Keywords

attitude bacterial index ballpoint pen blindness cataract in leprosy Chhattisgarh clinical demonstration cold water comorbidities contact screening Corneal grafts corneal opacity cotton wool de novo histoid leprosy delay disabilities disability disappearance Erythema nodosum leprosum Europe grade-2 disability health related quality of life Histoid Hansen’s India Knowledge leprosy Leprosy linkages medical interns medical students Myanmar nerve function impairment ocular conditions ophthalmology Portugal practice Purulia Semmes Weinstein nylon monofilament sensory impairment social determinants southeast Nigeria spatial analysis sterile needle trends warm water

Volume - 91, Issue - 1

editorial
Page 1
Perspectives
Pages 2 - 13
Original Papers
Pages 14 - 24
  • Documenting the decline of leprosy in Europe: The example of Northern Portugal

    • Guilherme Gonçalves
    • Isabel Andrade
    • Carlos Pinheiro
    • Paul E.M. Fine
    Volume 91, Issue 1

    | Published on March 2020

    Background:

    There is continued uncertainty over trends of leprosy, including in areas with low incidence, where it may be possible to identify areas where M leprae is no longer transmitted or where it no longer causes disease. WHO has reported data on leprosy in the European Region only since 2015.

    Methods:

    Data reported to WHO and published in the Weekly Epidemiological Record were reviewed, Data from five districts in northern Portugal were collected from the National General Directorate of Health and Municipal Health Authorities.

    Results:

    Basic information on 133 leprosy cases has been reported to WHO by thirteen of the 54 states in the European Union since 2015. Data on place of birth of the cases were reported by ten states since 2016, implying eleven cases possibly attributable to transmission within Europe. Detailed but incomplete data on 38 leprosy cases notified in northern Portugal 1990–2018 are described and discussed. Of those cases which appear to have been autochthonous, none were born after 1966, none were notified after 2007, and the only three notifications after 2005 were for relapses.

    Conclusions:

    Data on leprosy in the European Region are obviously incomplete. The large majority of cases now detected are attributable to infections contracted abroad, but a small number of cases possibly attributable to local transmission are still being identified. Analysis of data from five districts in northern Portugal indicate that this region is no longer endemic for the disease, and that transmission in the area is likely to have ceased at least 40 years ago. The methods illustrated in this paper could be applied to data on leprosy in other regions of Europe, to better define the geographic limits of leprosy today.

Original Papers
Pages 25 - 40
  • Is Myanmar on the right track after declaring leprosy elimination? Trends in new leprosy cases (2004–2018) and reasons for delay in diagnosis

    • Myo Ko Ko Zaw
    • Srinath Satyanarayana
    • Kyaw Ko Ko Htet
    • Kyu Kyu Than
    • Chan Tun Aung
    Volume 91, Issue 1

    | Published on March 2020

    Background:

    Myanmar declared leprosy elimination in 2003. In 2018, the country reported 2,214 new leprosy cases of whom 263 had Grade-2 disability (G2D). The country aims to reduce new cases with G2D to <53 cases by 2023 through early diagnosis and treatment.

    Objectives:

    To describe the trends (actual and projected) in new leprosy cases from 2004 to 2023 and to explore the reasons for delay in diagnosis.

    Methods:

    Mixed-methods study. The quantitative part—ecological study using numbers of new leprosy cases from 2004–2018. For qualitative part, new cases with G2D and health care providers were interviewed.

    Results:

    The annual total new cases, new multibacillary cases, new cases with G2D, new child cases are showing a declining trend. Total new cases and new cases with G2D, between 2004 and 2018 have declined by 40% and 28% respectively. If the current trends continue there will be 1,785 (95% CI: 1546-2024) new cases and <53 new cases with G2D in 2023. The interviews of patients and providers yielded the following reasons for delay in diagnosis: incorrect knowledge about leprosy, delay in recognition of symptoms, inappropriate care seeking, and fear of stigma and discrimination. Reduction in health system efforts, lack of local leadership, human resource constraints and decreased funding also contributed to delay in diagnosis.

    Conclusions:

    The declining trends and the possibility of achieving the target for new cases with G2D by 2023 is encouraging. The country must address the challenges mentioned by patients and health care providers as a priority, to accelerate the decline in new cases.

Original Papers
Pages 41 - 55
  • Magnitude of social determinants in high risk areas of leprosy in a hyperendemic city of northeastern Brazil: An ecological study

    • Antônio Carlos Vieira Ramos
    • Marcelino Santos Neto
    • Luiz Henrique Arroyo
    • Mellina Yamamura
    • Ivaneliza Simionato Assis
    • Josilene Dália Alves
    • Marcos Augusto Moraes Arcoverde
    • Luana Seles Alves
    • Thaís Zamboni Berra
    • José Francisco Martoreli Júnior
    • Flávia Meneguetti Pieri
    • Ricardo Alexandre Arcêncio
    Volume 91, Issue 1

    | Published on March 2020

    Objective:

    To investigate the association of certain social determinants with areas at high-risk for leprosy in a hyperendemic city in northeastern Brazil.

    Methods:

    An ecological study was carried out in Imperatriz, a hyperendemic municipality of northeastern Brazil. The units of analysis were urban census tracts, in which variables related to the number of dwellers per domicile, literacy and per capita monthly income were selected for the construction of the social determinants dimensions, by means of the Principal Components Analysis (PCA) technique. Spatial scan statistics were applied to identify areas of elevated leprosy risk and binary logistic regression was performed, considering the high-risk areas as the dependent variable and the social determinants dimensions as the independent variable. The Odds Ratios (ORs) were calculated with its 95% Confidence Intervals (CIs). The Receiver Operating Characteristic (ROC) Curve was applied to verify the discriminative power of the model. Type I error was set at 5% (p < 0.05).

    Results:

    2,552 leprosy cases were georeferenced and the scan statistic identified high-risk areas. The logistic model showed that social determinants were associated with high-risk areas (OR = 1.25, 95% CI = 1.07–1.49, p = 0.006). The area under the ROC curve value confirmed the discriminatory capacity for the model at 65%, which was considered sufficient.

    Conclusions:

    The high-risk areas for leprosy are associated with social determinants of low household per capita income, low educational levels and high numbers of residents per household.

Click to load more