Integration of the leprosy programme into primary health care: a case study of perceptions of primary health care workers.

Integration of the vertical leprosy programme into the existing horizontal health programme poses various administrative and operational challenges to programmers. In order to understand the preparedness of the PHC workers for integration of leprosy into primary health care services, 71 PHC workers were interviewed using a structured interview schedule. The results showed that about 42% of the staff have heard of the concept of integration earlier and 90% of the PHC staff are willing to treat leprosy patients in the primary health care centre, but only 72% were in favour of integration. The reasons for favouring integration were (1) wider coverage with MDT, (2) frequent field visits by the worker, (3) better rapport with the community, (4) timely treatment and (5) cost-effectiveness. About 28% of the staff members did not favour integration for the reasons that the leprosy programme would suffer, targets cannot be met, supervision would be difficult, knowledge of the staff was inadequate and importance cannot be given to leprosy as family planning is always a priority in PHC centres. About 43% of the staff felt that the performance of the leprosy programme would be better after integration. With regard to workload, 60% of the sample felt that there would be increase in the workload in the field, record maintenance and supervision. The difficulties foreseen by the workers were grouped into 6 categories, viz., administrative, managerial, technical, personnel, social and miscellaneous. It is worth noting that 91% of the staff that included all categories said they were not afraid of leprosy, but needed training in leprosy work. About 50% of the staff expected increase in salaries and promotions if integration took place.

"Outside project area" leprosy cases in 'A' ward of Mumbai.

Analysis of newly registered smear-positive cases in a ward of the metropolitan city of Mumbai, which has a railway terminus during 1990-97 revealed that 72% of the patients came from outside the project area, most of them arising from the States of Uttar Pradesh, Bihar and Orissa. They had unstable and temporary residences in the area and were employed in low income hard labour jobs. Nevertheless, it was found that their treatment completion rate was high. Using different approaches, e.g. through the community leaders of footpath dwellers and railway platform dwellers, and those of different state language groups' colonies, the new entrants were examined periodically and simultaneously proper rapport was maintained with the medical practitioners of the ward for more referrals to leprosy clinic. Such special approach may have to be developed to tackle such situation in other metropolis in the country.

Pattern of drug compliance in leprosy patients attending urban centres--a longitudinal study.

The pattern of drug compliance in 485 leprosy patients attending urban leprosy centres in Bombay was studied for 2 years. The study subjects included 113 patients with paucibacillary leprosy under dapsone monotherapy, 241 patients with paucibacillary leprosy under multidrug therapy and 131 patients with multibacillary leprosy under multidrug therapy. Their urine samples had been checked at least 6 times during the 2 years by DDS tile test at the time of their clinic attendance. The urine test results were not disclosed to the patients, but patients showing negative results were counselled about the need for regular drug intake. 35% of the patients were "Regular through out", 13% were "Irregular through out" and the other 52% who "Tended to be irregular" in their drug intake became "Regular" after counselling. Regularity in drug compliance was better in patients on multidrug therapy than in those on monotherapy. It is suggested that periodic testing of urine for checking for regularity of drug intake and subsequent counselling of patients should be made a routine practice to maintain drug compliance at a high level.

Prevalence of leprosy in slums in Bombay including a leprosy colony.

Transmission of leprosy which is related directly to the total quantum of infection in the community as a whole is decided by the existence of patients suffering from progressive and infectious forms of leprosy and their movement from place to place. This information is of great importance in cities like Bombay to identify the priority areas as targets towards which control efforts should be directed. In this presentation an attempt has been made to compare the leprosy survey figures from three different situations in the city. Selection is arbitrary, not made on statistical basis. The data of particular importance is from a leprosy colony located in North Bombay representing a hyperendemic situation and a normal slum adjacent to this colony, movement of population between these two colonies being free. Age specific prevalence rates of leprosy after examining more than 80% of population from these colonies are compared with data derived from normal slums situated elsewhere in the city. The figures reveal varying prevalence rates marked by an increasing trend in the prevalence figures, leprosy colony representing the largest pool of infection. These figures indicate that wider statistically planned investigations on similar lines in urban areas may provide epidemiological data useful for planning control measures on a more rational basis.

Leprosy detection through non-survey techniques.

Most practical and cheap techniques other than mass surveys to detect leprosy in urban slums are still not known. The population inhabiting a large somewhat isolated slum in North Bombay was exposed to intensive health education programmes over a period of two years. Leprosy cases reporting as a result of these measures as well as those detected by trained workers casually or through contact examination were registered at two weekly clinics conducted within the slum. A total of 184 patients out of whom 27 were smear +ve, were identifiable by these means. The population of the slum was found to be 18228. Total prevalence rate of leprosy after examining 14723 subjects in the colony was revealed to be 24 per 1000 (smear +ve cases: 2.2. per 1000) out of which a prevalence of 12.4 per 1000 (smear +ve cases: 1.8 per 1000) had actually come to our knowledge even before instituting mass surveys. The results of this study indicate that in comparable urban situation it should be possible to identify 54% of total leprosy cases by techniques other than surveys. More significantly a striking feature of this study is that 82% of cases of true public health significance namely smear +ve patients could be unearthed by these means.