Case detection, gender and disability in leprosy in Bangladesh: a trend analysis.

A trend analysis is presented of all newly detected leprosy cases over an 18-year period (1979-1996) in a highly leprosy endemic area of Bangladesh. A total of 23,678 new cases were registered, with an average of 860 new cases per year in the first 12 years, and increasing to around 3000 in 1996. The male:female (M:F) ratio decreased from 2.3 to 1.4. The proportions of newly detected cases with MB leprosy and of newly detected cases with any disability decreased over time. These reductions were more marked in the higher age groups of both sexes. The reduction in disability was primarily attributable to a decline in grade 2 disability. New case detection rates (NCDR) of all leprosy patients per 10,000 general population increased for males from 3 to 6; and for females from 1 to 4, while the NCDR of MB leprosy decreased in males from 1.4 to 0.6, and in females fluctuated around 0.45. The NCDRs of leprosy patients with disabilities showed an initial decrease in the first period, especially in males, but later showed an increase. The NCDR of males with disability was about twice as high as that of females. Finally, female NCDRs in the ages between 15 and 30 were low by comparison with the male NCDRs at the same time. This may be due to the sociocultural characteristics of the Bangladeshi society, with gender differences in exposure, health seeking behaviour and opportunities for case detection. Operational changes in the control programme have contributed to the changed profile of newly detected cases. This study shows that the application of general population statistics is essential for understanding the dynamics in leprosy control programmes under changing operational conditions. Combining case detection figures with such statistics helps to identify population groups that are possibly not benefiting sufficiently from the services provided, and to clarify the dynamics in control programmes and the future trends and programme requirements.     

Gender differentials in the social and family life of leprosy patients

A study was carried out at the Leprosy Control Unit, Government Medical College, Nagpur, India, to investigate gender differentials in the social and family life of leprosy patients. The study included 486 (268 males and 218 females) leprosy patients, who were diagnosed and registered at least 1 year prior to the data collection. It was observed that leprosy patients were isolated and refrained from various activities in the family. However, the effect of disease on this isolation was significantly greater in females as compared to males. Similarly, although, men and women were both affected in terms of their social life, women suffered more isolation and rejection from the society. The current study describes the gender differentials in the social and family life of leprosy patients in Central India.     

Disabilities in leprosy: an open,retrospective analyses of institutional records

Background and objectivesLeprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period.Material and methodsAn open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009–2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study.ResultsThe study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively.Limitation of studyMode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities.ConclusionNew deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.     

麻风治愈者心理健康及其影响因素的相关研究

目的：探讨麻风治愈的心理健康状况及其相关因素。方法：采用症状自评量表（SCL－90）、艾森克个性问卷（EPQ）、社会支持评定量表（SSRS）对155例麻风治愈进行评定及分析。结果：麻风治愈心理健康问题检出率为23．23％，最常见的心理健康问题是抑郁、焦虑、躯体化和人际关系敏感，与全国常模比较有显性差异。在控制年龄、性别因素下，心理健康各因子痛苦水平与社会支持分呈显负相关，与情绪不稳定人格呈显正相关。逐步回归分析表明，影响心理健康的因素有人格特征、社会支持、性别、职业、婚姻、化、躯残情况等。结论：麻风治愈的心理健康问题较为常见，与人格特征和社会支持等因素密切相关，加强心理健康教育有助于提高康复水平和生活质量。     

Delay in presentation and start of treatment in leprosy: experience in an out-patient clinic in Nepal

Delayed presentation is a recognized risk factor for disability in leprosy but is the result of complex interactions between physical, social, economic and psychological factors. The present study is a response to the situation in an outpatient clinic in Nepal where the wide variation in delay in presentation was a cause for concern. A purpose-written questionnaire was used to collect information on 166 consecutive outpatient admissions. The data included demographics, the first symptom of leprosy, first actions, initial help-seeking behaviour, the reasons for finally seeking treatment and experience with professional health services. Initial analysis found a relationship between delay in presentation and age, rural environment, leprosy classification, walking time, housing not shared with another person affected by leprosy, and an inappropriate first action. The relationship with lack of education and total travel time just failed to reach significance. Further analysis identified that for the study population initial lack of awareness of leprosy and an inappropriate first action were the primary contributors to delay. Extensive and effective health education is needed to address this situation.     

1998-2018年陕西省麻风流行特征分析

目的：了解1998-2018年陕西省麻风流行趋势和流行特征,为开展麻风防治工作提供理论依据。方法：通过全国麻风防治管理信息系统（LEPMIS）收集陕西省1998-2018年麻风病历资料,对麻风发现率、患病率和病例基本情况进行描述性分析。结果：1998-2018年陕西省新发现麻风病例共计477例,年平均发现率为0.070/10万,年平均患病率为0.305/10万;病例平均发现年龄为46.71岁;男女比为2.46:1;多菌型（MB）399例,占83.6% ;II级畸残共148例,畸残率为31.03%;新发现病例平均延迟期为62.01个月。结论：陕西省新发麻风病例依然存在畸残比高、延迟期长和高龄化等情况,应进一步加强低流行状态下麻风的监测,减少传播和畸残的发生。     

Assessing socio-economic factors in relation to stigmatization,impairment status,and selection for socio-economic rehabilitation: a 1-year cohort of new leprosy cases in north Bangladesh

The current leprosy elimination strategy focuses almost exclusively on delivery of leprosy diagnostic services and multi-drug treatment (MDT). However, the specific problems of people newly diagnosed with leprosy or cured with MDT primarily relate to impairment of nerve function and social and economic consequences of the diagnosis of leprosy. This study was carried out to investigate the relation between socio-economic factors and the development of nerve impairments and stigma. In addition the relation between socio-economic factors and selection for socio-economic assistance was studied. The study population was a cohort of 2364 newly diagnosed people with leprosy in rural Bangladesh in 1996, including 42.5% women, with an overall mean age of 31.4 years. Three hundred and sixty people (15.2%) had WHO grade 1 or 2 disability identified at diagnosis, and 50 (2.1%) had stigma identified on interview at home visit conducted within one month of diagnosis. One hundred and eighty-eight people (8%) were selected for specific assistance for rehabilitation, primarily interest-free loans for income generating activities or vocational training. Factors independently associated with WHO grade 1 or 2 disability at diagnosis were multibacillary (MB) classification, adult status, and manual occupations. Smear positivity, female sex, and the presence of dependents were associated with an increase in the experience of stigma. The presence of nerve impairments and stigma, as well as several indices of poverty were clearly associated with selection for inclusion in an integrated program for socio-economic assistance. An increased focus by leprosy services on the socio-economic factors associated with poorer physical and social outcomes is recommended. Where adequate finances and trained staff are available, efforts could be made to identify those at higher risk of poor outcomes, and to provide or to mobilize appropriately targeted socio-economic interventions.     

深圳市1985-2004年暂住人口麻风病流行病学分析

目的:了解深圳市暂住人口麻风病流行病学特征,为防治该人群麻风病提供依据。方法:对1985-2004年深圳市暂住人口中发现并登记的75例麻风病进行流行病学分析。结果:75例患者中,男女比例3.41∶1,多以青壮年为主;发病以结核样型麻风(T)为主,占50.67%,发现方式主要是皮肤科门诊发现,占86.67%;首诊畸残率为10.67%。结论:麻风病的防治,应加大防治知识宣传,提高专业人员素质。做好患者的身体、心理、社会康复,实行综合管理。     

Clinical features and outcome of first presentation anogenital warts in men and women

Objective Correlation of clinical features of patients on initial presentation of anogenital warts to outcome of treatment. Setting Outpatient genitourinary medicine clinic. Method Retrospective cohort analysis. Subjects Eighty-three male and 60 female patients attending the clinic with first episode anogenital warts within a 3-month period. Main outcome measures Relapse of warts following treatment. Total time for which treatment was given. Results Following one course of treatment, warts relapsed in 15% of the men, hut in only 37% of the women. After two courses, further relapse occurred in 31% of males and 18% of females (P < 0.001). Treatment for more than 6 months was required for 39% of men, but only 22% of women. Poorer outcome of treatment was related to larger size of warts at presentation. No significant relation was found between outcome and number, site or type of treatment used for warts, or for sexual behaviour or orientation of patients. A previously diagnosed sexually transmitted disease (STD) was reported by 34% of men and 28% of women: 28% of men and 23% of women had an STD diagnosed at the time of presentation with warts. No significant relation was found between outcome and STDs past or concurrent, including HIV. Female patients tended to have smaller warts than men but their better outcome remained significant after controlling for the size of warts. Conclusions Treatment outcome for genital warts is poor and significantly predicted by size of warts at presentation. Female patients have a better outcome from treatment of genital warts than male patients.     

A process report on physical and psychological determiners of social functioning in leprosy patients

Management and rehabilitation of leprosy patients needs information aoout the social acceptance and its association with physical and psychological problems of the affected person. Ninety three leprosy patients (72 male and 21 female) were selected from outpatient department of the hospitals/clinics and their demographic and clinical informations were recorded. The patients were screened for common menta diseases using GHQ-60 (Bengali version). The social functioning was assessed using SSFI. Mean age was 35.19 +/- 12.5 years, 69.9% of the subjects were from urban areas. Multibacillary cases accounted for 60.2% of the cases, 21.5% of the patients had deformity, 53.8% of the patients screened positive for common psychiatric diseases. Social functioning impairment of mild, moderate and severe level was 9.7%, 82.8, and 7.5% respectively. On Univariate analysis, presence of deformity was the only variable showing significant association with moderate to severe degree of social impairment. Using decision tree (Exhaustive CHAID) analysis, presence of deformity along with urban residence was strongly predicted severe social functioning impairment. The results of the study show the need to formulate suitable psychosocial intervention strategy especially in the context of high psychiatric morbidity.     

Correlates of psychiatric morbidity in patients with leprosy

The relationship between psychiatric morbidity in 30 leprosy patients under treatment as assessed by the General Health Questionnaire (GHQ-12) and certain variables of their illness and psychosocial factors is examined in this paper. Physical disability and duration of illness were the illness variables considered; knowledge and adjustment were the psychosocial variables included. Bell's Adjustment Inventory (BAI) measured the latter, psychiatric morbidity was positively correlated with physical disability (p < 0.05), knowledge about the disease (p < 0.01) and social, emotional and health maladjustment (p < 0.01), but not with duration of illness (p > 0.05). The importance of appropriate knowledge, social stigma and physical disability in leprosy is discussed in addressing the psychiatric morbidity of leprosy patients.     

麻风畸残的预防与康复

麻风发病率显著下降后,但其遗留的畸残康复问题日益突出。首先对麻风畸残患者作出合理的畸残状况评估,然后针对具体情况采用相应的康复措施,包括药物、手术、理疗、营养等。医学模式转变后,社区康复、社会经济康复明显提高了麻风畸残康复的效率,令患者和社会更易于接受,有力推动了麻风消灭运动的进程。     

2000-2019年广东省新发麻风病例2级畸残情况及影响因素分析

 目的:了解广东省新发麻风病例2级畸残情况及其影响因素,为麻风病防控提供理论依据。方法：从《全国麻风病防治管理信息系统（LEPMIS）》中收集广东省2000-2019年报告的新发麻风病例资料,建立数据库并经逻辑检错后,用SPSS 20.0软件进行统计分析。人口学特征、临床信息、畸残情况等采用描述性分析,畸残情况的影响因素采用Logistic回归分析。结果：共收集2000-2019年1 985例新发麻风病例资料,60岁及以上者占40.26%（798/1 982）,平均年龄为（54.33±18.25）岁。已婚占72.19%（1 015/1 406）,广东籍占84.03%（1 668/1 985）,汉族占95.82%（1 902/1 985）,职业主要为农牧民（60.59%,1 144/1 888）,文化程度主要为小学及以下（43.28%,544/1 257）。2级畸残比例为18.29%（363/1 985）。多因素Logistic回归显示2级畸残的危险因素包括男性（OR=2.61,95%CI:1.63~4.20）、汉族（OR=5.90,95%CI:1.70~20.53）、延迟诊断（OR=4.00,95%CI:2.67~5.98）、体重过低（OR=4.63,95%CI:2.06~10.42）和确诊时有神经损害（OR=31.94,95%CI:9.95~102.58）。结论：导致麻风病患者发生畸残的因素较为复杂,主要因素有麻风病例延迟诊断期的长短、身体健康状况以及神经损害情况等。各级医疗机构应加强对麻风病疑似症状的筛查,早发现、早诊断、早治疗,降低新发麻风病畸残比例,提高麻风病例生活质量。     

Nerve function impairment in leprosy: design, methodology, and intake status of a prospective cohort study of 2664 new leprosy cases in Bangladesh (The Bangladesh Acute Nerve Damage Study).

The Bangladesh Acute Nerve Damage Study (BANDS) is a prospective cohort study designed to investigate epidemiological, diagnostic, therapeutic and operational aspects of acute nerve function impairment in leprosy. The study is based at a single centre in Bangladesh, in an area with a high prevalence of leprosy. The centre, Danish Bangladesh Leprosy Mission, has a well-established vertical leprosy control programme. In this paper, the study design and methodology are described, together with definitions of nerve function impairment (NFI) used in this and subsequent papers. The study recruited 2664 new leprosy cases in a 12-month period. The male:female ratio is 1.25:1, and 17.61% of the cohort are under 15 years of age. In all, 83.33% of the cohort are paucibacillary (PB), and 16.67% multibacillary (MB). However, the MB rate amongst males is 19.72%, and amongst females is 12.85%, despite an equal period of delay to diagnosis. 55% of patients presented for treatment within 12 months of developing symptoms 6.12% of the total number of cases were smear positive, and 36.71% of the MB cases were smear positive. 9.61% of the total number of cases were graded as having World Health Organisation (WHO) disability grade 1, and 5.97% had grade 2. Amongst MB cases, 27.48% had WHO grade 1 disability present, and 18.24% had grade 2 present, compared with 6.04% and 3.51%, respectively, amongst PB cases. A total of 11.90% of the cohort had sensory NFI of any kind, and 7.39% had motor NFI. Ninety patients presented with NFI needing treatment (3.38%), and of these, 61 (67.78%) had silent NFI. MB patients had a prevalence of reaction/NFI needing treatment nearly 7 times higher than PB cases (15.32% amongst MB; 2.30% amongst PB), and males nearly double that of females (5.67% amongst males, 2.96% amongst females). The most commonly affected nerve by function impairment was the posterior tibial (sensory) with 6.46% of nerves affected (9.38% of patients), followed by the ulnar nerve with 3.23% of nerves impaired (5.56% of patients). Future research and publications, building on this foundation, will focus on the following areas: the incidence of NFI and reactive events, the risk factors for developing NFI, and the response to treatment of patients developing acute NFI.     

A woman with leprosy is in double jeopardy

The double jeopardy associated with female leprosy patients is the central theme underpinning this essay. It constitutes a combination of biological factors unique to women and culturally defined bias, resulting in more stigmatization and isolation for women. Having examined the female immunological response and biological roles, the essay continues by focusing on the gender-culture perspective of leprosy. It draws upon an historical analysis of the experiences of Indian and African women to illustrate the ways in which gender roles impact upon health education and the utilization of health care services. Concluding comments suggest strategies that might improve female leprosy patient status, and views towards future research.     

Current situation of leprosy colonies/leprosaria and their future in P.R. China

OBJECTIVE: To identify the current situation of leprosy colonies/leprosaria and make some recommendations for improving the quality of life of people affected by leprosy in China. METHODS: A national survey using designed forms was carried out in 2004. The forms were filled in by local heads responsible for the management of leprosy colonies/leprosaria and sent to Provincial and National Centres for analysis. RESULTS: China had 605 leprosy colonies/leprosaria with 555 active leprosy patients (on treatment) and 18,175 ex-patients (people affected by leprosy) living in them at the end of 2004. Among 18,730 patients and people affected by leprosy, 13,430 (71.7%) had grade 2 disabilities. Among those with visible disability, 6392 (47.6%) lost the ability to take care of themselves due to serious deformity. Because of a decrease in health workers working at leprosy colonies and a shortage of medical materials, the health care quality of these people was neglected. Most colonies/leprosaria were located at remote and isolateS places with difficult transportation, and most buildings/houses were in danger of collapse because the colonies/leprosaria were built in the 1950's. Those affected by leprosy were in great need of help. CONCLUSION: The authors recommend that small, remote and isolated leprosy colonies should be closed. New leprosaria at District, Provincial or National levels should be established or some old leprosaria with good transportation should be reconstructed to house those affected by leprosy from closed leprosy colonies/leprosaria. The newly established or reconstructed leprosaria could act as centres for reference, training, rehabilitation and research on leprosy.     

江苏省麻风治愈存活者慢性病患病现状及影响因素分析

目的:了解江苏省麻风治愈存活者慢性病患病现状,分析影响因素。方法:采用普查的方法,调查麻风院村内以及社会上的麻风治愈存活者(以下分别简称为住村组和居家组),了解他们的慢性病患病情况及影响因素。结果:共有12724例麻风治愈存活者完成了该项调查,包括803例麻风院村内休养员和11921例院外治愈存活者,其中男8969例,女3755例。高血压、高血脂、冠心病、脑卒中、糖尿病、肿瘤、精神病患病率分别为28.7%、2.9%、5.2%、2.8%、5.3%、2.0%、0.4%。住村组、女性、非农业户口、高年龄为麻风治愈存活者的慢性病患病的危险因素(P<0.05)。结论:麻风治愈存活者不仅有生理畸残和心理障碍,还面临着慢性病如高血压、糖尿病等困扰。     

Childhood leprosy in eastern Nepal: a hospital-based study

A hospital-based retrospective study on childhood leprosy was carried out at B.R. Koirala Institute of Health Sciences, Dharan, covering the period April 1998-April 2002. 20 (4.45%) leprosy patients were detected in children aged 6-14 years. The male:female ratio was 4:1. History of contact was found in 10% of the patients. The commonest type of leprosy was borderline tuberculoid leprosy (550%), followed by borderline lepromatous leprosy (301%). Most of the patients had more than one lesion. Nerve involvement and grade 2 deformity were noted in 55% and 20% of the patients respectively. Slit skin smear was positive in 30% of patients.