The 35kDa antigen of
Social and cultural factors influencing knowledge, attitudes and practices (KAP) towards leprosy in two communities in eastern Sudan were studied to determine their effects on treatment seeking and compliance. The study was qualitative using focus small group discussions, personal interviews and direct observation. The target populations were Masalit and Hawsa, the two main tribes in the area. Knowledge about the pathological cause of leprosy was lacking but the clinical manifestations were well recognized, particularly among the Masalit, in whom the disease is more common than the Hawsa. Among the Masalit there was a widely held belief that leprosy was caused by eating meat of the wild pig and a certain type of fish. The Hawsa, who are more devout Muslims, do not eat pig and associate leprosy with consumption of two types of fish. Between both tribes, the stigma of leprosy was not strong and the degree of rejection was more towards those with severe disease, particularly patients with ulcerated lesions and severe deformities. Patients were cared for by the family and lived in a separate hut within the families’ housing compounds. In this remote area where medical services are scarce or nonexistent, those interviewed did not realize that leprosy was treatable by modern medicine. This influenced the treatment-seeking behaviour of patients, who were often treated by spiritual healers and other traditional medicine practices. With the introduction of multidrug therapy and health education of patients and society, many more patients are now seeking medical treatment, indicating a change in health seeking behaviour.
From 1979 to 1999, the ALERT leprosy control programme has covered a well-defined area in central Ethiopia using standardized case finding strategies. During this period, the leprosy prevalence has decreased more than 30-fold, there has been a 3-fold decrease in case detection and a 6-fold decrease in the case detection rate. The proportion of MB patients among new cases increased by around 80% and the proportion of children among new cases decreased by around 60%. Several factors may have contributed to these trends. The impact of the introduction of MDT and the shortening of the duration of the MB regimen are shown, but other factors are also discussed at length: an increase in the population of the area, cleaning up of the registers, changing case definitions, changes in staff motivation and fluctuations, even small ones, in case finding intensity and coverage. Do the observed trends reflect a reduction in the transmission of the leprosy infection? Because of the many confounding factors, it would be difficult to answer that question positively at present. Additional rigorous data collection and analysis is required.
Although there is no genetic diversity in isolates of