Existing knowledge on risk factors for the development of clinical leprosy among contacts of known leprosy patients is reviewed with the aim to identify factors associated with leprosy among contacts that have potential for developing effective targeted interventions in leprosy control. Different definitions of ‘contact’ have been used and most studies on this subject were among so-called household members. Yet several studies indicate that contacts found in other places than the household are also at risk of developing leprosy. The type of leprosy and the bacterial index are the main patient-related factors involved in transmission, but also contacts of PB patients have a higher risk of contracting leprosy as compared to the general population. The most important contact-related factors are the closeness and intensity of the contact and inherited susceptibility, while the role of age and sex of the contacts is not clear. The role of socio-economic factors is also vague. The significance of immunological and molecular markers in relation to risk of transmitting or developing leprosy is not yet fully understood, but there is an indication that contacts who are sero-positive for anti-PGL-I antibodies are at increased risk of developing clinical leprosy. The presence of a BCG scar is likely to be related to a lower risk. Analogies with tuberculosis suggest that the ‘stone-in-the-pond’ approach to control may be applicable to leprosy too. Sputum smear negative tuberculosis patients are known to spread the bacteria to others. This analogy strengthens the suggestion that the contacts of paucibacillary leprosy cases should also be included in contact tracing and examination. It is concluded that targeted interventions should be aimed at close contacts of both MB and PB patients inside and outside the household, particularly when genetically related.
The way people interpret their disease and its treatment, or the meanings of these, has an impact on the way they deal with their disease and its treatment; meanings shape actions. In this article, the influence of the patients’ interpretations on their coping with leprosy and its treatment, their help seeking and adherence behaviour is explored. This article describes the findings of a qualitative study, in which 29 people who discontinued treatment and 47 people who were released from treatment were interviewed in depth. All were registered at general health posts. Exploring the meanings of leprosy and its treatment in patients in Nepal resulted in the identification of six different categories of meanings. Each of these influenced the way people coped with leprosy and its treatment, their help seeking and adherence behaviour. These different categories are discussed. The main conclusion is that the explanatory models of the interviewees and of the health worker are different and that if we want to improve our leprosy services more health education has to be given whilst at the same time listening more carefully to those affected by this disease. This will give us greater insight into the way people understand their disease and its treatment and the measures we can take to prevent discontinuation of treatment.
Based on a qualitative interview study conducted in eastern Nepal, this paper explores the quality of services received by people with leprosy and the impact of quality of services received on adherence behaviour. The study found that a person’s status within the family and community influenced the quality of care, which in turn affected adherence to treatment. Five major types of deficiency in the quality of care experienced were identified, particularly by the poor people and by women. These were the attitude and behaviour of the health worker, the practitioner-centeredness of the care and lack of information sharing, the organization of the health services, barriers in accessibility of the leprosy services, and lack of, or carelessness in, patient referral. This paper explores these types of deficiencies and the way people affected by leprosy cope with them. People of a higher status had access to enabling factors which allowed them to continue treatment, people of a lower status had to endure many disadvantages which had a great influence on their adherence behaviour.