Keywords

active case finding Case detection classificaion contact screening COVID 19 and leprosy customized insoles delay in diagnosis Diabetes diabetes Diagnosis diagnostic test elimination Epidemiology epidemiology familial leprosy force sensitive resistors functioning Leprosy leprosy leprosy delays leprosy in Nepal mental wellbeing Nepal neuropathy NTD offloading passive and active case finding passive and active leprosy case finding plantar pressure Senegal Sensory neuropathy stigma therapeutic footwear Validation study WHODAS 2.0

Volume - 92, Issue - 1

editorial
Page 1
Original Papers
Pages 2 - 10
  • High transmission of leprosy among inhabitants in two former isolated leprosy villages in Senegal

    • Madoky Magatte Diop
    • Lahla Fall
    • Pauline Dioussé
    • Ibrahima Mané
    • Hyacinthe Zoubi
    • Fatou Badiane
    • Karl Puchner
    • Amadou Doucoure
    • Mahamath Cissé
    • Laure Almairac
    • Christa Kasang
    Volume 92, Issue 1

    | Published on March 2021

    Background:

    In Senegal, endemic areas of leprosy are mainly concentrated in urban settings, and transmission occurs particularly among children. This study aims to determine the prevalence of leprosy in two highly endemic foci in Senegal as well as to evaluate the association between the detection of leprosy and the family history of leprosy.

    Methods:

    The study is a cross sectional study with cluster sampling in two former isolated leprosy villages, Mballing and Koutal. Informed consent was obtained, followed by a questionnaire and a clinical examination. The data collected included: demographics, family history of leprosy, relapse and treatment history. The analysis was done via chi-square or Fisher tests (with an agreed risk of 0.05 and a precision of 0.02).

    Results:

    A total of 1605 people over 2 years of age were examined, of whom 881 were female. Children between 2 and 15 years made up 44% (699/1605). Active leprosy was detected in 83 cases constituting a prevalence rate of 5.2%. Overall, a total of 69 new cases were confirmed, 41 being children. The median age was 20.4 years. Of the 69 newly detected cases, 59 (85.5%) were paucibacillary indicating early detection. The rate of grade 2 disability was 2.9%. Altogether 36 of the new patients (52%) had a family history of leprosy.

    Conclusion:

    A high level of Mycobacterium leprae is circulating within the study population and transmission is ongoing. In addition to the influence of the contact profile, genetic susceptibility to leprosy could explain the high number of familial leprosy cases in these special areas, isolated for many years. Further research is needed and additional measures for leprosy control, such as post exposure prophylaxis with single dose rifampicin, should be implemented to interrupt transmission.

Original Papers
Pages 11 - 28
  • Delays in passive and active leprosy detection in post-elimination Nepal

    • Ulla-Britt Engelbrektsson
    • Udaya Nath Yogi
    • Peter Nicholls
    • Madhusudan Subedi
    Volume 92, Issue 1

    | Published on March 2021

    Objectives:

    In late 2009, Nepal reached the leprosy elimination goal. However, the expected gradual decline in registered prevalence did not take place. In early 2015, the International Nepal Fellowship (INF) launched a three-year research project on leprosy delays in the western part of the country. The main focus of the present article is on health-seeking processes as reported by patients diagnosed in INF outpatient skin clinics (the Outpatient cohort) and by patients diagnosed in a massive, government-led, one-off, case detection operation (the Follow-up cohort). The former represents voluntary presentations and passive case detection, the latter, active case finding in the field.

    Methods:

    A mixed qualitative and quantitative approach with in-depth patient interview data enhanced by consultations with key informants and on the spot observations, plus structured data from clinic records and interviews.

    Results and Conclusions:

    The mean delay of the Outpatient cohort was found to be 28.1 months, and 23.2 months for the Follow-up cohort. While the causes of delay are complex, the long delays foremost reflect a lack of ability of individuals and families to recognize the seriousness of early leprosy symptoms compounded by health service professionals’ failure to diagnose the condition.

    Without early case detection and treatment, Nepal will not free itself of leprosy. A broad-scale dissemination of public education and awareness of leprosy is essential and so is an upgrading of leprosy skills among private and public health service professionals. In addition, in some contexts a double approach of self-referrals and active screening is likely to be necessary.

Original Papers
Pages 29 - 37
  • Delay in Leprosy Diagnosis — A multi-center, multi-country Asian study

    • Erik Post
    • Wim Brandsma
    • Inge Wagenaar
    • Khorshed Alam
    • Vanaja Shetty
    • Sajid Husain
    • Cita Rosita Sigit Prakoeswa
    • Mahesh Shah
    • Krishna Bahadur Tamang
    Volume 92, Issue 1

    | Published on March 2021

    Delay in reporting for possible leprosy diagnosis and a delay in making the diagnosis of leprosy may result in unnecessary complications.

    Objective:

    Which factors contribute to late reporting and a missed diagnosis of leprosy?

    Method:

    A questionnaire, involving 1243 newly diagnosed patients, was used to explore reasons for possible delay in diagnosis and start of treatment; the patients were being managed in six projects in four leprosy endemic countries, and needed treatment for nerve function impairment,

    Results/Conclusions:

    Delays in reporting for diagnosis and in establishing the diagnosis are multifactorial and differ between the research sites. Factors contributing to the delay are person and program related, including concealment of suspected disease, perhpas because of shame, accessibility of the clinic, and expertise within the diagnostic services. They need to be addressed in different ways to minimize delay thereby reducing risks for complications. 

Original Papers
Pages 38 - 46
  • Pure neural leprosy—mind the diagnosis

    • Wim Brandsma
    • Erik Post
    • Inge Wagenaar
    • Khorshed Alam
    • Vanaja Shetty
    • Sajid Husain
    • Cita Rosita Sigit Prakoeswa
    • Mahesh Shah
    • Krishna Bahadur Tamang
    Volume 92, Issue 1

    | Published on March 2021

    Introduction:

    Pure Neural Leprosy (PNL) is a known clinical diagnosis of leprosy. There is great epidemiological variability in the diagnosis and there appears to be no consensus about its definition and classification. Given the reported prevalence it is for operational reasons important that there is consensus about its definition, classification and treatment.

    Method:

    The TENLEP (Treatment of early Neuropathy in LEProsy) database was used to analyze patients that were enrolled with a diagnosis of PNL to determine proportions of patients with PNL enrolled in six research sites in four geographically different leprosy endemic countries. Demographics were looked at and frequency of nerves involved in PNL.

    The database consists of data of 1240 patients that were enrolled to determine efficacy of prednisolone in the prevention of clinical neuropathy (N = 372) or the treatment of clinical neuropathy (N = 868).

    Results:

    In the clinical trial 76 (8.8%), and in the subclinical trial 28 (7.5%) patients were enrolled with the diagnosis of PNL. There was great variability in diagnosis and enrollment of PNL patients in the two cohorts. The ulnar nerve is the most affected (enlargement and/or function loss) of all nerves.

    Conclusion:

    Our findings corroborate with the findings of other studies regarding the occurrence of PNL. The diagnosis needs to be carefully made and additional tests or assessments may be needed before a definitive diagnosis of Pure Neural Leprosy can be made.

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