NEW DEVELOPMENTS IN ALERT LEPROSY CONTROL PROGRAMME AND THE ISSUES OF INTEGRATION

ABSTRACTIntroduction of Multidrug Therapy (MDT), as recommended by the WHO in 1982, started in Shoa Administrative Region in the beginning of 1983. From the results of introduction of the new regimens in two districts in the north-eastern part of the region, it can be concluded that implementation of MDT for paucibacillary patients has proven to be successful and feasible. Implementation of MDT in Addis Ababa and two surrounding districts, which started in March 1984, gives so far very promising results. Essential requirements for successful implementation of MDT are discussed. Reasons are given for a continuously high workload, at least during the .first years after the majority of the patients have been released from chemotherapy. Integration of leprosy control with the general medical services should definitely be aimed at; however, integration should be carefully planned and timed. Implementation of MDT requires reorganization and upgrading of virtually all aspects of leprosy control. This asks for specialization as regard planning, organization and evaluation. Another aspect of integration is the combination of tuberculosis and leprosy. The leprosy control services could strengthen the tuberculosis services at the time laboratory services have been established and the initial phase of intensive treatment has been secured

Granulomatous Reactivation during the Course of a Leprosy Infection: Reaction or Relapse

Leprosy is a serious infectious disease whose treatment still poses some challenges. Patients are usually treated with a combination of antimicrobial drugs called multidrug therapy. Although this treatment is effective against Mycobacterium leprae, the bacillus that causes leprosy, patients may develop severe inflammatory reactions during treatment. These reactions may be either attributed to an improvement in the immunological reactivity of the patient along with the treatment, or to relapse of the disease due to the proliferation of remaining bacilli. In certain patients these two conditions may be difficult to differentiate. The present study addresses the histopathology picture of and the M. leprae bacilli in sequential biopsies taken from lesions of patients who presented such reactions aiming to improve the differentiation of the two conditions. This is important because these reactions are one of the major causes of the disabilities of the patients with leprosy, and should be treated early and appropriately. Our results show that the histopathology picture alone is not sufficient, and that bacilli's counting is necessary

Understanding non-compliance with WHO-multidrug therapy among leprosy patients in Assam, India

Objectives: The study was undertaken to assess the adherence to World Health Organization (WHO)-multidrug therapy (MDT) and its successful completion by the leprosy patients and the extent of such defaulting, its correlates and reasons. Design: Retrograde cohort analysis was conducted during the fi rst quarter of 2007 from the cases registered for WHO-MDT treatment during 2002 to 2005 in Kamrup district of Assam, India. Results: A total of 254 leprosy cases refl ected the treatment seeking behavior of registered cases during the study period. Majority of the cases were from urban areas and defaulter rate higher in urban areas. The study group consisted of 60.63% males and 39.37% females. Both the compliance and default was higher in the age group of 16 to 30 years. Majority of defaulters (32.28%) had passed the high school leaving certifi cate examination had per capita monthly income between Rs 500 - 749 (30.71%) and belonged to social class IV (33.86%) and V (30.71%). Signifi cant statistical association was found between gender, literacy status, per capita income per month and socioeconomic status with treatment outcome. On analysis for the reasons of defaulting treatment; majority (33.07%) defaulted treatment due to loss of occupational hours when they come for receiving drugs at health center, 25.98% defaulted due to adverse reactions of drugs and 18.11% feared social stigma among major causes. Conclusions: The causes of defaulting treatment were related to gender, educational status, income as well as social class, or some combination of these. Recommendations, on strategic interventions to obviate the cause for noncompliance, were presented