Leprosy elimination: progress and challenges in Nigeria, Kaduna State tb and leprosy control programme as case study

The study aims at describing the achievements and challenges of Leprosy control in Kaduna State using appropriate indicators. The study was a five year (2004-2008) retrospective review of the Leprosy records and annual reports of all the twenty three LGAs in Kaduna State. Various Leprosy indicators were calculated and presented in different graphic presentations. Focus group discussions were organised with the aim of identifying current challenges of Leprosy control in the State. There was a decline in the new Leprosy cases detected annually from 226 cases in 2004 to 140 cases in 2008. The prevalence rate ranged between 0.3-0.4 per 10;000 population within the five year period. The proportion of children among new cases dropped from 12 in 2004 to 5 in 2007 and increased to 9 in 2008. Grade 2 disability among new cases was very high (between 21-27) within the same period. Leprosy elimination target has been achieved in Kaduna State; but new cases with high proportion of children and WHO grade 2 disability were still been reported

Social Stigma as an Epidemiological Determinant for Leprosy Elimination in Cameroon

Leprosy has been eliminated as a public health problem in most countries of the world according to the WHO; but the social stigma to the disease is still very high. The present study was performed to investigate the role of social stigma as a determinant for leprosy elimination in a leprosy endemic region of Cameroon. Focus group discussions; in-depth interviews and structured questionnaires were used to investigate leprosy social stigma among lepers; their contacts and a control group consisting of patients attending a health facility for reasons other than leprosy. Informed consent was sought and gained prior to starting the study. Focus group discussions and in-depth interviews identified three types of stigma: lack of self-esteem; tribal stigma and complete rejection by society. From the 480 structured questionnaires administered; there were overall positive attitudes to lepers among the study population and within the divisions (P=0.0). The proportion of participants that felt sympathetic with deformed lepers was 78.1[95confidence interval (CI): 74.4-81.8] from a total of 480. Three hundred and ninety nine (83.1) respondents indicated that they could share a meal or drink at the same table with a deformed leper (95CI: 79.7-86.5). Four hundred and three (83.9) participants indicated that they could have a handshake and embrace a deformed leper (95CI: 80.7-87.3). A total of 85.2(95.0CI: 81.9-88.4) participants affirmed that they could move with a deformed leper to the market or church. A high proportion of 71.5(95.0CI: 67.5-75.5) participants stated that they could offer a job to a deformed leper. The results indicate that Menchum division had the lowest mean score of 3.3 on positive attitudes to leprosy compared with Mezam (4.1) and Boyo (4.8) divisions. The high proportion of positive attitudes among the participants and in different divisions is a positive indicator that the elimination of leprosy social stigma is progressing in the right direction. Quantification of stigma to assess the elimination struggle is a new research area in public health

Childhood Leprosy in Essimbiland of Cameroon: Results of Chart Review and School Survey

Background: The WHO targeted to eliminate leprosy from the world as a public health problem by reducing the prevalence to less than 1 case per 10000 population based on the use of multi-drug therapy (MDT). Despite the success of MDT; endemic pools still exist in some countries that have attained the national elimination threshold. Objective: Assess the burden of childhood leprosy and control efforts in Essimbiland of Cameroon. Methods: The records of children patients were reviewed in two main primary health care institutions and 4 primary schools in Essimbiland having 459 pupils were surveyed for leprosy. A purposive sampling of all available registers and pupils was used. Results: A total of 1129 case files were reviewed covering the periods before MDT (1961-1967) implementation in 1982 and post MDT (1982-1999); no records were available from 1968-1991.From chart review; 42 (23.3) new leprosy cases from 1961-1967 and 35 (12.2) from 1982-1998 were from the Mbingo leprosarium. 31(39.7) of 78 childhood leprosy cases from chart review [1961-1967 and 1982-1999] were from Essimbiland. Of the 35 incident childhood leprosy cases from 1982-1998; 24(68.6) were from Essimbiland compared to other divisions. Poor record - keeping on leprosy was common in the study area. Among 459 pupils surveyed in 4 primary schools; 6(1.3) new leprosy cases were identified giving a prevalence of 131 per 10;000 pupils. The common skin lesion was on the back but one pupil had both hands clawed. 16(3.5) pupils were placed on observation. All the new leprosy cases from the school survey were indigenes of Essimbiland. Conclusion: Childhood leprosy is a public health problem in the Essimbiland requiring school surveys and a house-tohouse search for new cases

A Study of Health Workers' Knowledge and Practices Regarding Leprosy Care and Control at Primary Care Clinics in Eerstehoek area of Gert Sibande District in Mpumalanga Province; South Africa

Background: Leprosy is now a rare disease in South Africa. It does still occur; however; and it is an important cause of preventable disability. The target of eliminating leprosy as a public health problem has long been reached in the country in terms of the World Health Organization (WHO) definition of less than one case of leprosy per 10 000 population. However; there is still a commitment to the eradication of the disease in the country. 1 Also; as leprosy is a chronic communicable disease with an extraordinary long incubation period; it is expected that even in areas where the elimination target has been reached; a proportion of the population infected several years ago will show clinical disease; resulting in the occurrence of new cases for many years to come. There is; therefore; a continuing need for vigilance regarding leprosy in South Africa. The low prevalence of leprosy in South Africa is found mostly in the eastern coastal areas and the south-eastern Highveld region; comprising mostly the provinces of Eastern Cape; KwaZulu-Natal and Mpumalanga. The strategy of leprosy care and control programmes in the country is currently that of decentralisation and integration into the general health care services at the primary health care (PHC) level in accordance with the WHO recommendations. The low prevalence of leprosy is associated with a fear of the loss of leprosy-specific skills within the healthcare services that could result in considerable delay in the diagnosis and treatment of the disease. One of the goals of the South African leprosy care and control programme is the maintenance of a high level of awareness of leprosy by health workers (HWs) at the primary care level of the general healthcare services in order to ensure early diagnosis and treatment of the disease in the light of the low prevalence. A successful leprosy care and control programme within the general healthcare services at the PHC level is highly dependent upon the HWs having adequate knowledge of; and practical training on; leprosy.Methods: This study describes PHC workers' knowledge of leprosy; and their practical involvement in leprosy care and control activities at PHC clinics in the Eerstehoek area of Gert Sibande district in Mpumalanga Province; South Africa; where leprosy still occurs.Results: The results of the study reveal that the PHC workers have a general lack of basic clinical knowledge of leprosy; and a very low level of practical involvement in leprosy work at the PHC clinics in the area. A majority of the PHC workers expressed the desire for training on leprosy; and the willingness to provide care to leprosy patients at the PHC clinics.Conclusion: Training strategies that are recommended to improve the PHC workers' knowledge of leprosy and to promote their practical involvement in leprosy work at the PHC clinics include: more emphasis on leprosy teaching during the training of PHC workers at training institutions; more leprosy-specific in-service training of the PHC workers; special training of the PHC workers on practical leprosy work; and regular follow-up and supervision of the PHC workers at PHC clinics by specialised or experienced leprosy workers

Leprosy control in Zimbabwe : from a vertical to a horizontal programme

In Zimbabwe leprosy control services were re-established in 1983; following the war of independence. Its main objectives were the nation-wide implementation of multiple drug treatment (MDT) and the intergration of leprosy control into the general health services. The MDT regimens have led to a rapid reduction of the prevalence of leprosy. At the beginning of 1989 357 patients were on a treatment and 1299 under follow-up. Six hundred and twenty-seven new cases have been detected since 1984; which represents an annual case detection rate of 1.6 per 100;000. This seems a fair reflection of the incidence rate; as the new cases are characterized by a minority of patients under the age of 15 (4) and a lepromatous percentage of 50. [abstract terminated]

Manual for leprosy control in Zimbabwe

"This manual describes the operational aspects of the Leprosy Control Programme in Zimbabwe. The Programme is based on Multiple Drug Treatment (MDT) according to the recommendations of the World Health Organisation published in the WHO Techinical Report no. 675 (1982) entitiled ""Chemotherapy of Leprosy for Control Programmes""."