Keywords

activities of daily living adamawa Aged Beijing children diagnostic delay Disability disability epidemiological tendency footwear fulani Gender grade 2 deformities isolation Leprosy leprosy micro-cellular rubber Neglected Tropical Diseases nomadic pastoralists physical activity qualitative study ready-made footwear reporting delay social participation stigma Stigma work performance

Volume - 88, Issue - 3

editorial
Page 297
Original Papers
Pages 298 - 305
  • A study of untreated leprosy affected children reporting with Grade 2 disability at a referral centre in West Bengal, India

    • Joydeepa Darlong
    • Pitchaimani Govindharaj
    • Famkima Darlong
    • Narayanan Mahato
    Volume 88, Issue 3

    | Published on September 2017

    Setting:

    An observational study of children diagnosed with leprosy and Grade 2 disability at a referral centre in West Bengal, India.

    Methods:

    A descriptive study was conducted of 21 children, diagnosed as new cases of leprosy with Grade 2 disability (G2D), and registered for treatment at The Leprosy Mission Hospital, Purulia, West Bengal, India. The socio-demographic and medical details were obtained from the patients charts. In-depth interviews were carried out with both the children and their parents to inquire about the factors responsible for the delay in diagnosis.

    Results:

    During a 3-year study period (2013–15), 1938 people were diagnosed as new active cases of leprosy at our referral centre; among the registered patients, 319 (16.5%) were children aged between 4 and 15 years, of whom 159 (50%) were diagnosed with multibacillary disease and 21 (6.6%) were reported with G2D. The disability proportion was lower in children compared with adults and higher in MB children compared with PB children. Paralysis of the intrinsic muscles of the hand was seen in 15 children and of these, 10 children had right hand ulnar paralysis and three had bilateral ulnar-median paralysis. Several children had noticed a patch as the first symptom and 15 had a leprosy-affected parent.

    Conclusion:

    This study shows that there is still a problem of children developing G2D before the diagnosis of leprosy is made, and points to some of the social factors responsible for delayed reporting and prompt starting of MDT. Better communication and innovative methods of persuading the families to report early need to be tested and urgently implemented.

Original Papers
Pages 306 - 317
  • A study of the linkage of poverty alleviation with self-care in South Central Nepal

    • Hugh Cross
    • Kerstin Beise
    • Ramesh Choudhary
    Volume 88, Issue 3

    | Published on September 2017

    Background:

    RECLAIM CDR was an empowerment project implemented by the Nepal Leprosy Trust (NLT) in four districts of Nepal. It ran from 2011 to 2016. The RECLAIM methodology reflected that of an earlier STigma Elimination Project that was implemented under the title of STEP. What follows in this paper are the salient findings of an independent evaluation of RECLAIM that took place in April 2016.

    Objectives:

    The main objective of RECLAIM CDR was to ascertain the extent to which the STEP methodology might impact on poverty alleviation.

    Method:

    Quantitative data relating to: impairment status, participation, selfefficacy, and relative poverty was analysed. Qualitative methods were also used for triangulation and to gain perspective.

    Results:

    50 of the self-care groups (SCG) that were established progressed to become self-help groups (SHG) with a total membership of 866 people.

    The median score on the Grameen Progress out of Poverty Index (PPI) rose from 27 to 38.

    There was an improvement in levels of social participation with 44% of beneficiaries reporting ”no restriction”.

    ”Eye Hand and Foot” scores suggested that 68% of leprosy affected SHG members neither experienced improvement or deterioration in impairment status.

    The median self-efficacy score rose from 20 to 29.

    47 of the 50 SHGs had organized and managed a variety of activities that demonstrated commitment to social responsibility.

    Conclusion:

    The outcomes of the project suggest that self-care, as applied by groups of people affected by leprosy does enhance perceived self-efficacy and that the energy generated by such perceptions leads to more productive and fruitful lives generally.

Original Papers
Pages 318 - 333
  • Development of a rights-based counselling practice and module to reduce leprosy-related stigma and empower people affected by leprosy in Cirebon District, Indonesia

    • Mimi Lusli
    • Ruth Peters
    • Joske Bunders
    • Irwanto Irwanto
    • Marjolein Zweekhorst
    Volume 88, Issue 3

    | Published on September 2017

    Objectives:

    Leprosy-related stigma remains a major and difficult challenge to tackle. This study charts the development of a counselling practice and module in which stigmatised individuals are involved as lay and peer counsellors. The practice and module aims to reduce leprosy-related stigma in Cirebon District, Indonesia.

    Results:

    An exploratory study including 53 interviews and 5 focus group discussions aimed to understand the characteristics of people affected by leprosy and the views of the community. Findings were used to develop a draft counselling practice which was then piloted. Sixty-two clients and several family members received counselling during the pilot study. The results of the exploratory and pilot study led to a counselling practice, comprised of an integration of individual, family and group counselling. The provision of medical knowledge about leprosy played an important role in combatting stigma at different levels. Responding to views expressed during the pilot, the proposed module focuses less on feelings of stigmatisation and more on taking action among others by raising awareness of human rights. This study showed that five counselling sessions can trigger clients to move from a seemingly hopeless situation into a place where one feels hope, takes initiatives and experiences less internalised stigma.

    Conclusion:

    Despite the context-dependent nature of stigma, the counselling module has potential as a stigma-reduction intervention for Indonesia and other countries where leprosy-related stigma is widespread. The counselling module presented here should be adjusted to a new context and tested before it can be scaled up.

Original Papers
Pages 334 - 342
  • Leprosy on Anjouan (Comoros): persistent hyper-endemicity despite decades of solid control efforts

    • Epco Hasker
    • Abdallah Baco
    • Assoumani Younoussa
    • Aboubacar Mzembaba
    • Saverio Grillone
    • Tine Demeulenaere
    • Guido Groenen
    • Philip Suffys
    • Bouke C. DE Jong
    Volume 88, Issue 3

    | Published on September 2017

    Introduction:

    Despite decades of solid leprosy control efforts, the disease remains highly endemic on the island of Anjouan, Comoros. Among a population of less than 400,000 over 300 new leprosy patients are diagnosed on average annually.

    Methods:

    We analysed routine data for the period of 2000–2015 for trends in epidemiological parameters and clustering in time and space.

    Results:

    Leprosy incidence remains high (7.4/10,000 per year, on average) with no indications of an imminent decrease. Increasing coverage of active case finding has led to increasing numbers of leprosy patients being detected over the past 8 years. The proportion of new patients presenting with visible deformities has consistently been low (2.4% on average). The proportion of children among new patients exceeds 30%, without any trend towards a decrease. At macro-level clusters in time and space were observed scattered across the island, without a clear pattern.

    Discussion:

    The leprosy epidemic on Anjouan continues unabated despite the activities of a well-organised control programme. There appears to be a need to further scale up case finding efforts and organise them in a more systematic manner. Use of modern technology, such as Geographic Information Systems, could help to improve targeting of casefinding efforts. Prophylactic treatment of contacts should be considered. Studying markers of infection such as anti PGL-1, and DNA finger printing of leprosy bacteria could provide insights in the patterns of transmission and could be useful in identifying those at higher risk of developing leprosy for prophylactic treatment.

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