Evaluation of national leprosy eradication programme in Satara District, Maharashtra

The aim of this study was to evaluate the impact of national leprosy eradication programme (NLEP) in Satara District. A retrospective record based study was conducted in the district leprosy control unit with evaluation indicators like prevalence rate (PR), new case detection rate (NCDR), percentage of cases released from treatment, proportion of female cases among new cases, proportion of multi bacillary (MB) cases among new cases, proportion of grade-2 disability among new cases and proportion of child cases among new cases and trend was analyzed for statistical significance by using Chi-square test. During study period from year March 2003-04 to March 2007-08, there was decrease in PR of leprosy from 2.46/10000 population to 0.62/10000 population, NCDR decreased from 3.46/10000 population to 0.77/10000 population and trend was statistically significant (p<0.001*, P<0.001*) respectively. Declining trend of grade 2 disability among new cases was noted and this was statistically significant (p<0.01*). Proportion of female cases among new cases showed little fluctuation from 43.3% to 47.5% but trend was statistically significant (p<0.03*). Proportion of MB cases among new cases increased from 44.4% to 53.6% while proportion of child cases among new cases decreased from 16.5% to 12% and trend was statistically significant (p <0.001*, p<0.001*) respectively. The NLEP has a favorable impact towards elimination of leprosy in Satara District, Maharashtra.     

Leprosy situation in endemic states of India and prospects of elimination of the disease

In India there is a dramatic fall in the prevalence rate (PR) of leprosy, but the new case-detection rate (NCDR) has not been reduced concomitantly. It is the operational efficiency of the National Leprosy Eradication Programme (NLEP) that has led to a significant reduction in the NCDR in Andhra Pradesh and Tamil Nadu. The ratio of PR to NCDR has been declining in these two states and it reveals that elimination could be reached even with the high NCDR level of 3 to 4 per 10000 population, particularly if single skin lesion (SSL) cases are discharged through single dose treatment of rifampicin, ofloxacin and minocycline (ROM). On the other hand, the significant number of cases detected in Bihar and Orissa during modified leprosy elimination campaigns (MLECs) reveals that there are lacunae in operational activities in new case-detection resulting in a large number of undetected cases in the community. Only one-third of the cases are reporting voluntarily. Awareness of leprosy is not adequate to motivate the patients to report voluntarily and complete their treatment, thus underscoring the need for relying on active case-detection so that transmission can be broken and elimination of leprosy achieved. In addition, the influence of socio-economic factors on continued occurrence of leprosy cannot be ruled out. The establishment of a sentinel surveillance system along with a computerized simplified information system to gain in-depth knowledge on the functioning of the NLEP will ensure operational efficiency. In view of this situation, the NLEP should adopt a more realistic approach towards reaching the elimination goal.     

Evaluation of National Leprosy Eradication Program after Integration into General Health System in Rajkot District,Gujarat from 2003 to 2014

Background:National Leprosy Eradication Program (NLEP) was launched in 1983 with the goal of elimination of leprosy as a public health problem.Aim:To evaluate the NLEP performance after integration into general health system from April 2003 to March 2014.Results:The PR of leprosy per 10,000 populations was significantly declined (P < 0.001) from 0.44 in 2003–2004 to 0.15 during March 2014. Reduction in NCDR trend was statistically significant (P < 0.001). The proportion of female cases among newly detected cases showed fluctuation from 36.23% in 2003–2004 to 37.10% in 2013–2014 (P > 0.05). The proportion of child cases also showed significantly declining trend from 12.08% in 2003–2004 to 6.70% in 2013–2014 (P < 0.05). Significant number of MB cases decreased from 122 (2003–2004) to 69 (2013–2014) (P < 0.001). Grade II disability proportion was 1.45% in the year 2003–2004, increased to 5.2% in 2009–2010 and then again decreased to 3.4% in 2013–2014 (P > 0.05). Proportion of patients RFT showed fluctuation from 66.66% (2003–2004) to 45.68% (2009–2010) and then 64.66% (2013–2014) (P < 0.001).Conclusion:The NLEP is having a favorable impact on the problem of leprosy by maintaining the elimination level of leprosy in Rajkot district over a decade.     

Leprosy among tribal population of Chhattisgarh state, India

Chhattisgarh state is still endemic for leprosy and has a large tribal population. During 2003-2009, a total of 1530 untreated leprosy cases reported to the Leprosy Mission Referral Hospital in Champa, of which 151(9%) were classified as belonging to the scheduled tribes. The characteristics of these new tribal patients are described and compared with other patients and to the demographics of the tribals in the general population of the State. While tribals were accessing the leprosy services similar to the other social groups, the delay in reporting, high BI and other features pose more serious problems in the transmission of leprosy and in management of complications due to the harsh environment and occupational patterns of the tribals. Appropriate strategies and more community based approaches will be necessary if these groups are also targeted for eradication of leprosy.     

Leprosy case detection using schoolchildren

An innovative method that combined awareness creation with screening of high school students by their peers was undertaken in 26 randomly selected schools in the project area of the Schieffelin Leprosy Research and Training Center, Karigiri, Vellore, India. This method entailed educating teachers and student leaders in grades 8-12 about leprosy and how to suspect leprosy among their peers. The student leaders in turn conducted a similar awareness programme for their peers and encouraged them to report if they suffered from any skin problem or skin lesion. Based on the reporting by their peers, the class leaders prepared a 'suspect list'. Within a fortnight of the awareness program, a trained leprosy worker visited the school and examined all the students on the 'suspect list'. Those diagnosed to have leprosy were referred to a medical officer, who then confirmed the diagnosis and initiated treatment. Among the 23,125 students enrolled in the 26 randomly selected schools, 234 student leaders were educated about leprosy and trained to detect suspect lesions among their peers. A total of 2200 (9.5%) children reported with skin lesions to their leaders and after screening by a leprosy supervisor and confirmation by a medical officer, 14 new cases (NCDR 6.05/10,000) were detected. This rate was found to be comparable with case detection rates of annual school surveys done during the National Leprosy Eradication Programme (NLEP), when all schoolchildren were examined. The paper suggests that schoolchildren can be used effectively in leprosy case detection and this method has the additional advantage of creating awareness among them, their teachers and communities.     

Leprosy: two case reports from Dresden, Germany

Leprosy is very rare in Germany. In 2003, only three cases were reported. In the Department of Dermatology, Dresden-Friedrichstadt, two cases from Asia had been diagnosed during the last 5 years, a paucibacillary tuberculoid leprosy and a multibacillary lepromatous leprosy. In both, there was a diagnostic delay of several months (3–7 months). The need for early detection of this mycobacteriosis also in nonepidemic areas of the world and the importance of a correct diagnosis by the dermatologist is hereby emphasized.     

Trends in new case-detection leprosy in Bihar, India

Multi-drug therapy (MDT) has been successfully implemented in all leprosy endemic countries. Prevalence of leprosy has declined remarkably after the introduction of MDT. Detection of new cases did not show expected decline in many endemic and low endemic situations. Bihar in India started implementing MDT in 1993. The Damien Foundation India Trust (DFIT) supported the leprosy control programme in Bihar by providing a district technical support team (DTST) for each district assigned to DFIT. Effective coverage was achieved in 1996-98. Data for the period 1996-2004 from 10 districts are presented in this paper. The total population in these districts was 29.4 million. Deformity among newly detected leprosy patients declined to 1% indicating effective early case-detection. Intensive new case-detection activities were in vogue contributing to high new case-detection rate (NCDR). The NCDR remained high during the 9-year period reported here and did not show any declining trend.     

Leprosy elimination campaigns in Orissa

Four Modified Leprosy Elimination Campaigns (MLECs) were conducted in Orissa by March 2003. Their impact on various leprosy indicators was analyzed. More than 70% of the people of the State were examined during these campaigns. The suspect rate decreased from 1.44% to 0.37% towards the fourth MLEC. About 15% of the suspects were clinically confirmed to be having leprosy. The total number of new cases detected during the MLEC years was on the decrease. A marked fall in new case-detection rate was observed during inter-MLEC years. This has resulted in fluctuation in the prevalence rate during the MLEC years, but the overall PR/10,000 population decreased from 12.18 in 1996-97 to 7.3 in March 2003. More than 40% of the total new cases and about 45% of total new child cases for the corresponding year were detected during the MLECs, and the proportion of total new case-detection was as high as 60.8% during the first MLEC. The proportion of female cases detected during succeeding MLECs improved and an almost equal number of female cases were detected during MLECs III and IV. Considering the present leprosy situation in Orissa and the effectiveness of MLECs in case-detection, it was recommended that such campaigns should be undertaken in select high prevalent blocks of the State at regular intervals, along with the strengthening of the integration of NLEP activities into primary health care activities.     

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.     

Two cases of leprosy in Valladolid

Leprosy is still a major health problem on a worldwide level, and although it does not reach endemic levels on our continent, it seems that there is an upward trend due to the number of imported cases diagnosed each year. We present two cases of lepromatous leprosy diagnosed in Valladolid within a five-month period. The last reported case of this disease in our community was over 20 years ago.     

Leprosy: between acceptance and segregation. Community behaviour towards persons affected by leprosy in eastern Nepal

This study describes community behaviour towards persons affected by leprosy in the eastern Terai districts of Nepal. The results show that 95% of the persons affected by leprosy recognized by the community have visible signs such as wounds, swellings and deformed feet or hands. Persons affected by leprosy still experience negative behaviour. Motives for negative community behaviour are mostly found in the fact that people fear infection by germs, but fear of a curse from God is also mentioned. This study shows that negative community behaviour is still present in eastern Nepal. Leprosy is more than a disease; the disease can nowadays be medically cured, but the sickness of leprosy still remains. Leprosy control programmes should focus on prevention of impairments and disabilities, because it seems that a visible sign is an important trigger for negative community behaviour.     

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.     

广州市部分门诊病人麻风病认知调查分析

目的:了解广州市部分门诊病人的麻风病知识水平,探索低流行状态下麻风病防治的有效途径。方法:采用自行设计的调查问卷对普通门诊病人和麻风村门诊病人进行麻风病知识、态度及行为调查。结果:接受调查者中大部分人对麻风病和麻风病人仍然存在较大程度的片面认识,恐惧和歧视的现象依然存在,麻风村门诊病人在客观认知和包容接纳方面优于所本部门诊病人。结论:低流行状态下麻风病防治工作不能放松,需多方面努力营造一个宽松的社会环境,最重要的工作环节是早期发现和治疗麻风病人。     

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.     

The current challenge of imported leprosy in Spain: a study of 7 cases

Backgroundalthough the foci of leprosy once present in Spain are now under control and almost inactive, isolated cases are still occasionally diagnosed. Meanwhile, population migration has brought about an increase in the incidence of cases corresponding to individuals from countries where leprosy is endemic, leading to changes in the epidemiology of this disease.Objectivesthe aim of this paper was to describe the clinical, epidemiologic, dermatologic, microbiologic, and therapeutic characteristics of cases of leprosy in our department in the last 5 years.Material and methodswe report the cases of imported leprosy seen in our department between 2004 and 2009.Resultsseven patients with leprosy (3 men and 4 women; age range, 26-80 years) were diagnosed; 2 were cases of tuberculoid leprosy, 2 borderline tuberculoid leprosy, and 3 indeterminate. All patients acquired the disease in South American or South African countries, but were residing in Spain at the time of diagnosis. One patient was a Spaniard, from Malaga, who had worked as a missionary in Venezuela for 25 years. The presence of the bacterium by either Ziehl-Neelsen stain or bacilloscopy could not be demonstrated in any of the patients.Conclusionswe would like to draw attention to the changes we have observed in the characteristics of cases of leprosy seen in our department, the majority of which are imported. It is important to maintain a clinical suspicion of leprosy in cases of granulomatous dermatitis, particularly in patients from countries where the disease is endemic.     

Leprosy in a renal transplant recipient: a case report and literature review

Leprosy is rarely seen in organ transplant patients; only ten cases of leprosy in organ transplant recipients have been reported. We herein report a Taiwanese renal transplant recipient concomitantly infected with borderline lepromatous leprosy. A 68-year-old male received renal transplantation at Guilin, China, in 2000, and then received immunosuppressive therapy with prednisolone, tacrolimus, and mycophenolate. Three years after transplantation, multiple erythematous tender nodules and plaques over the face and lower limbs developed. Biopsies and histopathological examination confirmed the diagnosis of leprosy. We treated the patient with a multidrug regimen including dapsone, clofazimine, and rifampine since November of 2003 with a good response. Unfortunately, he suffered from a cluster of complications after an accidental fall, finally leading to septic shock and death five months later. In summary, we report a rare case of new-onset leprosy after renal transplantation in Taiwan and suggest leprosy should be listed in the differential diagnosis of unusual skin manifestations in organ transplant patients.     

Epidemiological shift in leprosy in a rural district of central India following introduction of multi-drug therapy (April 1986 to March 1992 and April 1992 to March 2002)

This study compares the epidemiological pattern of leprosy in pre- (April 1986 to March 1992) and post- (April 1992 to March 2002) multi-drug therapy (MDT) periods by retrospective analysis of 3274 registered leprosy cases in the rural field area of Regional Leprosy Training & Research Institute (RLTRI), situated in Raipur district of Chattisgarh province of Central India. The area has high endemicity for leprosy. In the post-MDT period, prevalence rate (PR) came down to less than 1 in 10, while New Case Detection Rate (NCDR) remained almost static during the two periods. Of the total new registered cases, 30.1% were registered during the pre-MDT period and the remaining 69.9% during the post-MDT period. Comparison of key leprosy variables among new registered cases showed a 2-fold rise in the proportion of MB cases (14.8 versus 27.6%), 3.0% increase in proportion of child cases (15.3 versus 18.6%) and cases with deformity grade II (3.1 versus 5.9%) and 4.0% increase in female proportion (41.4 versus 45.7%) during the post-MDT period. A decline was noted in mean age of registration for both MB (6.4 years) and PB (5.7 years) groups in the post-MDT period. While comparing treatment and outcome related variables, a marked fall of 25.8 months was recorded in treatment duration in the post-MDT period. The defaulter rate came down by 45.0% and relapse rate by more than 12.0% during the same period. The study shows that MDT is effective operationally, but continued ongoing transmission of infection and delayed diagnosis needs corrective action.     

Cojedes: a leprosy hyperendemic state

Background Leprosy is a chronic infectious disease produced by Mycobacterium leprae. In 1997 Venezuela reached the goal of elimination of leprosy as a public health problem (according to the World Health Organization a prevalence rate of ≤1/10,000 inhabitants), but five states still had prevalence rates over that goal. For this study we selected Cojedes State, where prevalence rates remain over the elimination goal. Objective Evaluate the real leprosy situation in high‐prevalence areas of Cojedes State. Materials and methods Seven communities of Cojedes State were selected because they had the highest historic prevalence, as well as the highest prevalence in the year to be studied (1997). Results A rank correlation using Spearman’s test comparing historical prevalence rates (1946–1996) and detection rates (1998–2004) gave a statistically significant P < 0.05 value. Diagnosed leprosy cases were as follows: age: 3.2% under 15 years old; sex: male/female rates between 60% and 91.66% males. The highest number of cases were paucibacillary forms: indeterminate leprosy (33.07%) and borderline tuberculoid leprosy (32.28%); tuberculoid leprosy (7.00%); and multibacillary cases (lepromatous leprosy, LL) were only 2.36%. Bacteriologically, 18.52 patients were M. leprae positive. At the moment of diagnosis, 96.6% showed no disabilities, 3.4% showed grade I disabilities, and there were no grade II or III disabilities. Conclusion This study confirms that several communities in Cojedes State have extremely high leprosy rates.     

LEPROSY IN CHILDREN: A PROSPECTIVE STUDY

Background. Leprosy has been identified as an important health problem in the pediatric age group. The study of leprosy in children is imperative as it may unravel the missing links in the natural evolution of the disease and dispel the uncertainty of the precise incubation period. Methods. The study was undertaken on patients attending the Urban Leprosy Centre. There were 161 children in the age group of 0 to 14 years, amongst 3184 cases of leprosy, detected between 1981 and 1991. The diagnosis in each was formed after meticulously recording the clinical features, slit-skin smear examination, and histopathologic characteristics. In addition, a detailed history of duration of the disease was elicited by complement recall method. Results. The study revealed an incidence of 5.06% amongst leprosy patients, in an urban setting. The boys:girls ratio was 2.6:1. The mean duration of the disease was 1.2 years in paucibacillary and 2.8 years in multibacillary. History of intra- or extrafamilial contact was elicited in 8.7%. The typical lesion was a “hypopigmented macule,” either of indeterminate, tuberculoid, borderline tuberculoid, or borderline borderline leprosy. Borderline lepromatous, lepromatous, and polyneuritic leprosy were uncommon. Conclusions. Leprosy in children is a well-established distinct entity. Any hypopigmented macule in pediatric age group should arouse suspicion of leprosy. The diagnosis is clinical. Other investigative parameters, namely slit-skin smear, and histopathology may supplement but not supplant the diagnosis.     

Leprosy in eastern region of Rajasthan

Total population survey covering 28055 persons living in 34 villages of eastern Rajasthan was carried out. Out of 28055 persons 20276 (72.27%) were actually examined and 218 cases of leprosy were detected. Prevalence of leprosy was found to be 10.75/1000, which is very high and contrary to earlier observations regarding leprosy prevalence in Rajasthan. Leprosy problem in Rajasthan has been discussed.