Keywords

adolescent Brazil child claw hand functional evaluation gynaecomastia incidence leprosy Leprosy nerve decompression Participation Scale Social Participation social protection Stigma testicular atrophy Women

Volume - 89, Issue - 1

editorial
Page 1
Original Papers
Pages 2 - 12
  • Minimal essential data to document contact tracing and single dose rifampicin (SDR) for leprosy control in routine settings: a practical guide

    • Jan Hendrik Richardus
    • Christa Kasang
    • Liesbeth Mieras
    • Sunil Anand
    • Marc Bonenberger
    • Eliane Ignotti
    • Tanja Barth-Jaeggi
    • Helena Greter
    • Anuj Tiwari
    • Arielle Cavaliero
    • Peter Steinmann
    Volume 89, Issue 1

    | Published on March 2018

    In leprosy control there is a renewed interest in active case finding, which is increasingly being combined with chemoprophylactic interventions to try and reduce M. leprae transmission. The Leprosy Post-Exposure Prophylaxis (LPEP) programme, currently ongoing in eight endemic countries, pilots the provision of single-dose rifampicin (SDR) to eligible contacts of leprosy patients. LPEP has developed a surveillance system including data collection, reporting and regular monitoring for every participating country. This system is still largely programmespecific to LPEP. To facilitate continuity after completion of the project phase and start-up in other interested countries, we aim at identifying the minimal set of data required to appropriately document contact tracing activities and SDR administration for leprosy control in a routine setting.

    We describe four indicators for the index case (plus four already routinely collected) and seven indicators for household/neighbour screening, and community surveys. We propose two generic forms to capture all relevant information required at field and district level to follow-up on individuals or data if needed, provide guidance on the sequence of tasks, provide quality control by listing key questions to assess SDR eligibility, and facilitate reporting. These generic forms have to be adapted to local requirements in terms of layout, language, and additional operational indicators.

Original Papers
Pages 13 - 24
  • Effect of Brazil’s Conditional Cash Transfer Programme on the new case detection rate of leprosy in children under 15 years old

    • Kaio Vinicius Freitas De Andrade
    • Joilda Silva Nery
    • Maria Lucia Fernandes Penna
    • Gerson Oliveira Penna
    • Mauricio Lima Barreto
    • Susan Martins Pereira
    Volume 89, Issue 1

    | Published on March 2018

    Background:

    Poverty and other socio-environmental determinants may contribute to the occurrence of leprosy. However, there is no previous evidence on the effectiveness of cash transfer programmes in reducing leprosy case detection among children under 15 years old.

    Objective:

    This study aimed to assess the effect of the Brazilian conditional cash transfer programme (Bolsa Família Programme, BFP) on the reduction of new case detection rates (NCDR) of leprosy in Brazilians under 15 years old.

    Methods:

    We performed a mixed ecological study with the Brazilian municipalities as units of analysis, during 2004–2015. The main independent variables were: BFP coverage of target population (poor and extremely poor families) and BFP coverage of the total population of the municipalities. Data were obtained from public databases. We included 1,120 (of 5,570) municipalities in the analysis, using fixedeffects negative binomial models for panel data, adjusted for the municipal coverages of the Brazilian primary health care programme (Family Health Strategy, FHS) and for a set of sociodemographic covariates.

    Results:

    We found an increasing trend in the median BFP coverages and a decreasing trend in the NCDR of leprosy in individuals under 15 years old. This indicator was significantly reduced in municipalities with higher BFP coverages of target population (RR = 0.75; CI 95% 0.63–0.88) and higher BFP coverages of the total population of the municipalities (RR = 0.85; CI 95% 0.79–0.93).

    Conclusions:

    During the study period, BFP was associated with a reduction of the NCDR of leprosy among Brazilians aged less than 15 years old, living in municipalities with a high risk of leprosy transmission.

Original Papers
Pages 25 - 35
  • Functional evaluation of the hand after ulnar claw correction in patients with leprosy

    • Bernardo Couto Neto
    • Ana Paula Fontana
    • Diogo Correia Silva
    • Elifaz De Freitas
    • Antônio José Ledo Alves Da Cunha
    • Vagner Wilian Batista E Sá
    • Maria Katia Gomes
    Volume 89, Issue 1

    | Published on March 2018

    Purpose:

    To evaluate hand function in leprosy patients after reconstructive surgery for claw hand.

    Methods:

    Patients who had completed multidrug therapy (MDT) and who had undergone tendon transfer surgery for ulnar claw correction at either of two reference centres for leprosy in Brazil between 2010 and 2014, were included. Clinical evaluations, Screening of Activity Limitation and Safety Awareness (SALSA) Scale, Disabilities of the Arm, Shoulder, and Hand Score (DASH) Questionnaire and the Jebsen Taylor Test (JTT) were used to measure arm/hand function recovery after surgery. Data were analyzed with the one sample t-test (p < 0.05).

    Results:

    Twenty-three patients participated in the study, with 13 males (57%), a mean age of 49.5 years and an average of 6.3 years post-surgery. On the SALSA Scale total score, 59% of the individuals had mild or no limitation of activity. On the specific score for the hand domain, 91% had mild or no limitation. The mean score of the DASH Questionnaire was 24.45. On the JTT, when comparing individuals who had surgery on the right hand with normative values for the dominant hand, matched for mean age and gender, there was a significant difference for all six tasks. When comparing individuals who had surgery on the left hand with normative values for the non-dominant hand, there was greater proximity between the means, although still significantly different.

    Conclusions:

    The SALSA, DASH and JTT were easily applicable and useful to measure the functional limitation of the leprosy hand. The data demonstrated that the patients had a good impression of their hand’s improved functionality after surgery. Patients exhibited mild to no disability. These results reinforce the importance of early diagnosis of neuritis and immediate therapeutic interventions to prevent physical disability.

    Level of evidence: Therapeutic study - Level III

Original Papers
Pages 36 - 45
  • Empowerment of Communities in the Promotion of Prevention of Disability (POD) for Persons Affected by Leprosy in Tanzania

    • Grace Mwasuka
    • Zawadi Shaban
    • Burchard Rwamtoga
    • Deus Kamara
    • Christine Chipaga
    • Blasdus Njako
    • Roland Mueller
    • Edith Roset-Bahmanyar
    • Kalisa Pascal
    • Christa Kasang
    Volume 89, Issue 1

    | Published on March 2018

    Objective:

    The ‘Prevention of Disability (POD) project for persons affected by leprosy’ was designed to strengthen early diagnosis through community empowerment in high endemic districts in Tanzania and to reduce occurrence of leprosy related Grade 2 disabilities.

    Methods:

    The project activities were implemented in leprosy high endemic districts with prevalence rates above 1/10,000 population between 2012–2015. 12 districts were involved and 12 new POD Committees with 236 POD members were trained to be trainers. The POD committees trained 100 village health committees with 1,300 members using the POD training manual under the supervision of District Social Welfare Officers [SWOs] and District Tuberculosis and Leprosy Coordinators [DTLCs].

    Results:

    A total of 134,104 people were reached with 65,827 school children from 225 schools and 68,277 adults from 248 villages. Through sensitisation activities involving district POD committees, village health committees, drama groups and community members, 3,483 leprosy suspects were identified and 531 were confirmed by DTLCs as new leprosy cases. Through active case finding activities in household contacts 1399 contacts were reached and 73 new leprosy cases were confirmed.

    Conclusions:

    Statistics over the last 14 years showed that there was a decreasing of new leprosy cases notifications during routine passive cases finding period. With start of empowerment of community and household screening activities, the numbers of new cases in the districts increased tremendously. This suggests that there is a high presence of hidden cases. The numbers of new detected cases were in some districts more than doubled by the interventions. The relative low percentage of Grade 2 disability of 9% in the project compared to a current national average of over 12% support the effectiveness of the intervention ‘empowerment of communities’ for early case detection.

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