[Can plantar ulcers associated with leprosy be treated in the field. Results of experience in Senegal]. / Peut-on soigner les maux perforants plantaires des anciens malades de la lèpre sur le terrain? Résultats d'une expérience au Sénégal.

The introduction of a program for the treatment of plantar ulcers (PU) in field conditions in Senegal was studied. The program was complementary to the Health Education and Protective Footwear to Prevent Disability (POD) initiatives within the Senegalese anti-leprosy program. The wound care given in health centers was coded and simplified. Access to hospitals was made easier for those patients requiring surgery. More than 30% of patients with PU were treated each year, with a mean of 62% cured. An increasing number of leprosy patients have been admitted to regional hospitals for surgery. Never before have patients with signs of leprosy had access to general hospitals. This study emphasizes the need for regular supervision of the individuals treating wounds.

[The training of health personnel by the Marchoux Institute in Bamako from 1979 to 1995]. / La formation du personnel de santé par l'Institut Marchoux de Bamako de 1979 à 1995.

The Marchoux Institute, an OCCGE centre for leprosy research, has provided training for more than a thousand health workers between 1979 and 1995. Formerly, this training was offered entirely at the Marchoux Institute. It was aimed at leprosy control workers administering dapsone monotherapy within the framework of vertically integrated programmes. With the introduction of treatment programmes using multidrug therapy, leprosy control was integrated into the comprehensive health services. This change in approach dramatically increased the need for training and made it necessary to adapt the training offered by the Marchoux Institute. Since 1990, the Marchoux Institute has targeted doctors in training and health care staff at the supervisory level. The rise in the number of health agents to be trained has led to the arrangement of short-term training courses in the States concerned, with the participation of facilitators from the Marchoux Institute.

[Status of the integration of the antileprosy campaign in the general health services in Senegal]. / Etat de l'intégration de la lutte antilépreuse dans les services de santé généraux au Sénégal.

The survey on the integration of leprosy control in Senegal with the general health services has shown that the level of integration varies according to the services offered. Both strong and weak points have been detected and it is therefore advisable to reinforce the findings that are positive and to seek solutions to the problems. 82.1% of the male nurses in charge of health center included in the survey have already had to refer suspected cases of leprosy to the Leprosy Specialist for confirmation. In 85.7% of the cases, it is the Nurses-Persons in Charge who administer the supervised dose of multidrug therapy. The external validity of this study is problematic; nevertheless, these results could still draw the attention of administrators, decision-makers, and other persons of influence to the problems that could curb the integration of leprosy control with the general health services.

[Antileprosy polychemotherapy in the member states of the OCCGE: a decade of implementation (1983-19930). The National Coordinators of the Leprosy Program of the 8 states of the OCCGE]. / La polychimiothérapie antilépreuse dans les Etats membres de l'OCCGE: une décennie de mise en oeuvre (1983-1993). Coordonnateurs Nationaux de Programme Lèpre des 8 Etats de l'OCCGE.

MDT for leprosy recommended by WHO in 1981 has been introduced and implemented in 8 Member States of OCCGE (an organization for leprosy control in francophone West Africa). This implementation from 1983 to 1993 can be divided in two phases: 1983-1987: introduction phase by pilot projects; 1988-1993: extension phase by national leprosy control programmes. During the ten years, MDT coverage rose to 68%, leprosy prevalence rate widely decreased (40.71 to 6.56 per 10,000), while annual detection rate weakly varied (1.89 to 1.26 per 10,000). Factors influencing this evolution of leprosy are brought out and recommendations are made about strategies to be developed for leprosy control up to year 2000.

[Determining factors of non-compliance among patients undergoing polychemotherapy in the district of Bamako (Mali)]. / Facteurs déterminants de l'irrégularité des malades sous PCT dans le district de Bamako (Mali).

In order to examine the factors determining irregularity among patients undergoing multidrug therapy in Bamako district, we conducted a non-experimental study based, in the first instance, on medical records and later on a questionnaire. One thousand one hundred and seventy-five (1,175) treatment cards were reviewed in this way. The results of our study show that 3.1% of the patients fail to attend treatment sessions regularly and that multibacillary patients have more irregular attendance than paucibacillary patients. We have not observed any statistically meaningful difference between old and new patients as far as irregularity in attending multidrug therapy sessions is concerned. The second part of our research based on a questionnaire targeting a group of cases (36 patients who did not attend regularly) and a random control group (50 patients who attended treatment regularly but had missed at least one treatment) has shown that it is only for Item VI ("Have you ever missed your appointment because you perhaps considered yourself cured?") that a statistically meaningful difference emerges between cases and controls regarding the rates of affirmative responses (p < 0.05).