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Volume - 89, Issue - 3

Page 177
Original Papers
Pages 178 - 196
  • Routine Surveillance Data as a Resource for Planning Integration of NTD Case Management

    • Hope Simpson
    • Benedict Quao
    • Emmy Van Der Grinten
    • Paul Saunderson
    • Edwin Ampadu
    • Cynthia Kwakye-Maclean
    • Samuel Odoom
    • Nana-Kwadwo Biritwum
    • Rachel Pullan
    • Jorge Cano
    Volume 89, Issue 3

    | Published on September 2018


    There is a high burden of morbidity due to neglected tropical diseases. To help address this, the World Health Organization recommends integration of case management (CM). Here, we present a practical framework designed to identify areas that could benefit from an integrated CM strategy in Ghana. We also investigated the accessibility of primary health care (PHC) to CM cases, and the impact of this on morbidity at diagnosis.


    Routinely detected cases of Buruli ulcer (BU) and leprosy, and suspected lymphedema identified through morbidity surveys during mass drug administration campaigns in Ghana in 2014 were remotely georeferenced. We estimated distances from cases’ home communities to the nearest primary healthcare facility (PHC), and compared rates of reported disease, completeness of clinical information, and risk of more severe morbidity, relative to PHC accessibility.


    We georeferenced communities of 295/350 reported leprosy cases, 240/333 BU cases, and 1,557/2383 instances of lymphedema. Overlap of these diseases was predominantly around Accra and in the Upper East Region. Rates of reported disease appeared higher in populations with higher accessibility to PHC, and leprosy cases living further from PHC had a higher risk of disability at diagnosis.


    This investigation demonstrates the feasibility and value of using routinely collected data to map CM-NTDs at low cost. The maps presented are intended to provide a resource for planning the implementation of integrated CM for NTDs in Ghana. This approach could be easily implemented by national health services in other endemic countries in the future.

Original Papers
Pages 197 - 207
  • Use of peripheral sensibility and intrinsic muscle dysfunction of hands and feet in household contacts of patients as a screening test for early diagnosis of leprosy in two endemic areas of Colombia

    • Moya H. Schutte
    • Hector Serrano-Coll
    • Willem J. Theuvenet
    • Camilo Beltrán
    • Nora Cardona-Castro
    Volume 89, Issue 3

    | Published on September 2018

    Leprosy affects peripheral nerves and causes disability. Colombia has a high grade 2 disability rate among new leprosy cases, indicating late diagnosis. An early and economic screening method for leprosy is required in endemic countries. In this study, sensibility and intrinsic muscle function of hands and feet were examined by Semmes Weinstein Monofilament (SWM) testing, Froment’s and Paper Grip Test (PGT) in 20 leprosy patients, 24 household contacts (HHC), and 59 controls from different townships in Colombia. We compared thresholds for hand and foot (heaviest detected filament) and nerve thresholds (heaviest detected filament per innervated area). Excluded participants were those with other causes of peripheral neuropathy, ages below 18 and above 65. Patients had significantly higher SWM thresholds and more intrinsic muscle dysfunction than controls for all extremities and nerves (P ≤ 0.004). HHC had significantly higher thresholds than controls in left hands and both feet (P < 0.001). The frequency of a positive Froment’s test was higher in HHC than in controls (P = 0.037). Follow-up of HHC will investigate if the higher SWM thresholds are due to leprosy. SWM testing is an economic method which could easily be implemented and possibly assist in detecting new leprosy cases among HHC in the field.

Original Papers
Pages 208 - 218
  • Pain perception and functional limitation, assessed in the years after nerve decompression in leprosy

    • Maria Dias Torres Kenedi
    • Elifaz De Freitas Cabral
    • Kazuê Narahashi
    • Felipe José Jandre Dos Reis
    • Marcus André Acioly
    • Afranio Lineu Kritski
    • Maria Kátia Gomes
    Volume 89, Issue 3

    | Published on September 2018


    Surgical decompression of peripheral nerve trunks is a widely recognised procedure in the management of leprosy-associated neuropathy in endemic areas. The purpose of this study is to explore patients’ perception in terms of pain and functional limitation after neural decompression surgery in leprosy.


    Fifty-three patients (87 surgeries) underwent peripheral nerve decompression surgery from 1999 to 2014 at our institution and were eligible for this study. Patients were interviewed with a semi-structured form and established questionnaires (DN-4, McGill Pain Questionnaire, visual analogue scale [VAS], and SALSA) and then physical impairments were assessed by physical examination. Some data were retrospectively retrieved from medical records for comparative analysis.


    Surgery occurred with a mean time of 5.1 ± 4.1 years, prior to the interview. Most (59%) patients had one operated limb and 38 (71.7%) declared complete resolution of pain after surgery. There was a 64% reduction in the use of analgesics and an 81% reduction in corticosteroid use. Postoperative chronic pain affected 15 patients (28.3%), mostly of neuropathic type (86.7%). The majority of patients were generally satisfied (87%) with the surgical results and 58.5% of subjects had mild or no functional limitation at the time of the interview.


    Patients had a positive experience after neural decompression surgery for leprosy-associated neuropathy in terms of reduced pain and functional limitation, and high levels of satisfaction.

Original Papers
Pages 219 - 230
  • Neglected tropical diseases (NTD) morbidity and disability toolkit validation: A cross-sectional validation study of the EMIC-AP stigma scale for affected persons and the WHOQOL-DIS scale in Papua, Indonesia

    • Rosaline T. De Korte
    • Emma L. Vellacott
    • Arry Pongtiku
    • Andreas L. Rantetampang
    • Wim H. Van Brakel
    Volume 89, Issue 3

    | Published on September 2018


    There is a lack of information about the burden of neglected tropical diseases (NTDs) in terms of morbidity and disability. Therefore, there is a need for agreed instruments that can provide this information. This study is a first phase validation study of the EMIC-AP and the WHOQOL-DIS instruments conducted in Papua, Indonesia. Leprosy and Lymphatic filariasis are common NTDs in Papua. The research question was: “How valid are the EMIC-AP and the WHOQOL-DIS of the NMD toolkit among people affected by the NTDs leprosy or lymphatic filariasis living in Papua, Indonesia?”

    Methodology/Principal Findings:

    Data were gathered using translated interviewadministrated versions of the questionnaires. The sample included participants with leprosy (n = 16) and lymphatic filariasis (n = 18) experiencing disabling consequences from their NTD. The study focused on item equivalence (relevance and acceptability), semantic equivalence (understanding and meaning) and operational equivalence (format of administration and questions, and suitability of response scales). Testing of the item equivalence showed that 94% thought the questions of WHOQOL-DIS were relevant and 90% felt comfortable with the topics. Concerning the EMIC-AP, 93% thought the questions relevant, and 90% felt comfortable. Semantic equivalence was more problematic with 51% and 23% having difficulties in understanding the WHOQOL-DIS and the EMIC-AP, respectively. Seventy-three percent was positive about the format of the EMIC-AP, while only 58% was positive about the WHOQOL-DIS format.


    The item equivalence was good for both the WHOQOL-DIS and EMIC-AP, and the operational equivalence showed room for improvement for the WHOQOL-DIS. The semantic equivalence was relatively poor. This was especially true for the WHOQOL-DIS. The main reason for this is that there are over a 250 different languages in the province of Papua. With minor adjustments, it is likely that the EMIC-AP can be used under the condition that the participants speak sufficient Bahasa. The WHOQOL-DIS does not appear suitable for use with this population.

    Author Summary

    This study tested two instruments that measure stigma (EMICAP) and quality of life (WHOQOL-DIS) among people affected by leprosy or lymphatic filariasis in Papua, Indonesia. The interviews comprised questions of both instruments and additional questions to get the participants opinion about the instruments. The focus of this study was on whether the participants understood the questions, whether they were relevant and acceptable and if the design of the questionnaires were clear. Using the answers to the additional questions, we could check whether the translations of the instruments were applicable for persons affected by NTDs in Papua. Results showed that the WHOQOL-DIS was not considered suitable for use with NTD-affected people in Papua. In contrast, the EMIC-AP can be used in Papua after some minor adjustments and if participants are fluent in Bahasa Indonesia.

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