Keywords

Anaesthetic foot anxiety beliefs chemokines chemoprophylaxis community participation Community stigma community stigma community-based programs Cosmetic camouflage customized insole cytokines depression diagnosis DLQI gender Hansen’s disease health education Kiribati leprosy Leprosy leprosy reactions lymphatic filariasis M. leprae matrix metalloproteinases MMP-9 mycobacteria nitric oxides perception protective footwear reactions serum skin lesions social distance soluble toll like receptor 2 stigma ulcer recurrence ulcers

Volume - 91, Issue - 4

editorial
Page 299
Review Article
Pages 300 - 313
  • Gender perspective in leprosy programs: A critical literature review

    • Gema Martos-Casado
    • Diana Gil-González
    • Carmen Vives-Cases
    Volume 91, Issue 4

    | Published on December 2020

    Objective:

    To analyze the gender perspective in articles on community participation programs carried out with people affected by leprosy.

    Methodology:

    A critical literature review was carried out with an ad-hoc guide based on three documents related to the analysis of the gender perspective in scientific publications. Different variables related to the theoretical framework, methodology, results and discussion were analyzed in addition to two transversal variables related to gender biases and the use of terms related to sex/gender.

    Results:

    Thirty articles related to community intervention programs and leprosy were analyzed, identified in a prior scoping review. The results showed that, in general, a gender perspective was not taken into account in the majority of the sections analyzed. Although there was a tendency to disaggregate data based on sex, subgroups of men and women were not analyzed, nor was there discussion of the differences between the two. In all of the articles, there was evidence of the presence of gender biases, and in the majority there was a proper use of the terms sex and gender.

    Conclusions:

    Results show that in the case of the studies we analyzed, a gender perspective was not taken into account in the approach to community intervention programs related to leprosy. It is necessary to develop strategies to incorporate a gender approach in research related to leprosy in order to address the gap in inequalities between men and women affected by the disease.

Original Papers
Pages 314 - 327
  • A single dose of rifampicin to prevent leprosy; quantitative analysis of impact on perception, attitudes and behaviour of persons affected, contacts and community members towards leprosy in India, Nepal and Indonesia

    • L. Mieras
    • M. K. Singh
    • P. R. Manglani
    • M. M. Arif
    • N. L. Banstola
    • B. Pandey
    • T. Budiawan
    • R. Utami
    • T. Wibowo
    • A. I. Iswandi
    • R. Peters
    • W. van Brakel
    Volume 91, Issue 4

    | Published on December 2020

    Introduction:

    This study looked at the effect of post-exposure prophylaxis (PEP) with single-dose rifampicin (SDR) and the education given along with SDR-PEP on stakeholders’ perception regarding leprosy. It is a side study of the Leprosy Post-exposure Prophylaxis (LPEP) Program.

    Methods:

    The study was done in LPEP implementation areas in India, Nepal and Indonesia. A before and after survey design was used, with qualitative and quantitative data collection methods. This paper presents the quantitative results. In each country 100 interviews were held with representatives of leprosy patients, contacts and community members, before and 1–1.5 years after starting the LPEP Program. Three tools were used: a knowledge, attitudes and practices questionnaire, EMIC community stigma scale and social distance scale (SDS).

    Results:

    The most notable effect at follow-up was increased knowledge regarding leprosy in all stakeholder groups, especially leprosy patients. A positive effect was seen on how people think about persons affected by leprosy, reflected by the lower SDS scores in the contact groups in India and Nepal. No negative effects were found on people’s perception and reported behaviour. Participants did express or perceive reluctance to disclose a person’s leprosy status, but this did not negatively affect willingness to participate in the LPEP Program.

    Conclusion:

    This study showed that implementation of SDR-PEP and accompanied education led to increased knowledge on leprosy among patients, contacts and community members and it had no negative effect on perception. SDR-PEP implementation provides an opportunity for health education, including messages to help reduce stigmatisation of persons affected by leprosy.

Original Papers
Pages 328 - 342
  • Acceptability of rapid diagnostic tests among patients and their contacts in the Philippines is sustained beyond the completion of treatment

    • Malcolm S. Duthie
    • Florenda O. Roferos
    • Armi A. Maghanoy
    • Marivic F. Balagon
    Volume 91, Issue 4

    | Published on December 2020

    Background

    Diagnosis of leprosy currently requires individuals suspecting themselves to be affected to present for expert clinical exams. Clinic attendance can be impacted by a variety of logistical and psychological factors, but rapid diagnostic tests (RDT) could potentially be used as a screening tool to provide triaged referrals.

    Methods

    In 2015, 200 newly diagnosed, predominantly multibacillary (MB), leprosy patients attending Cebu Skin Clinic, Philippines, were interviewed with regard to their perception of how leprosy had impacted their lives and their level of acceptance of an immunologic, lateral flow-based RDT as a tool for leprosy control. Six hundred household contacts (HC) of some index cases were also asked to respond to a questionnaire. Each participant provided responses from multiple choice options and the same surveys were repeated on a regular basis to a sub-set of the cohort over the ensuing 4 years.

    Results

    At the time of diagnosis many patients (73.0%) and their HC (66.5%) reported that their lives had already been adversely affected by leprosy. RDT were perceived positively by both groups with the majority (87% patients and 71% HC) considering the tool as ‘very important’. No patients, and only 0.8% HHC, considered that tests would be of no benefit. In general, patients preferred an extensive RDT monitoring schedule following their diagnosis and indicated a preference that testing be confined among HHC rather than being extended to their larger community. Annual follow-up of a sub-set of participants (131 patients and 170 HC) indicated a retained enthusiasm for testing and, importantly, a marked decrease in those that would not like testing among community contacts, with an increase from 58.5% to 89.4% indicating that they would like testing among their respective HC. Importantly, the perceived impact of leprosy on the lives of both patients and HC declined during the monitoring period that occurred concomitantly with a progressive increase in the number of HC stating that they would definitely submit to testing.

    Conclusion

    Our data demonstrate an enthusiasm for regular use of RDT among these particular patients and their HC. Due to their ease of use and point of care applicability RDT could be accepted within high-risk target populations to provide an entry point to inform the early detection of leprosy.

Original Papers
Pages 343 - 352
  • Cosmetic camouflage of visible skin lesions enhances life quality indices in leprosy as in vitiligo patients: an effective stigma reduction strategy

    • P. Narasimha Rao
    • Manogna Vellala
    • Arun Raghav Potharaju
    • K. Udaya Kiran
    Volume 91, Issue 4

    | Published on December 2020

    The use of cosmetic camouflage for blemishes on skin of affected people is known to improve their Dermatology Life Quality Index (DLQI). Although the use and benefits of cosmetic camouflage is known and reported in vitiligo, its value in leprosy, where visible skin lesions are a reason for stigma and discrimination, is yet to be explored. A key resolution of the WHO Global Leprosy Strategy 2016–2020 is to stop discrimination and promote inclusion of persons affected by leprosy into society. Improving the DLQI of leprosy patients with the use of cosmetic camouflage is an effort in that direction.

    Objectives:

    We undertook this study to examine the change brought about by cosmetic camouflage in the DLQI of leprosy patients with visible skin lesions and, to compare the results with its use in vitiligo, as both are disorders associated with pigment dilution in the skin.

    Methods:

    The DLQI score was calculated for 9 consenting leprosy and 14 vitiligo patients at the time of enrolment. All patients were taught the simple technique of cosmetic camouflage of their skin patches on exposed parts of the body, such as face and arms/forearms. The DLQI scoring was calculated again after one month of use of cosmetic camouflage and compared with the baseline value.

    Results:

    The mean DLQI improved significantly (p < 0.0001) after the use of cosmetic camouflage in both vitiligo and leprosy groups, indicating the efficacy of camouflage in improving the quality of life. In addition, it was observed that the mean improvement in DLQI was higher in the leprosy group (14.67 ± 3.87) than in the vitiligo group (8.64 ± 2.96), the difference being statistically significant (p < 0.05), suggesting that camouflage has a very high impact on the quality of life in leprosy.

    Conclusions:

    Leprosy-related stigma and discrimination are pervasive in almost all cultures of the world. Such stigma affects many aspects of social participation. The WHO global strategy document 2016–2020 advocates inclusion of at least one stigma reduction strategy in all leprosy programme plans. Use of cosmetic camouflage for visible skin lesions on exposed parts of the body in leprosy patients could be one such strategy.

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