Keywords

Adherent leucoma bacteriological index CLTRI contact tracing disability Effectiveness electromyography elephantiasis-like epidemiology folliculotropic mycosis fungoides Hansen; Nerve abscesses; Borderline tuberculoid leprosy; Downgrading Type 1 reaction Hansens disease Hyper-endemic leprosy Igbo Lepromatous leprosy lepromatous leprosy leprosy Leprosy leprosy reactio lupus vulgaris mimick Mycobacterium leprae Necrotic ENL neuropathy Orientation Participation Scale physiotherapy Psychometric Sat Scan spatial analysis spatial clustering Split Skin Smear Toliara-Madagascar tuberculoid leprosy uniform multidrug therapy

Volume - 87, Issue - 3

editorial
Page 275
Review
Pages 276 - 293
  • The prevalence of leprosy in school-students and evaluation of school-based screening for leprosy: A Systematic Review

    • Katherine Fowden
    • Richard Franklin
    • Patricia Graves
    • David Maclaren
    • John Mcbride
    Volume 87, Issue 3

    | Published on September 2016

    Leprosy is a Neglected Tropical Disease (NTD) causing significant physical and functional disabilities around the world. The objective of this systematic review was to evaluate school-based leprosy screening as a means of identifying early leprosy cases. Using a structured search method, 30 suitable publications were identified. Whilst all studies included in this review were found to identify cases of leprosy through school-based screening, sample sizes were high and numbers detected were small, raising concerns about the feasibility and sustainability of school-based screening as a stand-alone intervention for leprosy detection. For school-based screening programmes to become a sustainable intervention, the inclusion of both capacity building and health education components into school-based screening and intervention programmes should be further explored. More research is needed to consider alternate methods which maximise the efficiency of school-based approaches in the early case detection of leprosy. Also, cases found at school may be used to find further active cases via family and friends. School-based screening could be an effective solution for the early identification of leprosy particularly in areas of high endemicity, however to date there is limited data on its effectiveness compared with other interventions.

Original Papers
Pages 294 - 304
  • Trends and spatial clustering of leprosy cases over a decade in a hyper-endemic area of western Maharashtra, India

    • Sanjana Kuruwa
    • Vasna Joshua
    • Vanaja Shetty
    • Nerges Mistry
    Volume 87, Issue 3

    | Published on September 2016

    India accounts for 58.8% of globally reported new leprosy cases, wherein the Raigad district continues to report a high annual new case detection rate. The objective of this study was to assess the effect of integration of leprosy treatment into the public health system across 5 Public Health Centers (PHC) in this area. Spatial clustering and trends of leprosy cases prior to and post integration are reported.

    The study findings show a drop in prevalence rate (PR) was similar across all 5 PHCs with a steeper drop post integration into the public health system. A higher PR in 2007 08 was the result of an active survey. Post 2005, a higher proportion of MB cases indicate delayed diagnosis. An average of 7.95% ± 2.4% cases presented with some form of deformity and 19.54% ± 5.6% of total cases were child cases both higher than the national average.

    Some areas of high clustering before integration were not identified as clusters later, indicating reduced prevalence. The lack of high risk clusters in the post integration period may be due to passive detection of cases which is supported by an active survey that identified new cases.

    Spatial scans enabled the identification of clusters across adjacent areas which overcome administrative boundaries. This emphasizes the need to analyze disaggregated data to get a broader perspective of leprosy. Thus, analyzing prevalence in conjunction with key indicators such as presence of MB cases, child cases and deformity and their spatial distribution provided a more comprehensive assessment of the situation of leprosy.

Original Papers
Pages 305 - 313
  • Epidemiology and spatial exploratory analysis of leprosy in the district of Toliara, Madagascar

    • Veronique Suttels
    • Tom Lenaerts
    Volume 87, Issue 3

    | Published on September 2016

    Objectives:

    As leprosy case-notification is plateauing worldwide, a more targeted approach including contact tracing and possibly treating hotspots becomes necessary. This study aims to provide an update on the epidemiology of leprosy in the District of Toliara by comparing the local leprosy indicators to national data, along with a geographical exploration of patients origin and identification of hotspots.

    Results:

    A cohort of 87 patients who started polychemotherapy (PCT) in 2013–2014 was identified at the principle hospital of Toliara. When compared with national findings, two-tailed z scores for proportions (95% confidence interval) indicate a significantly lower proportion of MB cases (79%, P = 0.01), a higher proportion of females (39%, P = 0.001) and a lower proportion of PCT completion in MB patients (59%, P = 0.00001) in this cohort. Two maps were generated illustrating origin of patients by municipality and hotspots in the urban area and coastal rural regions along the Route Nationale 9 (RN9).

    Conclusions:

    This study demonstrates the differences in leprosy indicators when comparing Toliara district to Madagascars national data with a significantly low PCT completion rate in this patient cohort. A geographical exploration on patients provenance reveals the appearance of hotspots especially in easily accessible municipalities. In interpreting hotspot analysis and eventually selecting appropriate strategies/interventions, care should be taken to take account of possible underestimation of leprosy burden in rural and difficult-to-reach areas.

Original Papers
Pages 314 - 321
  • Results of eight years follow up among multibacillary patients treated with Uniform Multidrug Therapy in China

    • Yan Liangbin
    • Shen Jianping
    • Yu Meiwen
    • Zhang Guocheng
    • Li Jinlan
    • Yu Xiufeng
    Volume 87, Issue 3

    | Published on September 2016

    Objective:

    To analyse the results of treatment among multibacillary (MB) patients 8 years after treatment with 6 months multidrug therapy (MDT). Methods: Newly detected and relapsed MB leprosy patients were treated with 6 months WHO-MDT. The patients were followed up for 8 years. The effectiveness of treatment was assessed by clinical status and bacteriological changes.

    Results:

    A total of 114 patients were recruited. Forty two patients dropped out from the study for various reasons. Only 72 patients remained for the final analysis. The mean Bacteriological Index (BI) of all patients decreased from 2.93 ± 1.39 before treatment, to 0 at the end of the eight year follow up period, with an average annual BI decrease of 0.42. The rate of smear negativity of all patients was 100% at the end of follow up. 38 (53%) patients experienced leprosy reactions during the study and one patient relapsed, giving a cumulative relapse rate of 1.3% or 0.035 per 100 patient-years.

    Conclusion:

    The finding that all MB cases with initially positive skin smears, who were treated with only 6 months of MB-MDT, became negative within 8 years showed that the response to this regimen is good in a majority of MB cases.

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