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Volume - 84, Issue - 4

Original Papers
Pages 256 - 265
  • Correlation between the spatial distribution of leprosy and socioeconomic indicators in the city of Vitória, State of ES, Brazil

    • Poliane Barbosa Sampaio
    • Adelmo Inácio Bertolde
    • Ethel Leonor Noia Maciel
    • Eliana Zandonade
    Volume 84, Issue 4

    | Published on December 2013

    Introduction:

    Leprosy is a disease that is directly linked to poverty. The number of cases in Vitória, the capital city of Espríto Santo, has been decreasing in recent years, but the disease remains highly endemic. This research aimed to identify relationships between the epidemiological status of leprosy and socioeconomic indicators during the period from 2005 to 2009.

    Methods:

    An ecological study was performed based on the spatial distribution of leprosy in Vitória, Espírito Santo, between 2005 and 2009. The source data used were records available at the Secretary of State for Health of the Espírito Santo. We used the Urban Quality Index (IQU) as the leprosy-associated socioeconomic variable. The data were analysed with covariate and spatial effects by the WinBugs programme (Version 1.4) and R (Version 2.12).

    Results:

    The spatial distribution of leprosy in the district is not uniform. By studying the geographic distribution of leprosy cases, and the risks estimated by the complete Bayesian model, it was possible to gain further insight into the distribution of leprosy cases. It was noted that neighbourhoods with a low IQU have a higher leprosy case detection rate than neighbourhoods with a higher IQU. This result reinforced the theory that a low IQU is associated with the emergence of leprosy.

    Conclusion:

    The model methodology adopted enabled the verification of the effect of the influence of covariates related to the social determinants of health as well as the spatial structure, in contrast to the gross rate method that does not aggregate this information. The results obtained suggest that leprosy control may be promoted by improving the socioeconomic indicators of neighbourhoods, and highlights the need for implementation of health policies aimed at people who live in areas where they are at greatest risk of getting sick.

Original Papers
Pages 266 - 282
  • Combining peer-led self-care interventions for people affected by leprosy or diabetes in leprosy-endemic countries. What do health care professionals think?

    • Willemijn de Bruin
    • Evelien Dijkkamp
    • Erik Post
    • Wim H. van Brakel
    Volume 84, Issue 4

    | Published on December 2013

    Introduction:

    Leprosy is slowly decreasing in incidence whereas diabetes is a growing health concern. Despite differences in aetiology, both diseases may lead to peripheral neuropathy and subsequent injuries and permanent impairments. There are also indications of similarities in psychosocial consequences. Prevention of Disability (POD) and self-management are often recommended for both diseases. This led to the idea of exploring the feasibility of combined peer-led self-care interventions for people with these disorders.

    Objective:

    To explore the opinions of health care professionals about combining peer-led self-care interventions for people affected by leprosy or diabetes in leprosy-endemic countries.

    Method:

    An exploratory study was conducted to collect quantitative data by means of an e-questionnaire and qualitative data through in-depth semi-structured interviews with key informants.

    Results:

    In total, 227 respondents answered the e-questionnaire and 22 in-depth interviews were conducted. Resemblances in physical complications between leprosy and diabetes were confirmed by the respondents. Psychosocial similarities included limitations in daily activity and in social participation, but stigma in leprosy was thought to be an important difference. Considerable overlap in current practices was found, mainly in patient education in POD, skin assessment and skin care, and the recommendation to use protective footwear. Knowledge exchange between leprosy and diabetes specialists is limited, although combined interventions were reported. The majority of respondents think that combined interventions are ‘possible’ (33.3%) or ‘possible and promising’ (30.8%). Professionals working with both diseases are more positive than those working with leprosy or diabetes only. The greatest barriers for combined interventions are perceived to be leprosy-related stigma, differences in underlying socio-economic status, attitudes of health care professionals and the current organization of health care systems.

    Conclusions:

    Responses indicate perspectives for combined interventions for the prevention of disabilities. For this, it is essential to intensify knowledge exchange between leprosy and diabetes professionals, to overcome barriers and to secure government policy support. Opportunities should be assessed in a situation-specific way.

Original Papers
Pages 283 - 291
  • Self-care groups of leprosy-affected people in Mozambique

    • Sunil Deepak
    • Paulo Estivar Hansine
    • Carole Braccini
    Volume 84, Issue 4

    | Published on December 2013

    Introduction:

    In 2011, the national leprosy control programme in Mozambique decided to promote the setting up of self-care groups (SCGs) for prevention and care of disabilities.

    Objectives:

    To present an overview of the national SCG strategy and to understand the perceptions of people with leprosy regarding the benefits and challenges of participating in the SCGs in Mozambique.

    Methods:

    Semi-structured group interviews were carried out with 22 SCGs involving 299 leprosy affected people in Nampula and Manica provinces.

    Results:

    SCGs are involved in different activities and do not limit themselves to activities related to disability care. The majority of respondents expressed satisfaction about their participation in SCGs. Apart from perceived benefits in relation to their disabilities, the majority of SCG members also reported benefits in social participation. Lack of training, insufficient resources for income generation and long distances were the major challenges for SCGs, especially in the Manica province.

    Conclusions:

    People affected with leprosy perceive SCGs as useful in self-care for prevention of disabilities and social participation.

Original Papers
Pages 292 - 301
  • The quality of life of people with leprosy-related residual impairment and disability in Malawi – Is there a difference between people living in a leprosarium and those re-integrated into their communities?

    • Dorothy Chingu
    • Madeleine Duncan
    • Seyi Amosun
    Volume 84, Issue 4

    | Published on December 2013

    Objective:

    To compare the quality of life of people affected by leprosy living in a leprosarium and those reintegrated in communities in the southern region of Malawi.

    Design:

    A translated version of the World Health Organization Quality of Life BREF questionnaire (WHOQOL-BREF) was administered among two groups of people with leprosy-related residual impairment and disability living in either a leprosarium (male 47, female 53) or re-integrated into communities (male 41, female 57). The cross-sectional quantitative survey was conducted by trained Leprosy Control Assistants (LCAs). Descriptive statistics of mean and standard deviation were used to summarise the data while differences between the groups were evaluated using independent t-test. Level of significance was set at P < 0.05.

    Results:

    Demographic data revealed that there were more residents of an older age in the leprosarium. There was no statistically significant differences in the WHOQOL-BREF mean scores between by those affected by leprosy living in the two contexts. Statistically significant differences existed in the psychological, physical and environmental domains when age and gender were used as confounding factors.

    Conclusions:

    We conclude that there is need to provide interventions that will encompass age and gender to all those affected by leprosy to improve their quality of life in both contexts.

Original Papers
Pages 302 - 307
  • Superposition of Leprosy and other neglected tropical diseases in the State of Rio de Janeiro: a case series report

    • Daniel Garbin Di Luca
    • Pedro José Secchin De Andrade
    • Anna Maria Sales
    • Vinícius Martins De Menezes
    • Maria Clara Gutierrez Galhardo
    • Maria Inês Fernandez Pimentel
    • Marcelo Rosankidki Lyra
    • José Augusto Da Costa Nery
    Volume 84, Issue 4

    | Published on December 2013

    This is a report on eight non-HIV infected leprosy patients presenting unusual co-infection with other, often neglected, tropical diseases, namely: American tegumentary leishmaniasis (ATL), sporotrichosis, and cryptococcosis. To the best of our knowledge, there have been very few ATL-leprosy co-infection reports in the literature to date and only one previous description of the coexistence of leprosy-cryptococcosis and leprosy-sporotricosis.

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