expected when transmission is reduced. The site visit is important in this situation in allowing examination of the case detection activities, as well as in looking for new, undetected cases in the population.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Comparative leprosy vaccine trial in south India.

This report provides results from a controlled, double blind, randomized, prophylactic leprosy vaccine trial conducted in South India. Four vaccines, viz BCG, BCG+ killed M. leprae, M.w and ICRC were studied in this trial in comparison with normal saline placebo. From about 3,00,000 people, 2,16,000 were found eligible for vaccination and among them, 1,71,400 volunteered to participate in the study. Intake for the study was completed in two and a half years from January 1991. There was no instance of serious toxicity or side effects subsequent to vaccination for which premature decoding was required. All the vaccine candidates were safe for human use. Decoding was done after the completion of the second resurvey in December 1998. Results for vaccine efficacy are based on examination of more than 70% of the original "vaccinated" cohort population, in both the first and the second resurveys. It was possible to assess the overall protective efficacy of the candidate vaccines against leprosy as such. Observed incidence rates were not sufficiently high to ascertain the protective efficacy of the candidate vaccines against progressive and serious forms of leprosy. BCG+ killed M. leprae provided 64% protection (CI 50.4-73.9), ICRC provided 65.5% protection (CI 48.0-77.0), M.w gave 25.7% protection (CI 1.9-43.8) and BCG gave 34.1% protection (CI 13.5-49.8). Protection observed with the ICRC vaccine and the combination vaccine (BCG+ killed M. leprae) meets the requirement of public health utility and these vaccines deserve further consideration for their ultimate applicability in leprosy prevention.

Adolescent↗