Transforming Lives: A Qualitative Study Seeking Insights Into Reconstructive Surgery for Leprosy Patients in Western Maharashtra.

Introduction Leprosy remains a significant health issue, especially in areas where diagnosis and treatment face numerous barriers, leading to preventable deformities and disabilities. This study aims to explore the obstacles to reconstructive surgery for leprosy patients, from both patient and healthcare provider perspectives. By conducting a qualitative analysis, the study seeks to assess the impact of reconstructive surgery on patients' quality of life, encompassing their physical, psychological, emotional, and social well-being. Methods This qualitative study was conducted from April to May 2024. One focus group discussion (FGD) for 12 participants, along with two in-depth interviews, was conducted for the patients at a leprosy rehabilitation center in western Maharashtra who have completed leprosy treatment and have undergone reconstructive surgeries for their disability. One in-depth interview was conducted with the key informant (a healthcare provider who is a surgeon who performs reconstructive surgeries for leprosy patients). Participants were selected through purposive sampling until information saturation was achieved. Interviews were conducted in local languages and analyzed using thematic analysis to identify key barriers and themes. Results A qualitative analysis of feedback from leprosy patients who underwent reconstructive surgery (RCS) highlights the importance of family support and the transformative impact of surgery on functionality and psychological well-being. Stigmatization and fear often delayed treatment-seeking behavior, but government incentives alleviated economic burdens, and participants expressed readiness to recommend RCS to others. Surgeons emphasize the variety of surgeries performed, eligibility criteria, recovery period, and success rate of 85-90%, noting the importance of financial accessibility and a multidisciplinary approach. Suggestions for improvement include infrastructure enhancement, adequate funding, and active case detection by the National Leprosy Eradication Programme (NLEP). Conclusion The findings highlight the complex interplay of factors contributing to delays in reconstructive surgery for leprosy patients in India. Addressing these barriers requires multifaceted interventions, including increasing public awareness, improving healthcare infrastructure, and enhancing support systems for patients. Policy development should focus on these areas to reduce disparities and improve the outcomes of reconstructive surgery in resource-limited settings.

Dr. Dharmendra's Enduring Influence on Leprosy: From Laboratory to Disease Control.

A stalwart of Indian dermatology, Dr. Dharmendra was particularly known for his breakthrough research on leprosy. Spanning over several decades, his work was marked by significant contributions, including the development of Dharmendra's lepromin, which served as a critical diagnostic tool and in advancing the understanding of immunological aspects of leprosy. Born in 1900 in present-day Pakistan, his early education and work experiences set the foundation for his later achievements in leprosy research. Despite the social stigma associated with the disease at the time, Dr. Dharmendra's dedication led him to take up key roles, such as the first director of the National Leprosy Control Programme and head of the Central Leprosy Teaching and Research Institute in Chengalpattu. His work significantly impacted leprosy control efforts in India. ⁤⁤His legacy was further cemented by his leadership in founding the Indian Association of Leprologists and his tireless editorial work in the Indian Journal of Leprosy. Through his publications and ongoing research, even after retirement, he continued to influence the field. Dr. Dharmendra's life and work remain a cornerstone of leprosy research, inspiring future generations. His legacy continues to be felt in the ongoing efforts to combat leprosy.

Triple Infectious Syndrome: Pulmonary Tuberculosis and HIV in a Case of Pure Neuritic Leprosy With Underlying Diabetes Mellitus.

Pulmonary tuberculosis (PTB), human immunodeficiency virus (HIV), and leprosy are of public health importance, as all three diseases are communicable and contribute to disease burden in society. Co-infection with these three entities is extremely rare but leads to significant mortality and morbidity. We report a case that highlights the diagnostic challenges and therapeutic management of a patient who was diagnosed with pure neuritic leprosy on multibacillary-multidrug therapy (MB-MDT) and subsequently co-diagnosed with PTB and HIV. The patient was started on anti-tubercular therapy and anti-retroviral therapy for treatment under India's national health programs, which play a major role in treating those of low socioeconomic status. The optimization of these therapeutic drugs is quite challenging during treatment due to potential drug interactions and toxicities. High clinical suspicion is required to rule out PTB before initiating rifampicin-containing MB-MDT, which can lead to rifampicin-resistant TB and screening for HIV. As there is a social stigma associated with these patients, they require good psychological support during and after treatment.

Implementation of National Leprosy Eradication Programme during COVID-19 era: A qualitative research.

Introduction The COVID-19 pandemic imposed new challenge to the implementation of the National Leprosy Eradication Programme. According to national data, after lockdown due to COVID-19, there was a 29% reduction in total leprosy cases reported in the first quarter (April-June) of 2020 in comparison to 2019. Objectives To explore the difficulties faced by different stakeholders of the National Leprosy Eradication Programme like policy makers, doctors, grass root level health workers as well as leprosy patients during COVID-19 pandemic with respect to programme implementation and access to leprosy care. Materials and Methods Qualitative research was undertaken including two focus-group-discussions held among six leprosy patients diagnosed after lockdown and nine ASHA workers as well as six in-depth interviews of doctors, leprologists, and programme managers. Ethics committee approval was sought and informed consent was obtained from all participants. All focus-group-discussions were electronically recorded and the in-depth interviews telephonically recorded, transcribed and translated from Bengali-to-English. Transcripts were separately coded by researchers and thematically analysed with the help of Visual-Anthropac software version 1.0. Results Solitary focus on COVID-19 control, capacity building and information, education and communication, leprosy case search & surveillance, co-infection among health workers, transportation issues were the themes explored from focus-group-discussions of health workers and ASHA workers. Similarly, the present study identified six themes from in-depth interviews of programme manager, leprologists, programme manager as diagnostic difficulty, operational issues, rehabilitation issues, capacity building & information education and communication activities and way forward. Limitations The research reveals the perceptions of rural population of Eastern India with high leprosy prevalence, which might not be applicable for urban areas or low prevalent districts Conclusion The solitary focus of the administration towards COVID and shifting the infrastructure and human resource only towards the management of COVID can lead to resurgence of the leprosy. Having an organised framework of operations, catering to the need of the front-line workers in rendering services, utilizing the digital platform and social media, and focusing on rehabilitation would be needed to overcome the crisis.

Cost-effectiveness of incorporating Mycobacterium indicus pranii vaccine to multidrug therapy in newly diagnosed leprosy cases for better treatment outcomes & immunoprophylaxis in contacts as leprosy control measures for National Leprosy Eradication Programme in India.

Background & objectives: The elimination goal for leprosy as a public health problem at the national level was achieved in 2005 in India. However, the number of new cases reporting annually remained nearly the same during the last 10-15 years. Moreover, a substantial number of these new cases reported disabilities for the first time. Therefore, besides multidrug therapy (MDT), newer strategies with focus on effectively decreasing the number of new cases, optimizing the treatment of detected cases, averting disabilities and arresting the transmission of the disease are required. So the objective of this study was to assess the cost-effectiveness of Mycobacterium indicus pranii (MIP) vaccine implementation in National Leprosy Eradication Programme (NLEP) for newly diagnosed leprosy patients as well as their contacts to arrest/decrease the transmission and occurrence of new cases. Methods: This was a model-based estimation of incremental costs, total quality-adjusted life years (QALYs) gained, new cases averted, deaths averted, incremental cost-effectiveness ratio (ICER) and budget impact of the vaccination intervention. This model included the addition of MIP treatment intervention to the newly detected leprosy patients as well as vaccination with MIP to their contacts. Results: Using the societal perspective, discounted ICER was estimated to be ₹73,790 per QALY gained over a five-year time period. Probabilistic sensitivity analysis (PSA) was assessed by varying the values of input parameters. Majority (96%) of simulations fell in North East quadrant of cost-effectiveness plane, which were all below the willingness to pay threshold. Interpretation & conclusions: Introduction of MIP vaccination in the NLEP appears to be a cost-effective strategy for India. Significant health gains were reduction in the number of new leprosy cases, decreased incidence and severity of reactions during treatment, and after release from treatment, prevention of disabilities, thus reducing the cost as well as stigma of the disease.

Trends and patterns of leprosy over a decade in a tertiary care hospital in Northern India: A retrospective analysis.

BACKGROUND: Leprosy was declared to be eliminated from India in 2006, but recent reports point to an increase in newly detected cases despite the overall fall in prevalence. AIM: This study aimed to analyze the patterns and trends of epidemiological and operational indicators of leprosy at a tertiary care center in northern India over a decade. METHODS: This is a 10-year retrospective study from 2005 to 2014 conducted at the urban leprosy centre (ULC) of the Department of Dermatology, Venereology, and Leprology, Government Medical College, Jammu (J and K), India. Data were obtained from the preformatted standard leprosy cards of the urban leprosy centre. Details of demographic data, clinical features, smear results and treatment received were collected from individual cards and analyzed to observe various epidemiological trends. RESULTS: A total of 743 cases were analyzed for the period 2005-2014, of which 8.6% were childhood cases, 52.5% patients were immigrants, and 56.4% were farmers and laborers. Lepromatous cases showed a significantly increasing trend when compared with tuberculoid cases (P < 0.05). Smear positivity was seen in 29.6% of cases and showed an increasing trend (P < 0.05). An important observation was the increase in multibacillary cases. World Health Organization (WHO) grade 2 disability also showed an increasing trend over the past decade pointing to delayed diagnosis. LIMITATION: The study is limited by its retrospective design. CONCLUSION: The increasing trend of lepromatous and multibacillary cases and cases with grade 2 disability is a poor sign as it indicates delays in diagnosis. Further, smear-positive cases contribute to continued transmission of disease in the community. Leprosy has been declared to be eliminated, but recent reports including the present study suggest a rise in newly detected cases and hence in disease burden.