Leprosy survey in night high schools in greater Bombay

A survey of 6096 students attending night high schools in Bombay, gave the prevalence rate of leprosy 9.3 per 1000 in this group. 10.5% of the cases identified were having more serious forms of leprosy characterised by nerve involvement or skin smear positivity. Night school screening has limited value as it can only be conducted in big industrial cities and such surveys cover only a very small proportion of the population. However, in view of the current tendency of population shift from rural to urban areas and since such survey can identify a number of established cases it can be included among the other routine leprosy case detection activities in big cities, where night schools exist.     

Community leaders involvement in leprosy health education

As an alternative approach, 310 community leaders consisting of village political leaders, school teachers, Govt. staff, members of socio-welfare and religious agencies, graduate students and traders from 21 villages of Chingleput district of Tamilnadu (India) were interviewed to explore the possibilities of their involvement in leprosy health education community. Though majority (76%) of respondents were not fully aware about various aspects of leprosy and showed negative reactions (51%) towards leprosy patients; almost all realised the importance of educating community about leprosy for its early control, for which a large majority (88%) of them had expressed their willingness to participate in leprosy health education and control programme by devoting an average of 4.4 +/- 5.4 hours per week. A good number (54%) of them had also been educating people about leprosy in one or the other way. The leaders who had been exposed to leprosy health education especially in recent past, were significantly better equipped with knowledge about leprosy and its control and were much more willing to participate in NLCP, than others. Study concluded that if the community leaders are approached, educate and motivated properly, they would certainly involve themselves to provide a valuable strength to our leprosy health education and control programme.     

Community participation in case detection of leprosy in Nagpur district of Maharashtra

Involving special community groups for new case detection is of great importance for achieving the target of elimination of leprosy. During 1998-99, thirty village level Mahila mandals (women's groups), 6950 teachers and students and 34,548 heads of families were co-opted to participate in case detection. They examined 56,113 persons including 378,959 school students and 184,940 family members. Of the examined population, 275 were suspected to be cases of leprosy by mahila mandals, 411 by teachers and students and 747 by heads of families. Subsequent examination of the suspected cases by trained medical officers and paramedical workers confirmed 203 of them to be cases of leprosy. This exercise showed that when proper attempts were made to involve the community, case detection activity became easier, besides helping to disseminate knowledge about leprosy in the community.     

The Texas peer education sun awareness project for children: primary prevention of malignant melanoma and nonmelanocytic skin cancers.

Sixteen Texas elementary school students participated in a peer education sun awareness project. Upon completion of this program, student awareness about sun protection significantly improved. Peer education for elementary school students about skin cancer prevention may result in the primary prevention of future skin cancers.     

Histoid leprosy: review of the literature

Leprosy is a chronic granulomatous inflammation primarily of the peripheral nervous system, skin, and reticuloendothelial system caused by Mycobacterium leprae. It presents clinically as an erythematous or hypopigmented anesthetic patch and a thickened and/or tender cutaneous nerve trunk. Leprosy is also called Hansen disease. Leprosy is a great imitator of other skin diseases, and it can present with different morphological lesions, which is why an expert eye is needed to diagnose it. One of the important clinical presentations of leprosy is histoid leprosy, which is very difficult to diagnose due to different clinical and histopathological findings that mimic, e.g., a fibromatous disorder. Histoid leprosy is a very rare clinicopathological variant of leprosy. It is clinically characterized by skin‐colored, soft, succulent nodules, and plaques on apparently normal skin and histologically by a dense bundle of histiocytes arranged in storiform. Though histoid leprosy is a very rare type of leprosy, the higher load of lepra bacilli in these cases makes it a concern as a reservoir for leprosy.     

Modified leprosy elimination campaign (MLEC) for case detection in a remote tribal area in the State of Orissa, India

A leprosy project was established in a difficult to reach area under guidelines of Government of India. The leprosy services were provided by Koraput Leprosy Eradication Project (KORALEP) and general health services by Primary Health Care (PHC). Leprosy elimination campaigns (LECs) were suggested by WHO to detect more cases in the community. A modified leprosy elimination campaign (MLEC), carried out utilizing the services of primary health care workers is discussed in this paper. Apart from the trained health workers, Anganwadi workers along with some literate people from the district were also included in the search teams. In all, 1543 cases were shortlisted from the suspects identified and on re-examination 576 cases were confirmed as active cases. Sixty percent of the cases detected were very early cases with two to three skin lesions. This could be achieved with a very brief training of health workers and involving village voluntary workers. MLEC was found to be a useful tool for case finding in such areas.     

四川省15年麻风病人涂片查菌检查质控报告

目的:在麻风流行县进行麻风菌查菌检查质量控制,提高基层检验技术。方法:省中心实验室对参加质控县按双盲法随机抽取10％的细菌涂片,由省考评员按“麻风检验质控手册”标准对抽取片的制片、染色及镜检进行质评,同时各县人员必须判读中心实验室阅过的菌片,找出存在的问题。结果:连续15年对全省流行县进行细菌质控。参评县最少17个,最多97个,共抽查4529张。1986年制片、染色及细菌密度指数(BI)平均由86.97％上升至96.88％,质量稳步提高。结论:在麻风流行县进行细菌质控可以提高麻防工作质量,提高检验人员水平,便于实施。     

Effects of environment and education on knowledge and attitude of nursing students towards leprosy

The objective of this cross-sectional comparative study was to find the effects of environment and education on knowledge and attitude of nursing students towards leprosy. Data were collected, using a pretested questionnaire, from the first year and third year students of a School of Nursing attached to a leprosy specialty hospital and also from a comparable School of Nursing attached to a general hospital. The results showed that trainees acquired more knowledge on leprosy during training in both schools of nursing. However, those trained in leprosy hospital environment had higher knowledge and attitude scores than those trained in general hospital environment. The attitude of the trainees attached to leprosy hospital was favourable even before they had formal training in leprosy. Those trained in the general hospital showed more favourable attitude after training compared to before training. School of Nursing attached to leprosy hospital provided an atmosphere conducive to learning and understanding more about leprosy. The trainees retained what was learnt because of regular association with patients affected by leprosy. For employment in hospital or community based services or research related to leprosy, nurses trained in a leprosy hospital would have added value of knowledge and attitude.     

Sun protection policies in Miami-Dade County public schools: opportunities for skin cancer prevention

Childhood exposure to ultraviolet radiation from the sun and a history of sunburns are risk factors for skin cancer. Because children spend time outdoors when they are at school, school sun protection policies are an important health issue, particularly in areas of the country with year-round warm and sunny climates, such as Florida. To better understand the sun protection policies and practices in South Florida schools, a sample (n = 51) of elementary and middle schools in Miami-Dade County public schools were surveyed as part of a CDC-funded cancer control program at the University of Miami. Of the principals and teachers surveyed, most (78%) knew about the county school system's guidelines for avoiding excessive heat exposure, which include two sun protection measures. Two-thirds reported that they shared these guidelines with teachers; 21% shared them with parents. Few schools monitor implementation of the guidelines, although 70% schedule outdoor activities to avoid peak sun hours. No schools required sunscreen, hats, or protective clothing. Physical education teachers and students spend an average of 4.5 and 0.6 hours per day outdoors, respectively. Improved school sun protection policies and monitoring of such policies is needed to reduce sun exposure and skin cancer risk for both students and staff.     

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-governmentai 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.     

Prevalence of mental distress in the outpatient clinic of a specialized leprosy hospital. Addis Ababa, Ethiopia, 2002

Leprosy is a chronic disease that leads to physical disability as a result of nerve damage. Stigma and associated psychosocial problems are common and may increase the risk of mental disorders. This study was conducted to estimate the prevalence of mental distress amongst people attending a Specialized Leprosy and Dermatology Hospital, ALERT, Addis Ababa. Alternate patients from the daily register of outpatients were interviewed for symptoms of mental distress using the Self Reporting Questionnaire (SRQ). This questionnaire was administered by two specially trained nurses. The study population consisted of 786 people. Of these, 60% had leprosy and the remainder had other skin diseases. The sex distribution of the study population was approximately equal. The overall prevalence of mental distress was found to be 34.6%. Among people with leprosy the prevalence was 52.4%, compared with 7.9% in those with other skin conditions. This represented a 7-fold increased risk of mental distress in people with leprosy, adjusted OR = 7.14 (95% CI; 4.15, 12.35). Physical disability was also strongly associated with mental distress. This study showed that the 1-month prevalence of mental distress was significantly higher in patients with leprosy compared to patients with other dermatological conditions. Such a study allows identification of non-specific mental distress. Thus, future work should be directed at further characterizing the nature and severity of mental disorder in this group. However, our study has indicated a need for the integration of psychosocial care into our current medical treatment of patients with leprosy.     

The private GP and leprosy: a study.

In urban and rural areas alike, people in India tend to prefer private medical care to the existing government health services. Nevertheless, the large private health care sector has hitherto been virtually alienated from activities of public health importance including priority disease control programmes. This study of 106 private general practitioners (GPs), practising in low socioeconomic areas of Bombay, shows a gross lack of knowledge and awareness among private doctors about leprosy and also about the National Leprosy Control Programme. The possible reasons are discussed. Effective involvement of GPs in the National Leprosy Control Programme should facilitate both integration and better implementation of leprosy control activities. The study also highlights some areas for future interventions at both primary and secondary health care levels and the need for a strategy, based on larger studies, to train and make private doctors participate in controlling diseases of major public health concern like leprosy.     

People's perception of leprosy--a study in Delhi

Leprosy is considered to cause more social than medical problems. The present study focussed on this aspect in order to investigate the level of awareness among people--about their attitude towards the disease and the afflicted. The results are based on interviews with 104 persons in Delhi. The sample data revealed that the level of knowledge of leprosy was inadequate. The cause of the disease was known to 44.2% of those interviewed, while 31.7% were completely ignorant; 6.7% believed it to be the consequence of an individual's past misdeeds, and 1.9% believed it to have been caused by divine curse. 63.1% were aware that the disease is curable. 73.1% of the persons interviewed sympathised with leprosy-afflicted beggars. 61.5% favoured leprosy patients to stay with their families and within their communities. 67.3% felt that the cured could marry, while 25% felt that the leprosy-afflicted should stay in leprosy colonies away from the society. 54.8% were reluctant to employ the leprosy-afflicted as domestic help, and 31.7% were reluctant to establish matrimonial relationship with a family having a leprosy-afflicted person. The data call for intensification ofpublic awareness regarding the aetiology of leprosy. Positive and scientific information should be disseminated to minimize the social prejudices associated with the disease.     

Leprosy treatment during pregnancy and breastfeeding: A case report and brief review of literature

Leprosy is a chronic disease which primarily affects the skin, mucous membranes and peripheral nerves due to Mycobacterium leprae. It is now infrequent in Europe and is rarely reported during pregnancy. Leprosy can be exacerbated during pregnancy, and without treatment it can permanently damage the skin, nerves, limbs and eyes. Therefore, it is important to treat leprosy during pregnancy. This article describes a patient with multibacillary lepromatous leprosy who was treated with multidrug therapy during pregnancy and breastfeeding. The patient delivered a healthy baby girl without perinatal complications, and the infant's growth and development were normal during the 1‐year follow‐up period. Multidrug therapy consisting of dapsone, rifampicine, and clofazimine is highly effective for people with leprosy and considered safe, both for the mother and the child. Antileprosy drugs are excreted into human milk but there is no report of adverse effects except for skin discoloration of the infant due to clofazimine. Multidrug therapy for leprosy patients should be continued unchanged during pregnancy and breastfeeding.     

Inter-observer reliability in assessment of sensation of skin lesion and enlargement of peripheral nerves in leprosy patients

The accurate diagnosis of leprosy is important to both individuals and to the community. The diagnosis of leprosy is based on clinical examination. However, the reliability of clinical assessment of sensation in skin lesions and thickness of peripheral nerves on palpation has not been well studied, due to the lack of a gold standard. We report an inter-tester reliability study of the clinical assessment of skin lesions and thickness of ulnar and popliteal nerves in leprosy patients by different staff. For sensory testing of skin lesions, the agreement between the leprologist and leprosy control staff, and between one student and leprosy control staff, was poor (kappa values < 0-4). The agreement between the leprologist and the two students, between the two students, and between the other student and local leprosy control staff were fair (kappa values > 0.4, but < 0-6). For the palpation of ulnar and popliteal nerves, the agreement ranged from 0.36 to 0.52 and from 0.02 to 0.29 in different pairs of testers, respectively. The reliability of clinical diagnostic skills based on both sensory testing of skin lesions with the cotton wool method and palpation of superficial peripheral nerves was unsatisfactory.     

Awareness about the persons with disability act among leprosy patients and other disabled persons

To assess the level of awareness about the different provisions of the Persons with Disability Act (PWD Act) among leprosy patients and other disabled, 233 disabled persons from the self-help groups formed by Vadathorasalur Leprosy Control Unit have been interviewed using a structured interview checklist. The results show that 74.7% of the respondents were aware that identity cards are available for the disabled, 56.2% were aware of the free education benefit to the disabled, as low as 35.6% were aware of the scholarships, 33% knew about the employment reservations, 24.9% heard about the housing scheme of the government for the disabled, but 24.5% only knew about law against discrimination, 31.8% came in contact with institutions for the severely disabled and only 16% were aware of the unemployment allowance to the disabled. The level of awareness is low among women with regard to all components of the Act. It was found that students studying up to secondary level were not aware of the availability of scholarships and free education, which needs to be seriously looked into, especially by educational institutions. The level of formal education played a significant role in increasing awareness about the Act among literates. The knowledge is low among persons of all occupations. The study showed that there is a great need for an educational intervention programme to publicize the provisions of the Act among the disabled and their families.     

The current state of leprosy control activities in Sri Lanka

In Sri Lanka the overall prevalence of leprosy was 0.14 per 1000 population and the incidence 0.07 per 1000 population at the end of 1987. Although the endemicity is low in the island, disease transmission has not yet been achieved as the annual detection of new cases and the child rate has been gradually rising. The major activities of the leprosy control programme are case-finding, treatment and defaulter retrieval, health education, rehabilitation and training. The field programme is implemented through 15 specially trained paramedical workers. In addition there are 5 medical officers attached to the Anti-leprosy Campaign. The Director of the Anti-leprosy Campaign is in overall charge of the National Leprosy Programme and is also project manager for the Sri Lanka Emmaus Leprosy Control Project.     

Leprosy in Post-Elimination Era in India: Difficult Journey Ahead

Leprosy is a chronic inflammatory disease of skin and peripheral nerves. Elimination of leprosy as a public health problem was reached at the global level in the year 2000 and by India on 31^st December, 2005. Thereafter, leprosy services in India have been integrated with General Health-Care System resulting in reduced focus and funds. Sustaining the gains made so far in controlling leprosy is a big challenge and there is no time for complacency. Pockets of high endemicity with prevalence rate of > 1 still exist in many states. Our data from a tertiary care center indicates poor epidemiological control and ongoing disease transmission. To combat this, dermatologists all over India should continue to play a central role in capacity building and training of undergraduate and post-graduate students, medical officers, and field workers.     

Head lice infestation in schoolchildren and related factors in Mafraq governorate, Jordan

Background Little is known about the effect of socioeconomic status on the infestation by head lice in schoolchildren in Jordan. Materials and methods A cross‐sectional school‐based study was conducted from December 2009 to February 2010. A list of all primary schools in Mafraq governorate was obtained (394 primary schools). Eight primary schools were randomly selected (four male schools and four female schools). Data were collected by five well‐trained nurses. Hair was examined for head lice as well as for eggs/nits. Analysis of data was conducted by using SPSS software version 16. The chi‐square test was used to assess statistical significance of subgroup differences in the prevalence of infestation, and multivariate logistic regression was used to control for potential confounding. Results Out of 1550 primary schoolchildren screened, 412 (26.6%) were infected with lice, 163 (19.6%) boys and 249 (34.7%) girls. The results showed significant variations in head lice infestation by factors such as gender, age, and socioeconomic variables (family income, father’s education, mother’s education, number of rooms, number of siblings younger than 15 years, frequency of hair washing per week, and bathing per week). There was no significant variation in lice infestation with parents’ occupation (P > 0.05). Conclusions Socioeconomic status is a major factor influencing the occurrence of pediculosis capitis among schoolchildren in both sexes. Improving standards of living and personal hygiene might significantly reduce pediculosis capitis in schoolchildren in Jordan.     

Polyhexanide 0.2% in treatment of trophic foot ulcers in leprosy - preliminary study

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which affects peripheral nerves, skin and mucous membranes. The impairment of neural function as well as sensory or sensory-motor disabilities in leprosy continue to be a problem that requires careful attention in the management of patients with the aim to avoid or minimize their progression to prevent sequelae. One of the most common characteristics of these ulcers is the tendency to chronicity, with variable therapeutic response. In this article, we shall discuss the therapeutic management of thirteen trophic leprosy ulcers in eight patients using polyhexanide 0.2% products.